Difference between revisions of "Pleural invasion"

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'''Visceral pleural invasion''' is the presence of tumour in the visceral [[pleura]]. It 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>
[[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]].


The visceral pleura is the pleura that covers the [[lung]].
==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 has two elastic layers:<ref name=pmid23020722/>
*External elastic layer.
**Usually thick/prominent.
**Important for [[cancer staging|staging]].
*Internal elastic layer.
**Thin - may be difficult to see.
**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===
Pleural invasion can be subgrouped as follows:<ref name=pmid19057261/>
{| class="wikitable sortable"
!Category
!Description
!Tumour stage ([[TNM staging]])
|-
|PL0 †
|tumour confined to lung, not through elastic layer
|T(any)
|-
|PL1 †
|tumour beyond (external) elastic layer of the visercal pleura, not at pleural surface
|at least T2 ‡
|-
|PL2
|tumour at surface of pleura, not in parietal pleura
|at least T2
|-
|PL3
|tumour within parietal pleura and visceral pleura
|at least T3
|}
 
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 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==
*Tumour close to visceral pleura, e.g. <1 mm - high probability of VPI.
*Puckering of the visceral pleura overlying the tumour - suspicious for VPI.
 
==Microscopic==
Features - for PL1:
*Must be through the external elastic layer.<ref name=pmid23020722>{{Cite journal  | last1 = Dacic | first1 = S. | title = Dilemmas in lung cancer staging. | journal = Arch Pathol Lab Med | volume = 136 | issue = 10 | pages = 1194-7 | month = Oct | year = 2012 | doi = 10.5858/arpa.2012-0282-CC | PMID = 23020722 }}</ref>
 
Note:
*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==
[[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.
 
===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==

Latest revision as of 19:01, 15 November 2015

Pleural invasion is the presence of tumour in the pleura. Pleural invasion is considered a poor prognosticator in lung cancer,[1][2] and important in determining the tumour stage in lung cancer staging.

Visceral pleural invasion. H&E stain. (WC)

General

 
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 has two elastic layers:[3]

  • External elastic layer.
    • Usually thick/prominent.
    • Important for staging.
  • Internal elastic layer.
    • Thin - may be difficult to see.
    • Irrelevant for staging.

Images - normal pleural

  • Lung visceral pleura - intermed. mag.

  • Lung visceral pleura - high mag.

Modified Hammar classification

Pleural invasion can be subgrouped as follows:[1]

Category Description Tumour stage (TNM staging)
PL0 † tumour confined to lung, not through elastic layer T(any)
PL1 † tumour beyond (external) elastic layer of the visercal pleura, not at pleural surface at least T2 ‡
PL2 tumour at surface of pleura, not in parietal pleura at least T2
PL3 tumour within parietal pleura and visceral pleura at least T3

Notes:

  • † The interface between PL0 and PL1 is the most challenging. Use of an elastic stain is recommend when there is uncertainty.[3]
  • ‡ The up-staging of small tumours is not completely without controversy; there is data for lung adenocarcinomas less than 2 cm that suggests VPI is not an outcome predictor.[4]

Gross

  • Tumour close to visceral pleura, e.g. <1 mm - high probability of VPI.
  • Puckering of the visceral pleura overlying the tumour - suspicious for VPI.

Microscopic

Features - for PL1:

  • Must be through the external elastic layer.[3]

Note:

  • Tumour trapped within the (external) elastic layer is still PL0.[3]

Images

  • Adenocarcinoma - VPI - very low mag.

  • Adenocarcinoma - VPI - low mag.

  • Adenocarcinoma - VPI - intermed. mag.

  • Adenocarcinoma - VPI - intermed. mag.

  • Adenocarcinoma - VPI - high mag.

  • Adenocarcinoma - VPI - very high mag.

Stains

 
Visceral pleural invasion. Miller stain. (WC)

Images

  • Adenocarcinoma - VPI - Miller - very low mag.

  • Adenocarcinoma - VPI - Miller - low mag.

  • Adenocarcinoma - VPI - Miller - intermed. mag.

  • Adenocarcinoma - VPI - Miller - intermed. mag.

  • Adenocarcinoma - VPI - Miller - very high mag.

See also

References

  1. ↑ 1.0 1.1 Travis, WD.; Brambilla, E.; Rami-Porta, R.; Vallières, E.; Tsuboi, M.; Rusch, V.; Goldstraw, P. (Dec 2008). "Visceral pleural invasion: pathologic criteria and use of elastic stains: proposal for the 7th edition of the TNM classification for lung cancer.". J Thorac Oncol 3 (12): 1384-90. doi:10.1097/JTO.0b013e31818e0d9f. PMID 19057261.
  2. ↑ Shimizu, K.; Yoshida, J.; Nagai, K.; Nishimura, M.; Ishii, G.; Morishita, Y.; Nishiwaki, Y. (Jul 2005). "Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer.". J Thorac Cardiovasc Surg 130 (1): 160-5. doi:10.1016/j.jtcvs.2004.11.021. PMID 15999057.
  3. ↑ 3.0 3.1 3.2 3.3 Dacic, S. (Oct 2012). "Dilemmas in lung cancer staging.". Arch Pathol Lab Med 136 (10): 1194-7. doi:10.5858/arpa.2012-0282-CC. PMID 23020722.
  4. ↑ Nitadori, J.; Colovos, C.; Kadota, K.; Sima, CS.; Sarkaria, IS.; Rizk, NP.; Rusch, VW.; Travis, WD. et al. (Nov 2013). "Visceral pleural invasion does not affect recurrence or overall survival among patients with lung adenocarcinoma ≤ 2 cm: a proposal to reclassify T1 lung adenocarcinoma.". Chest 144 (5): 1622-31. doi:10.1378/chest.13-0394. PMID 23807749.
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