Presentation
History of being treated for cervical cancer 6 years prior, as well as HIV and hypertension. Now left-sided chest pain and dyspnea for 3 days.
Patient Data
White out of the left hemithorax with an associated shift of the mediastinum and trachea towards the right.
Two attempts at pleural tap were unsuccessful, with a subsequent attempt yielding blood-stained pleural fluid.
Pleural fluid analysis showed an exudate. Tuberculosis microbiological testing was negative and general bacterial microscopy and culture were negative. Pleural fluid LDH was elevated (335 U/L, normal 100-190 U/L).
Left apical pleural mass with associated massive left-sided pleural effusion.
Further lytic bone lesions, pleural deposits and cannonball lesions in the right lung.
HISTOLOGY
Specimen: Pleura
Clinical information: The patient is a 41-year-old female known for carcinoma of the cervix. A pleural biopsy was done.
Gross examination: The specimen consists of fragments of red and white tissue.
Microscopic examination: Microscopic examination of the pleura biopsy shows dense fibrous connective tissue consistent with pleura, fibrin, granulation tissue as well as infiltrating tumor. The tumor grows in large nests, glandular differentiation is present.
Immunohistochemical stains for CK7 and p16 are strongly positive.
There is focal positivity with the CK5/6. The p63, CK20, TTF1, NAPSINA and CDX2 were
negative.
Diagnosis: The features are consistent with a metastatic adenocarcinoma with IHC evidence of endocervical origin.
Case Discussion
Pleural neoplasms are most commonly metastases than primary malignant mesothelioma. They commonly cause pleural effusion. The pathophysiology involves decreased lymphatic drainage of pleural fluid or increased capillary permeability due to inflammation.
Pleural metastases are not to be confused with a Pancoast tumor, which by definition is a malignancy present in the apex of the lung parenchyma.
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