Search Results (459)

Background/Objectives: Malignant pleural effusion is a common and distressing complication of advanced cancer, often resulting in severe symptoms such as dyspnoea, which significantly impacts patients’ quality of life. This study evaluates the effectiveness and safety of talc slurry pleurodesis as a palliative treatment for recurrent malignant pleural effusion and examines predictive factors for pleurodesis success and survival. Methods: A single-centre cohort study was conducted at the Thoracic Surgery Department of the University Clinical Centre of Kosovo between April 2022 and March 2024. The study included adult patients with recurrent and symptomatic malignant pleural effusion who met specific inclusion criteria for performing pleurodesis. Patients were followed prospectively with routine clinical evaluations until the conclusion of the study on 9 September 2024. Descriptive and inferential statistics were employed to evaluate the success of pleurodesis and its associated outcomes. Results: The study shows a success rate of 84.6% at 30 days post-procedure, with 57.6% achieving complete success and 42.4% partial success. Talc slurry pleurodesis was associated with minimal complications, with chest pain and fever being the most common adverse effects. The most significant predictors of survival post-pleurodesis identified were the Karnofsky Performance Status score and serum neutrophil-to-lymphocyte ratio. Patients with higher Karnofsky Performance Status scores and lower neutrophil-to-lymphocyte ratios had improved survival outcomes. Conclusions: This study suggests that talc slurry pleurodesis is an effective and safe option for managing malignant pleural effusions in patients with low-performance status, offering symptom relief and potentially extending survival in certain patients. Further research is required to refine predictive models for treatment success. Full article

Thoracic tumors, including lung adenocarcinoma (LUAD) and malignant pleural mesothelioma (MM), remain a leading cause of cancer-related deaths, primarily due to the challenges in treating advanced thoracic tumors. New drugs with optimal efficacy and minimal side effects are required. Traditional Chinese Medicine (TCM) compounds offer a promising alternative. Our study explores the effectiveness of the TCM compound Narciclasine against LUAD and MM. Spheroids derived from LUAD (A549, LuCa1) and MM (MSTO-211H, H2052/484) cell lines were treated with Narciclasine, and efficacy was evaluated through cell morphology analysis, intracellular adenosine triphosphate (ATPi) and lactate dehydrogenase (LDH) assays, RT-qPCR, and western blot analysis. Narciclasine reduced cell viability, with an 80% reduction in viability in MM. It induced cell apoptosis and inhibited proliferation. The IC₅₀ values for Narciclasine ranged from 50 to 150 nM. In silico analysis identified shared gene targets between Narciclasine, LUAD, and MM. Narciclasine modulated the expression of genes associated with ferroptosis and cuproptosis, and the epithelial-to-mesenchymal transition. Narciclasine shows promising efficacy against LUAD and MM spheroid models. These findings warrant further investigation into the mechanisms of action and potential clinical application of Narciclasine for treating thoracic malignancies, offering hope for improved therapeutic options and patient outcomes. Full article

Peritoneal carcinomatosis (PC) and malignant pleural effusions (MPE) are two common complications of cancers metastatic to the respective body cavities. A PC diagnosis indicates metastasis to the tissue lining the abdominal cavity and is most common in patients with gastrointestinal and gynecological cancers. It is often accompanied by ascites, an accumulation of serous fluid in the abdomen. MPE presents as the accumulation of fluid in the space between the lungs and chest wall. It is a common terminal event in patients diagnosed with breast cancer, lung cancer, lymphoma, and mesothelial cancers, and less commonly, in a wide variety of other epithelial cancers. Due to the aggressive nature of cavitary tumors, the outcome of current treatments for both PC and MPE remains bleak. Although PC and MPE are characteristically affected by different sets of primary tumors (lung/breast/mesothelioma for MPE and gynecologic/gastrointestinal for PC), their environments share common cytokines and cellular components. Owing to the unique cytokine and chemokine content, this environment promotes aggressive tumor behavior and paradoxically both recruits and suppresses central memory and effector memory T cells. The cellular and secretomic complexity of the cavitary tumor environment renders most currently available therapeutics ineffective but also invites approaches that leverage the robust T-cell infiltrate while addressing the causes of local suppression of anti-tumor immunity. Interactions between the heterogeneous components of the tumor environment are an area of active research. We highlight the roles of the immune cell infiltrate, stromal cells, and tumor cells, and the soluble products that they secrete into their environment. A more comprehensive understanding of the cavitary tumor environment can be expected to lead to better immunotherapeutic approaches to these devastating conditions. Full article

