1. THORACIC CLUB MEETING AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA PLEURAL TUMORS

2. Case presentation Introduction Epidemiology Classification Aetiology Clinical presentation Investigation treatment conclusion

3. CASE PRESENTATION A. R. 55yr, H/Wife. Refered Yusuf Dantsoho Hospital. PC-Cough x5/12 -Haemoptysis x5/12 -Dyspnoea x5/12 -Lt Chest pain x4/12

4. Cough-distressing, non paroxysmal, mucoid sputum, -not posture related Associated with – - haemoptysis 50ml/day -low grade fever, night sweat. -no weight loss, contact with PTB pt. -Lt chest pain Dyspnoea-progressive.

5. No history of exposure to Asbestosis, irradiation. Does not smoke cigarret. No FHx. Other systemic review not contributory.

6. PMHx- admitted 2ce, chest tube. -anti TB for 3/12 Not a known Hypertensive, Diabetic. FSHx

7. General physical examination. Chest-RR-20/min SPO2 97% -Chest tube insitu Rt 5ICS -Deviated trachea Rt -decreased Lt chest expansion, tactile fremitus -dull Lt PN,decreased BS. Other Systemic Review-

8. Assessment-Lt haemorrhagic pleural Effusion due to -PTB -mesothelioma -Bronchogenic Ca

9. Available Investigation results CXR-

11. Sputum AFB- -ve Pleural fluid. Pleural biopsy. Abdominal USS. ESR-60mm/hr Pcv-36%. WBC-9x10 N-60% L-34% M-6%.

12. LITERATURE REVIEW PLEURAL TUMORS

13. INTRODUCTION Most common primary tumor of Pleura are benign and malignant Mesothelioma. Mesothelioma are malignancy of mesothelia cells lining pleural cavity. Often present as malignant effusion. Less common are sarcoma, lymphoma, etc. Virtually all cancers metastasize to pleura. Asbestos exposure implicative.

14. Epidemiology 2500-3000 cases /day. (US) 0.1-0.2 /100,000 population. 3-4 cases /yr in ABUTH 2-10 folds in Asbestos polluted area. Race-no predilection. Sex- M:F 3:1 Age-5-7 decade. -20-40yr post exposure.

15. Classification of Pleural tumors Primary tumors. Metastatic.

16. Mesothelioma-Benign localised M. -Malignant localised M. -Malignant epithelial M.

17. AETIOLOGY Asbestos- amphibole, crocidolite Erionite. Radiation, thorium dioxide. Loss of one copy of chromosome 22. SV40 Virus

18. Clinical features Asymptomatic. Cough. Chest pain.(50-90%) Dyspnoea. Haemptysis. +/- weight loss. Exposure to Asbestos.

19. Fever, night sweat, Hyperglycemia. Metastatic disease uncommon at presentation.

20. Physical Examinaton. Chest-Pleural effusion. Systemic examination –primary site.

21. Investigations Diagnostic Imaging studies- –CXR –CT scan –Ultra sonography – abdomino-pelvic.

22. VATs and biopsy. Pleural fluid-typically not diagnostic. Pleural biopsy-diagnostic in 98%. immunohistochemistry.

23. Lung function test. Ancillary investigation. Staging TNM Brigham-

24. Stage I - Completely resected within the capsule of the parietal pleura without adenopathy (ie, ipsilateral pleura, lung, pericardium, diaphragm, or chest wall disease limited to previous biopsy sites) Stage II - All stage I characteristics, with positive resection margins, intrapleural adenopathy, or a combination Stage III - Local extension of disease into the chest wall or mediastinum, into the heart, through the diaphragm or peritoneum, or extrapleurally to involve the lymph nodes Stage IV - Distant metastatic disease

25. TREATMENT Surgery-Extrapleural pneumonectomy. -Decortication. Radiotherapy. Chemotherapy. Trimodality. Prognosis

26. Conclusion Pleural tumors are rare and patients present late due to late diagnosis and referal from peripheral Hospitals, therefore overall prognosis is poor.