Closed pleural biopsy for neoplasm or inflammatory lesions:
Indication: Closed pleural biopsy is done to determine causes of pleural effusion after fluid analysis has been nondiagnostic.
It is an efficient method in diagnosis of Tuberculosis and malignant pleural effusions.
Closed pleural biopsy has fairly low sensitivity for diagnosis of cancer but it can be increased by adding cytologic evaluation.
It is necessary to do further investigations and follow-up in patients that have inflammation in pleural biopsy.
Specimens: These are either needle biopsies (Example: Trucut), punch biopsies or material obtained by thoracoscopy.
Tissues present include: Pleura, adipose tissue, skeletal muscle, nerves and lung parenchyma.
Distinction can be difficult in the following conditions:
(1) A florid reactive mesothelial proliferation and a mesothelial neoplasm
(2) A tubuloglandular mesothelioma and metastatic adenocarcinoma.
- Indicators towards mesothelioma as opposed to a reactive proliferation are a single population of frankly malignant cells arranged in papillary, tubulopapillary or microcystic pattern.
- Invasion of underlying tissue with transition to spindle cell forms (a biphasic pattern) is also a useful feature.
- Involvement of the pleura by metastatic adenocarcinoma is suggested by a separate population of malignant cells, distinct from mesothelial cells.
- In areas of pleural fibrosis and adhesions blood vessels can appear thick walled and sclerosed, or may take on a pseudoangiomatous appearance.
Open pleural biopsy - Pleural strip:
Indication: Open pleural biopsy is often necessary for the diagnosis of mesothelioma as a confident diagnosis can usually be made only when adequate tissue is available.
Specimens taken for treatment of recurrent pneumothorax:
Pneumonectomy or pleural stripping may be performed for recurrent pneumothoraces.
In young patients, pneumothoraces are often spontaneous but malignancy becomes more likely with increasing age.
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