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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 Tumour stage. | '''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 Tumour stage. | ||
==General== | |||
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. | ||
==Modified Hammar classification== | 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. | |||
===Modified Hammar classification=== | |||
Pleural invasion can be subgrouped as follows:<ref name=pmid19057261/> | Pleural invasion can be subgrouped as follows:<ref name=pmid19057261/> | ||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
| Line 15: | Line 24: | ||
|- | |- | ||
|PL1 | |PL1 | ||
|tumour beyond 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 | ||
|- | |- | ||
| Line 26: | Line 35: | ||
|at least T3 | |at least T3 | ||
|} | |} | ||
Note: | |||
*The interface between PL0 and PL1 is the most challenging. Elastic stains are recommend when there is uncertainty.<ref name=pmid23020722/> | |||
==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/> | |||
==Stains== | |||
*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. | |||
==See also== | ==See also== | ||