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Difference between revisions of "Pleural invasion"
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==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 | *‡ 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== | ||
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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== | ||
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==See also== | ==See also== | ||
*[[Lung tumours]]. | *[[Lung tumours]]. | ||
*[[Lung cancer staging]]. | |||
*[[Pleural effusion]]. | |||
*[[Pleura]]. | |||
==References== | ==References== | ||