Pleural Mesothelioma (PM) remains a challenging malignancy associated with asbestos exposure and characterized by poor prognosis. This review aims to consolidate recent findings on the efficacy of perioperative therapies encompassing chemotherapy, surgery, and emerging immunotherapy strategies. Current management strategies debate the role of surgery in early-stage patients, particularly due to the limited success of solitary treatment modalities and significant rates of postoperative complications. Retrospective studies indicate that multimodal treatment, incorporating surgical resection with perioperative chemotherapy, can enhance overall survival (OS), especially in favorable prognostic subsets. However, significant randomized trials, notably the MARS and MARS 2 trials, revealed that the addition of aggressive surgical strategies like extrapleural pneumonectomy (EPP) did not confer survival benefits and was accompanied by heightened morbidity. In light of persistent challenges, integrating perioperative chemotherapy—primarily with platinum-based regimens—has shown improved disease control outcomes. Neoadjuvant chemotherapy permits real-time assessment of tumor responsiveness, providing valuable clinical insights for surgical candidacy. The role of immunotherapy, particularly immune checkpoint inhibitors (ICIs), is also under active exploration, with preliminary results suggesting promising activity and manageable safety profiles. In conclusion, while current protocols primarily recommend surgery for a select group of patients, ongoing investigations into neoadjuvant approaches, adjuvant therapies, and novel immunotherapeutic strategies are crucial for developing effective, personalized treatment paradigms for PM. Future efforts should prioritize clinical trials that integrate these therapies within a structured multidisciplinary approach to optimize patient outcomes. Full article

Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy associated with occupational or environmental exposure to asbestos. Effective management of MPM remains challenging due to its prolonged latency period and the typically late onset of clinical symptoms. Accordingly, there is an increasing demand for the implementation of reliable, non-invasive, and data-driven diagnostic strategies within large-scale screening programs. In this context, the chemical profiling of volatile organic compounds (VOCs) in exhaled breath has recently gained recognition as a promising and non-invasive approach for the early detection of cancer, including MPM. Therefore, in this cross-sectional observational study, an overall number of 125 individuals, including 64 MPM patients and 61 healthy controls (HC), were enrolled. End-tidal breath fraction (EXP) was collected directly onto two-bed adsorbent cartridges by an automated sampling system and analyzed by thermal desorption–gas chromatography–mass spectrometry (TD-GC/MS). A machine learning approach based on a random forest (RF) algorithm and trained using a 10-fold cross-validation framework was applied to experimental data, yielding remarkable results (AUC = 86%). Fifteen VOCs reflecting key metabolic alterations characteristic of MPM pathophysiology were found to be able to discriminate between MPM and HC. Moreover, twenty breath samples from asymptomatic former asbestos-exposed (AEx) and eight MPM patients during follow-up (FUMPM) were exploratively analyzed, processed, and tested as blinded samples by the validated statistical method. Good agreement was found between model output and clinical information obtained by CT. These findings underscore the potential of breath VOC analysis as a non-invasive diagnostic approach for MPM and support its feasibility for longitudinal patient and at-risk subjects monitoring. Full article

Background/Objectives: Severe acute pancreatitis (SAP) carries substantial morbidity and resource burden, and early risk stratification remains challenging with conventional scores that require serial observations. The aim of this study was to develop and compare supervised machine-learning (ML) pipelines—integrating feature selection and SHAP-based explainability—for early prediction of SAP at emergency department (ED) presentation. Methods: This retrospective, single-center cohort was conducted in a tertiary-care ED between 1 January 2022 and 1 January 2025. Adult patients with acute pancreatitis were identified from electronic records; SAP was classified per the Revised Atlanta criteria (persistent organ failure ≥ 48 h). Six feature-selection methods (univariate AUROC filter, RFE, mRMR, LASSO, elastic net, Boruta) were paired with six classifiers (kNN, elastic-net logistic regression, MARS, random forest, SVM-RBF, XGBoost) to yield 36 pipelines. Discrimination, calibration, and error metrics were estimated with bootstrapping; SHAP was used for model interpretability. Results: Of 743 patients (non-SAP 676; SAP 67), SAP prevalence was 9.0%. Compared with non-SAP, SAP patients more often had hypertension (38.8% vs. 27.1%) and malignancy (19.4% vs. 7.2%); they presented with lower GCS, higher heart and respiratory rates, lower systolic blood pressure, and more frequent peripancreatic fluid (31.3% vs. 16.9%) and pleural effusion (43.3% vs. 17.5%). Albumin was lower by 4.18 g/L, with broader renal–electrolyte and inflammatory derangements. Across the best-performing models, AUROC spanned 0.750–0.826; the top pipeline (RFE–RF features + kNN) reached 0.826, while random-forest-based pipelines showed favorable calibration. SHAP confirmed clinically plausible contributions from routinely available variables. Conclusions: In this study, integrating feature selection with ML produced accurate and interpretable early prediction of SAP using data available at ED arrival. The approach highlights actionable predictors and may support earlier triage and resource allocation; external validation is warranted. Full article

