Pleura Pathology Study Guide

Pleura Pathology Video

Pleura pathology involves abnormalities of the pleura.

Pleura pathology includes:

Pneumothorax
Mesothelioma

Pneumothorax

Pneumothorax is air buildup in the pleural space.

Spontaneous pneumothorax is because of rupture of an emphysematous bleb.

Pneumothorax leads to collapse of a portion of the lung.

The trachea shifts to the same side of the collapse.

When there is a penetrating chest wound, tension pneumothorax develops.

The pleural gap allows air in but not airflow.

The trachea is pulled in the opposite direction of the wound.

Pneumothorax is a medical emergency.

Pneumothorax is treated by inserting a chest tube.

Pneumothorax. A chest tube placed on the right for a pneumothorax James Heilman, MD -Not altered CC BY-SA 4.0
Pneumothorax. A chest tube placed on the right for a pneumothorax James Heilman, MD - Not altered. CC BY-SA 4.0
Pneumothorax. Not altered. CC.
Pneumothorax. Not altered. CC.
Pneumothorax. Chest X-ray showing a pneumothorax on the right (left in the image), where the absence of lung markings indicates that there is free air inside the chest James Heilman, MD - Not altered. CC BY 3.0
Pneumothorax. CT scan of the chest showing a pneumothorax on the person's left side (right side on the image). A chest tube is in place (small black mark on the right side of the image), the air-filled pleural cavity (black) and ribs (white) can be seen. The heart can be seen in the center. en:User:Clinical Cases - Not altered. CC BY-SA 2.5
Pneumothorax. Anteroposterior expired X-ray at the same time, more clearly showing the pneumothorax in this case Mikael Häggström, M.D. Not altered. CC0
A 29-year-old male, status post gunshot wound. Emergently performed supine lateral chest radiograph at initial presentation (a) demonstrated an anterior right pneumothorax (solid arrow). Follow-up frontal chest radiograph (b) obtained 7 days later revealed a persistent right apical pneumothorax (small white arrow). Upon retrospective review, an alveolar- pleural fistula (black arrows) was present on this coronal reformatted image from the initial CT evaluation (c). This was secondary to lung laceration sustained along the bullet track. Axial minIP (d) image demonstrates the communication of this pulmonary laceration with the pneumothorax. Demystifying the persistent pneumothorax: role of imaging. Chaturvedi A, Lee S, Klionsky N, Chaturvedi A - Insights into imaging (2016). Not Altered. CC.

Mesothelioma

Mesothelioma is a malignant neoplasm of mesothelial cells.

Mesothelioma is strongly linked to occupational exposure to asbestos.

Mesothelioma presents with:

Chest pain
Dyspnea
Recurrent pleural effusions

Mesothelioma. Coronal reformat of a CT of the chest in a patient with left sided mesothelioma. Note the extensive pleural mass with contraction of the left hemithorax. Frank Gaillard. CC BY-SA 3.0.
Mesothelioma. CXR demonstrating a mesothelioma James Heilman, MD - Not altered. CC BY-SA 3.0
Mesothelioma. CT scan of a patient with mesothelioma, coronal section (the section follows the plane that divides the body in a front and a back half). The mesothelioma is indicated by yellow arrows, the central pleural effusion (fluid collection) is marked with a yellow star. Red numbers: (1) right lung, (2) spine, (3) left lung, (4) ribs, (5) descending part of the aorta, (6) spleen, (7) left kidney, (8) right kidney, (9) liver. - Not altered. CC BY-SA 4.0
Mesothelioma. Micrograph of a pleural fluid cytopathology specimen showing mesothelioma. Nephron - Not altered. CC BY-SA 3.0
Mesothelioma. Diffuse pleural mesothelioma with extensive involvement of the pericardium. The Armed Forces Institute of Pathology (AFIP) - Not altered. Public Domain
Mesothelioma. Micrographs showing conventionally-stained mesothelioma in a core biopsy (higher magnifications on right). Robertolyra. Not altered. Public Domain.
Necropsy and histological observance. A. Mesothelioma in peritoneal cavity. Arrow indicates the tumor mass. B. H&E staining (20x). C. Mesothelin IHC (20x) with membrane staining. D. GFP IHC (20x) with cytoplasmic staining. In vivo imaging of human malignant mesothelioma grown orthotopically in the peritoneal cavity of nude mice. Feng M, Zhang J, Anver M, Hassan R, Ho M - Journal of Cancer (2011). Not Altered. CC.
Loss of nuclear BAP1 expression defines the majority of malignant peritoneal mesotheliomas arising within the abdomen and pelvis. (A-C) Absence of BAP1 immunostaining in a malignant mesothelioma arising in the abdomen/pelvis of a 70 year old woman (patient MPM11) with interstitial deletion of chromosome 3p encompassing the BAP1 locus, as well as an NF2 frameshift mutation. Retained BAP1 expression is seen in non-neoplastic stromal, inflammatory, and endothelial cells. (D-F) Absence of BAP1 immunostaining in a malignant mesothelioma arising in the abdomen/pelvis of a 67 year old man (patient MPM7) with focal homozygous deletion of a 300 kb segment on chromosome 3p encompassing the BAP1 locus. (G-I) Intact BAP1 immunostaining in a malignant mesothelioma arising in the abdomen/pelvis of a 19 year old woman (patient MPM13) with hotspot mutation in the TERT promoter, without chromosome 3p loss or BAP1 alteration. Genomic Profiling of Malignant Peritoneal Mesothelioma Reveals Recurrent Alterations in Epigenetic Regulatory Genes BAP1 , SETD2 , and DDX3X. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc. Not Altered. CC.