Malignant pleurisy

Japanese: 癌性胸膜炎

(4) Cancerous pleuritis (pleuritis carcinomatosa)
Concept: This is a condition in which cancer cells cause inflammation in the pleural cavity, resulting in the accumulation of pleural fluid. By type of cancer, lung cancer (especially adenocarcinoma) accounts for one-third of cases, followed by breast cancer, lymphoma, ovarian cancer, and gastrointestinal cancer. Bloody pleural fluid often occurs.
Pathophysiology: Cancer cells in the thoracic cavity produce inflammatory cytokines and vascular permeability factor (VEGF), which increases vascular permeability in the pleura and leads to increased pleural fluid production. Tumor cell embolism, etc., causes obstruction of lymphatic vessels in the parietal pleura, resulting in reduced absorption of pleural fluid.
Diagnosis and treatment: Cancer cells are detected and diagnosed by pleural fluid cytology. If the primary organ is unknown, immunostaining using a cell block of pleural fluid cells may be useful in estimating the primary organ. If the lung has collapsed due to a large amount of pleural fluid, pleural fluid drainage is performed to expand the lung, and then pleurodesis is performed using ^Picibanil® , minocycline hydrochloride, cisplatin, etc. Chemotherapy is performed for the primary cancer. [Yano Seiji]
■ References
Light RW: Pleural diseases. 4th ed. Lippincott Williams & Wilkins, Philadelphia, 2001.

Source : Internal Medicine, 10th Edition About Internal Medicine, 10th Edition Information

Japanese:

（4）癌性胸膜炎（pleuritis carcinomatosa）
概念
　癌細胞が胸腔内で炎症を惹起し胸水貯留をきたした病態である．癌種別では，肺癌（特に腺癌）が1/3と最も多く，ついで乳癌，リンパ腫，卵巣癌，消化器癌に多い．しばしば血性胸水となる．
病態生理
　胸腔内の癌細胞が炎症性サイトカインや血管透過性因子（VEGF）を産生し胸膜の血管透過性が亢進し胸水産生が増加する機序，腫瘍細胞塞栓などにより壁側胸膜のリンパ管が閉塞し胸水の吸収が低下する機序がある．
診断・治療
　胸水細胞診で癌細胞を検出し診断する．原発臓器が，不明な場合には胸水細胞のセルブロックを用いた免疫染色が原発臓器の推定に有用な場合がある．　大量の胸水により肺が虚脱している場合には，胸水ドレナージをして肺を拡張させた後，ピシバニール^Ⓡ，ミノサイクリン塩酸塩，シスプラチンなどを用いて胸膜癒着術を行う．原疾患の癌に対する化学療法を行う．［矢野聖二］
■文献
Light RW: Pleural diseases. 4th ed. Lippincott Williams & Wilkins, Philadelphia, 2001.

出典　内科学第10版内科学第10版について　情報

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