[Secondary tumoral pleurisy].
WHEN THE PRIMARY CANCER IS KNOWN: Secondary tumoral pleurisy can develop at any stage in the evolution of a neoplastic disease and its diagnosis is easy when the primitive cancer is known. Cytological analysis of the pleural liquid and/or biopsy often provides material and the slides can then be compared with those of the primitive cancer and a relationship established. However, a probabilistic diagnosis should not be in haste, without anatomopathological confirmation, since the causes of pleurisy in a cancer patient are varied. WHEN THE PRIMARY CANCER IS NOT KNOWN: The most difficult situation is that when the pleurisy is revelatory of a neoplastic disease. In this case, explorations should be limited to a few essential examinations guided by the clinical profile, without being tempted to carrying out exhaustive explorations of the primitive cancer, which would not change the prognosis. Before such explorations, it is essential to obtain a precise pleural diagnosis, and for this, the indication for a pleuroscopy must be easily and rapidly accessible. FROM A THERAPEUTIC POINT OF VIEW: Once the diagnosis of pleurisy has be established, treatment is in two parts, associated or not: local treatment consisting in pleural sympysis and general treatment (chemotherapy or even hormone therapy, adapted to the primitive neoplasia). Pleural sympysis is often performed using talc, either during the pleuroscopy (talc insufflated under visual control), or during thoracic draining (talc slurry).
Bréchot
Jeanne-Marie
JM
Service de pneumologie, Hôtel-Dieu, 1, Place du Parvis Notre-Dame, 75181 Paris. jeanne-marie.brechot@htd.ap-hop-paris.fr
Molina
Thierry
T
Jacoulet
Pascale
P
D001706:Biopsy; D006801:Humans; D009382:Neoplasms, Unknown Primary / Q000473:pathology; D010994:Pleura / Q000473:pathology; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D018700:Pleurodesis; D011379:Prognosis