Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

Pleural Tumors 1183

PLEURAL TUMORS

STEPHEN C. LAZARUS, MD

history & physical

History

■Depends on diagnosis

➣Malignant Mesothelioma

2/3 of patients – known asbestos exposure

latent period 30–45 years; most patients 50–75 years old

high prevalence in Cappadocian region of Turkey

➣Benign Fibrous Mesothelioma

Not associated with asbestos

Often an “incidental” finding on routine chest Xray

➣Primary Effusion Lymphoma

homosexual men with AIDS+KS-associated HHV-8

➣Metastatic Pleural Disease

75% due to lung (30%), breast (25%), and lymphoma (20%)

primary

6% ovarian, 3% sarcomas, 6% no primary found

Signs & Symptoms

■Malignant Mesothelioma

➣chest pain most common presenting symptom

➣dyspnea in 40%; also chills, fever, sweats, weakness

➣large effusion in 50%; progressive encasement of lung

■Benign Fibrous Mesothelioma

➣50% asymptomatic

➣Cough, chest pain, dyspnea and fever may occur

➣Hypertrophic pulmonary osteoarthropathy (20%) – may resolve

after resection

➣Symptomatic hypoglycemia (4%; due to insulin-like GFII)

■Primary Effusion Lymphoma

➣malignant lymphomatous effusion without mass

■Metastatic Pleural Disease

➣Dyspnea (>50%); chest pain (25%), anorexia, weight loss, malaise

➣20% asymptomatic

tests

Imaging

■Chest X-ray: may demonstrate effusion, pleural plaques, pleural-

based mass, underlying lung mass

■CT Scan: better visualization of pleural surface, mediastinum