Custom Search



Pulmonary Pathology Online

Histopathological Reporting of Pleural Biopsies

 Dr Sampurna Roy MD    




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.

An Approach to Histopathological Reporting of Pleural Biopsy:

Comments should be made on the following features:

- Pleural thickening:

- Hyaline fibrous tissue with a basket weave pattern in pleural plaques;

- Cellular fibrous tissue in an inflammatory process or neoplasia ;

- Features of inflammatory lesions:

- Reactive proliferation of mesothelial cells - non-specific.

- Palisaded histiocytes, which can be multinucleate, with fibrinoid necrosis in rheumatoid disease;

- Necrotizing granulomas in tuberculous pleurisy;

- Presence of neoplasm:

- Localized fibrous tumor of pleura, benign or malignant ;

- Mesothelioma : epithelial; mixed (biphasic) ; fibrous (sarcomatoid) or desmoplastic. 

- Metastatic carcinoma.

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. 

When underlying lung is included, the report should comment on the following features:

- It is involved by spread of tumor ;

- There is fibrosis ;

- Asbestos bodies are present.

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.

The microscopical report should comment on:

- The type and severity of inflammatory infiltrate.

- Eosinophils often seen in pneumothorax (eosinophilic pleuritis) ;

- The presence of specific features such as granulomas  ;

- The presence of neoplasia.


Further reading:

Value of closed pleural biopsy in diagnosis of pleural effusion.

Diffuse malignant pleural mesothelioma.

Histopathologic diagnosis of malignant pleural mesothelioma.

Current problems in the diagnosis of malignant pleural mesothelioma.

Diagnostic value of thoracoscopic pleural biopsy for pleurisy under local anaesthesia.

Diagnostic yield of closed pleural biopsy in exudative pleural effusion.

Closed pleural needle biopsy: predicting diagnostic yield by examining pleural fluid parameters.

Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study.

Determining the optimal number of specimens to obtain with needle biopsy of the pleura.

Blind pleural biopsy using a Tru-cut needle in moderate to large pleural effusion--an experience.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






Infectious Disease Online


Pathology Quiz Online 


Paediatric Pathology Online


Pancreatic Pathology Online




Endocrine Pathology Online


Eye Pathology Online


Ear Pathology Online


Cardiac Path Online


Pulmonary Pathology Online


Lung Tumour Online




Nutritional Pathology Online


Environmental Pathology Online


Soft Tissue Tumour Online


GI Path Online-India


Gallbladder Pathology Online


E-book - History of Medicine  


Microscope - Seeing the Unseen





Privacy Policy  

Advertising Policy

Copyright 2019