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Difference between revisions of "Pleural invasion"
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'''Pleural invasion''' is the presence of tumour in the [[pleura]]. Pleural invasion is poor prognosticator in [[lung cancer]],<ref name=pmid19057261>{{Cite journal | last1 = Travis | first1 = WD. | last2 = Brambilla | first2 = E. | last3 = Rami-Porta | first3 = R. | last4 = Vallières | first4 = E. | last5 = Tsuboi | first5 = M. | last6 = Rusch | first6 = V. | last7 = Goldstraw | first7 = P. | title = Visceral pleural invasion: pathologic criteria and use of elastic stains: proposal for the 7th edition of the TNM classification for lung cancer. | journal = J Thorac Oncol | volume = 3 | issue = 12 | pages = 1384-90 | month = Dec | year = 2008 | doi = 10.1097/JTO.0b013e31818e0d9f | PMID = 19057261 }}</ref><ref name=pmid15999057>{{Cite journal | last1 = Shimizu | first1 = K. | last2 = Yoshida | first2 = J. | last3 = Nagai | first3 = K. | last4 = Nishimura | first4 = M. | last5 = Ishii | first5 = G. | last6 = Morishita | first6 = Y. | last7 = Nishiwaki | first7 = Y. | title = Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. | journal = J Thorac Cardiovasc Surg | volume = 130 | issue = 1 | pages = 160-5 | month = Jul | year = 2005 | doi = 10.1016/j.jtcvs.2004.11.021 | PMID = 15999057 }}</ref> and important in determining the | [[Image:Lung adenocarcinoma visceral pleural invasion -- intermed mag.jpg|thumb|right|Visceral pleural invasion. [[H&E stain]]. (WC)]] | ||
'''Pleural invasion''' is the presence of tumour in the [[pleura]]. Pleural invasion is considered a poor prognosticator in [[lung cancer]],<ref name=pmid19057261>{{Cite journal | last1 = Travis | first1 = WD. | last2 = Brambilla | first2 = E. | last3 = Rami-Porta | first3 = R. | last4 = Vallières | first4 = E. | last5 = Tsuboi | first5 = M. | last6 = Rusch | first6 = V. | last7 = Goldstraw | first7 = P. | title = Visceral pleural invasion: pathologic criteria and use of elastic stains: proposal for the 7th edition of the TNM classification for lung cancer. | journal = J Thorac Oncol | volume = 3 | issue = 12 | pages = 1384-90 | month = Dec | year = 2008 | doi = 10.1097/JTO.0b013e31818e0d9f | PMID = 19057261 }}</ref><ref name=pmid15999057>{{Cite journal | last1 = Shimizu | first1 = K. | last2 = Yoshida | first2 = J. | last3 = Nagai | first3 = K. | last4 = Nishimura | first4 = M. | last5 = Ishii | first5 = G. | last6 = Morishita | first6 = Y. | last7 = Nishiwaki | first7 = Y. | title = Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. | journal = J Thorac Cardiovasc Surg | volume = 130 | issue = 1 | pages = 160-5 | month = Jul | year = 2005 | doi = 10.1016/j.jtcvs.2004.11.021 | PMID = 15999057 }}</ref> and important in determining the tumour stage in [[lung cancer staging]]. | |||
==General== | ==General== | ||
[[Image: Normal visceral pleura of lung - Miller -- high mag.jpg | thumb| right| Normal visceral pleura of the lung. [[Miller stain]]. (WC)]] | |||
The visceral pleura is the pleura that covers the [[lung]]; tumour invasion into it is known as '''visceral pleural invasion''' (abbreviated '''VPI'''). The parietal pleural covers the chest wall. | The visceral pleura is the pleura that covers the [[lung]]; tumour invasion into it is known as '''visceral pleural invasion''' (abbreviated '''VPI'''). The parietal pleural covers the chest wall. | ||
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**Irrelevant for staging. | **Irrelevant for staging. | ||
====Images - normal pleural==== | |||
<gallery> | |||
Image: Normal visceral pleura of lung - Miller -- intermed mag.jpg | Lung visceral pleura - intermed. mag. | |||
Image: Normal visceral pleura of lung - Miller - alt -- intermed mag.jpg | Lung visceral pleura - high mag. | |||
</gallery> | |||
===Modified Hammar classification=== | ===Modified Hammar classification=== | ||
Pleural invasion can be subgrouped as follows:<ref name=pmid19057261/> | Pleural invasion can be subgrouped as follows:<ref name=pmid19057261/> | ||
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!Tumour stage ([[TNM staging]]) | !Tumour stage ([[TNM staging]]) | ||
|- | |- | ||
