THORACIC CLUB MEETING AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA

1. THORACIC CLUB MEETINGAHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA PLEURAL TUMORS

2. Case presentation • Introduction • Epidemiology • Classification • Aetiology • Clinical presentation • Investigation • treatment • conclusion

3. CASE PRESENTATION • A. R. • 55yr, H/Wife. • Refered Yusuf Dantsoho Hospital. • PC-Cough x5/12 • -Haemoptysis x5/12 • -Dyspnoea x5/12 • -Lt Chest pain x4/12

4. Cough-distressing, non paroxysmal, • mucoid sputum, • -not posture related • Associated with – • - haemoptysis 50ml/day • -low grade fever, night sweat. • -no weight loss, contact with PTB pt. • -Lt chest pain • Dyspnoea-progressive .

5. No history of exposure to Asbestosis, irradiation. • Does not smoke cigarret. • No FHx . • Other systemic review not contributory.

6. PMHx- admitted 2ce, chest tube. -anti TB for 3/12 • Not a known Hypertensive, Diabetic. FSHx

7. General physical examination. • Chest-RR-20/min SPO2 97% • -Chest tube insitu Rt 5ICS • -Deviated trachea Rt • -decreased Lt chest expansion, tactile fremitus • -dull Lt PN,decreased BS. • Other Systemic Review-

8. Assessment-Lt haemorrhagic pleural Effusion due to -PTB • -mesothelioma • -Bronchogenic Ca

9. Available Investigation results • CXR-

11. Sputum AFB- -ve • Pleural fluid. • Pleural biopsy. • Abdominal USS. • ESR-60mm/hr • Pcv-36%. • WBC-9x10 N-60% L-34% M-6%.

12. LITERATURE REVIEW PLEURAL TUMORS

13. INTRODUCTION • Most common primary tumor of Pleura are benign and malignant Mesothelioma. • Mesothelioma are malignancy of mesothelia cells lining pleural cavity. • Often present as malignant effusion. • Less common are sarcoma, lymphoma, etc. • Virtually all cancers metastasize to pleura. • Asbestos exposure implicative.

14. Epidemiology • 2500-3000 cases /day. (US) • 0.1-0.2 /100,000 population. • 3-4 cases /yr in ABUTH • 2-10 folds in Asbestos polluted area. • Race-no predilection. • Sex- M:F 3:1 • Age-5-7 decade. • -20-40yr post exposure.

15. Classification of Pleural tumors • Primary tumors. • Metastatic.

16. Mesothelioma-Benign localised M. -Malignant localised M. -Malignant epithelial M.

17. AETIOLOGY • Asbestos- amphibole, crocidolite • Erionite. • Radiation, thorium dioxide. • Loss of one copy of chromosome 22. • SV40 Virus

18. Clinical features • Asymptomatic. • Cough. • Chest pain.(50-90%) • Dyspnoea. • Haemptysis. • +/- weight loss. • Exposure to Asbestos.

19. Fever, night sweat, Hyperglycemia. • Metastatic disease uncommon at presentation.

20. Physical Examinaton. • Chest-Pleural effusion. • Systemic examination –primary site.

21. Investigations • Diagnostic Imaging studies- • CXR • CT scan • Ultra sonography – abdomino-pelvic.

22. VATs and biopsy. • Pleural fluid-typically not diagnostic. • Pleural biopsy-diagnostic in 98%. • immunohistochemistry.

23. Lung function test. • Ancillary investigation. Staging TNM Brigham-

24. Stage I - Completely resected within the capsule of the parietal pleura without adenopathy (ie, ipsilateral pleura, lung, pericardium, diaphragm, or chest wall disease limited to previous biopsy sites) • Stage II - All stage I characteristics, with positive resection margins, intrapleural adenopathy, or a combination • Stage III - Local extension of disease into the chest wall or mediastinum, into the heart, through the diaphragm or peritoneum, or extrapleurally to involve the lymph nodes • Stage IV - Distant metastatic disease

25. TREATMENT • Surgery-Extrapleural pneumonectomy. -Decortication. Radiotherapy. Chemotherapy. Trimodality. Prognosis

26. Conclusion Pleural tumors are rare and patients present late due to late diagnosis and referal from peripheral Hospitals, therefore overall prognosis is poor.