Pleura
Other tumors
Metastases

Author: Vaidehi Avadhani, M.D. (see Authors page)

Revised: 26 March 2018, last major update April 2014

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Metastases pleura[TI]

Cite this page: Avadhani, V. Metastases. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/pleurametastases.html. Accessed August 16th, 2018.
Definition / general
  • Metastases to pleura are more common than primary tumors of pleura
Sites
  • Most common primary pleural neoplasms originate from chest wall, mediastinum, lungs
  • Lung cancer: most common type in pleural fluid is adenocarcinoma, followed by small cell neuroendocrine carcinoma; squamous cell carcinoma is rare
  • Extrathoracic malignancy: most common primary carcinomas are breast, gastrointestinal tract and ovary
  • Metastases: lung is most common primary site in men, breast in women (see table below)
  • For lung, breast and ovarian metastases, 92% of pleural effusions are ipsilateral to primary lesion
Pathophysiology
  • Adenocarcinoma of lung spreads to parietal pleura from visceral pleura along adhesions
  • Pleural metastases from extrathoracic sites occur via hematogenous or lymphatic spread
  • Malignant pleural effusions from breast occur via chest wall lymphatics or hepatic metastases, resulting in contralateral or bilateral effusions
Diagrams / tables

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Management
algorithm for
malignant
pleural effusion

Primary tumor
site in patients
with malignant
pleural effusion

Diagnostically
useful pleural fluid
characteristics

Clinical features
  • Most malignant effusions are symptomatic; dyspnea is most common symptom and may be associated with chest pain and cough
Diagnosis
Laboratory
  • Recommended tests for all sampled pleural effusions:
    1. Biochemistry: LDH and protein (send pleural fluid and blood simultaneously so that Light's criteria can be applied, Thorax 2010;65:ii4)
    2. Microscopy and culture
    3. Cytological examination
    4. Differential count
Radiology images

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PET: pancreatic metastases

EUS view

Case reports
Microscopic (histologic) images

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Metastatic breast carcinoma to pleura

Cytology description
  • Cytology helpful since associated pleural effusion contains tumor cells
Cytology images

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Diff-Quik

Positive stains