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Vol.52 No.1 contents | Japanese/English |
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- Original Article -
Identification of Pleural Effusion with Low Levels of Adenosine Deaminase but Without Signs of Acute Inflammation or Pleural Thickening to Diagnose Early Malignant Pleural Mesothelioma
Satoru Moriyama1,2, Masayuki Tanahashi2, Eriko Suzuki2, Hiroshi Haneda2, Naoko Yoshii2, Takeshi Yamada3, Hidefumi Sasaki1, Motoki Yano1, Yoshitaka Fujii1, Hiroshi Niwa21Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Science, Japan, 2Respiratory Disease Center, Division of Thoracic Surgery, Seirei Mikatahara General Hospital, Japan, 3Department of Respiratory Surgery, Kariya Toyota General Hospital, Japan
Objective. We reviewed the clinical findings and diagnostic methods used in the diagnosis of malignant pleural mesothelioma (MPM) in patients with pleural effusion with low levels of adenosine deaminase (ADA), but without signs of acute inflammation or pleural thickening. Materials and Methods. The hospital records of 40 patients with pleural effusion of unknown origin or pleural thickening were retrospectively investigated. In all of those studies, pleural effusion was exudative, lymphocyte-dominant, no mycobacteria or other bacteria, and low levels of ADA. Results. There were 30 men and 10 women with an average age of 62.8 years old. The diagnosis of MPM was obtained by cytology of the pleural effusion in 3 patients and by core-needle biopsy of the thickened pleura in 3. Thoracoscopic pleural biopsy under general anesthesia was performed for the other 34 patients. The pathologic diagnosis of pleural biopsy was MPM in 20 patients, inflammatory change in 12, and pleural dissemination of cancer in 2. All of the 7 patients with more than 100 μg/ml of hyaluronic acid in their pleural effusion received a diagnosis of MPM. A total of 20 of 23 patients with irregular or nodular pleural thickening on computed tomography findings were confirmed to have MPM. Moreover, 6 of 17 patients with smooth pleural thickening were confirmed to have MPM. In patients with nodular pleural thickening it was easy to make the diagnosis. However, in those with smooth thickening, careful observation was required to select the appropriate biopsy site and resection margins of full-thickness pleura. Conclusion. As the rate of MPM in the patients with pleural effusion with low levels of ADA, but without signs of acute inflammation or pleural thickening is high (65%), an early thoracoscopic pleural biopsy is strongly recommended.
key words: Malignant pleural mesothelioma, Pleural effusion, Pleural thickening, Thoracoscopic pleural biopsy
Received: February 22, 2011
Accepted: December 22, 2011
JJLC 52 (1): 10-16, 2012