|PL0 | |PL0 † | ||
|tumour confined to lung, not through elastic layer | |tumour confined to lung, not through elastic layer | ||
|T(any) | |T(any) | ||
|- | |- | ||
|PL1 | |PL1 † | ||
|tumour beyond (external) elastic layer of the visercal pleura, not at pleural surface | |tumour beyond (external) elastic layer of the visercal pleura, not at pleural surface | ||
|at least T2 | |at least T2 ‡ | ||
|- | |- | ||
|PL2 | |PL2 | ||
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|} | |} | ||
Notes: | |||
*The interface between PL0 and PL1 is the most challenging. Use of an elastic stain is recommend when there is uncertainty.<ref name=pmid23020722/> | *† The interface between PL0 and PL1 is the most challenging. Use of an elastic stain is recommend when there is uncertainty.<ref name=pmid23020722/> | ||
*‡ The up-staging of small tumours is not completely without controversy; there is data for [[lung adenocarcinoma]]s less than 2 cm that suggests VPI is not an outcome predictor.<ref name=pmid23807749>{{Cite journal | last1 = Nitadori | first1 = J. | last2 = Colovos | first2 = C. | last3 = Kadota | first3 = K. | last4 = Sima | first4 = CS. | last5 = Sarkaria | first5 = IS. | last6 = Rizk | first6 = NP. | last7 = Rusch | first7 = VW. | last8 = Travis | first8 = WD. | last9 = Adusumilli | first9 = PS. | title = Visceral pleural invasion does not affect recurrence or overall survival among patients with lung adenocarcinoma ≤ 2 cm: a proposal to reclassify T1 lung adenocarcinoma. | journal = Chest | volume = 144 | issue = 5 | pages = 1622-31 | month = Nov | year = 2013 | doi = 10.1378/chest.13-0394 | PMID = 23807749 }}</ref> | |||
==Gross== | ==Gross== | ||
| Line 49: | Line 57: | ||
Note: | Note: | ||
*Tumour trapped within the (external) elastic layer is still PL0.<ref name=pmid23020722/> | *Tumour trapped within the (external) elastic layer is still PL0.<ref name=pmid23020722/> | ||
===Images=== | |||
<gallery> | |||
Image: Lung adenocarcinoma visceral pleural invasion -- very low mag.jpg | Adenocarcinoma - VPI - very low mag. | |||
Image: Lung adenocarcinoma visceral pleural invasion -- low mag.jpg | Adenocarcinoma - VPI - low mag. | |||
Image: Lung adenocarcinoma visceral pleural invasion -- intermed mag.jpg | Adenocarcinoma - VPI - intermed. mag. | |||
Image: Lung adenocarcinoma visceral pleural invasion - alt -- intermed mag.jpg | Adenocarcinoma - VPI - intermed. mag. | |||
Image: Lung adenocarcinoma visceral pleural invasion -- high mag.jpg | Adenocarcinoma - VPI - high mag. | |||
Image: Lung adenocarcinoma visceral pleural invasion -- very high mag.jpg | Adenocarcinoma - VPI - very high mag. | |||
</gallery> | |||
==Stains== | ==Stains== | ||
[[Image:Lung adenocarcinoma visceral pleural invasion - Miller - alt -- high mag.jpg|thumb|right|Visceral pleural invasion. [[Miller stain]]. (WC)]] | |||
*Elastic stain (e.g. [[Miller stain|Miller]], [[Elastic trichrome stain|elastic trichrome]], [[Verhoeff-van Gieson stain|Verhoeff-van Gieson]]) - demonstrating tumour superficial to the (external) elastica. | *Elastic stain (e.g. [[Miller stain|Miller]], [[Elastic trichrome stain|elastic trichrome]], [[Verhoeff-van Gieson stain|Verhoeff-van Gieson]]) - demonstrating tumour superficial to the (external) elastica. | ||
===Images=== | |||
<gallery> | |||
Image: Lung adenocarcinoma visceral pleural invasion - Miller -- very low mag.jpg | Adenocarcinoma - VPI - Miller - very low mag. | |||
Image: Lung adenocarcinoma visceral pleural invasion - Miller -- low mag.jpg | Adenocarcinoma - VPI - Miller - low mag. | |||
Image: Lung adenocarcinoma visceral pleural invasion - Miller -- intermed mag.jpg | Adenocarcinoma - VPI - Miller - intermed. mag. | |||
Image: Lung adenocarcinoma visceral pleural invasion - Miller - alt -- intermed mag.jpg | Adenocarcinoma - VPI - Miller - intermed. mag. | |||
Image: Lung adenocarcinoma visceral pleural invasion - Miller -- very high mag.jpg | Adenocarcinoma - VPI - Miller - very high mag. | |||
</gallery> | |||
==See also== | ==See also== | ||
*[[Lung tumours]]. | *[[Lung tumours]]. | ||
*[[Lung cancer staging]]. | |||
*[[Pleural effusion]]. | |||
*[[Pleura]]. | |||
==References== | ==References== | ||