Background/Objectives: Unlike other thoracic malignancies, seeding malignant cells along surgical tracts is a known complication of invasive diagnostic or therapeutic procedures for pleural mesothelioma (PM). We report the tract dissemination rate and risk factors in 308 consecutive patients treated over 9 years in a single institution who underwent pleurectomy decortication (PD). Methods: Clinical and outcome data were reviewed. Fisher’s exact test, Kaplan–Meier estimators, and log-rank tests were used to identify significant risk factors for surgical tract dissemination and to compare overall survival. Results: There were 233 males (75.6%), 187 right-sided operations (61%), 190 (61.7%) epithelioid histology cases, and the median age was 69 (29–84). During the study, malignant cell dissemination in resected surgical tracts was diagnosed in 69 (22.4%) patients. The dissemination rates in epithelioid, biphasic, and sarcomatoid tumors were 24.7%, 20.4%, and 0%, respectively. Disseminated malignant surgical tract was associated with advanced nodal status (p = 0.001), advanced staging by the American Joint Committee on Cancer (AJCC 8th edition, p = 0.03), female sex (0.02), side of surgery (p = 0.03), and the number of video-assisted thoracoscopic surgery (VATS) ports (p = 0.003). In epithelioid mesothelioma, the median survival from diagnosis was 19.7 months in patients with tract seeding versus 36.3 months in patients without seeding (hazard ratio, 1.9; p = 0.001). Conclusions: Procedure tract dissemination occurs in almost every fourth patient with pleural mesothelioma and is associated with shorter overall survival in the epithelioid subtype. Full article

Background: The optimal surgical approach for malignant pleural mesothelioma (PM) remains a topic of debate. While extrapleural pneumonectomy (EPP) offers radical resection, it is associated with significant morbidity. Pleurectomy/decortication (P/D) is less extensive but may offer comparable oncologic outcomes with reduced perioperative risk. This study aimed to conduct a comprehensive systematic review and meta-analysis to systematically evaluate and quantitatively compare survival outcomes, 30-day postoperative mortality, and baseline characteristics between patients undergoing P/D and EPP for PM. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. MEDLINE, Embase, and Scopus were searched up to May 2025. Studies comparing EPP and P/D in PM that reported on survival, mortality, or baseline demographics were included. Data from 24 retrospective studies were extracted. Pooled estimates were calculated using random-effects models. Meta-regression and subgroup analyses were performed by geographic region and publication year. Results: P/D was associated with a significantly improved overall survival compared to EPP in the primary analysis (mean difference = 7.01 months; 95% CI: 1.15–12.86; p = 0.018), with substantial heterogeneity (I² = 98.5%). In a sensitivity analysis excluding one statistical outlier, the survival benefit remained significant (mean difference = 4.31 months; 95% CI: 1.69–6.93), and heterogeneity was markedly reduced. The 30-day mortality rate was also significantly lower for P/D (odds ratio = 0.34; 95% CI: 0.13–0.88; p = 0.027). Patients undergoing P/D were, on average, 3.78 years older than those undergoing EPP (p < 0.001), whereas no significant difference was observed in the sex distribution between groups. Subgroup analyses by region and publication year confirmed the robustness of the findings. Meta-regression did not reveal substantial modifiers of survival. Conclusions: P/D demonstrates superior overall survival and reduced perioperative mortality compared to EPP, without evidence of baseline demographic confounding. These findings, derived from retrospective comparative studies, support the preferential use of P/D in eligible patients, particularly in high-volume centers, given its favorable safety profile and superior median survival. However, the absence of randomized trials directly comparing P/D and EPP and the potential influence of patient selection warrant cautious interpretation, and surgical decisions should be tailored to individual patient factors within a multidisciplinary setting. Full article

Background: Pleural effusion is a common clinical condition encountered in emergency departments and often requires timely therapeutic intervention. This study aimed to assess the effectiveness and safety of ultrasound-guided pigtail catheter drainage in patients presenting with symptomatic pleural effusion. Methods: We conducted a retrospective analysis of 134 drainage procedures performed in a tertiary hospital emergency department in 2024. Adult patients who underwent ultrasound-guided drainage were included regardless of primary diagnosis. Results: Clinical improvement was observed in 86.6% of patients, while radiological improvement—assessed only in cases with complete follow-up imaging—was seen in 56.0%. Procedure-related complications were rare (3.7%), and 50% of patients were discharged directly from the emergency department, highlighting the feasibility of ambulatory management. Nearly half of the patients had underlying malignancy and were receiving palliative care. Conclusions: While indwelling pleural catheters (IPCs) are typically used in long-term outpatient settings, our study focused on temporary pigtail catheter drainage performed in-hospital as a symptom-relieving intervention. The findings align with previous studies supporting the safety and effectiveness of small-bore catheter use in this context. Ultrasound-guided pigtail drainage represents a low-risk, patient-centered approach that can reduce the burden on inpatient services and enhance quality of care for individuals with advanced disease. This method may be considered a first-line option in selected patients presenting with large or symptomatic pleural effusions in acute care settings Full article

Background/Objectives: Up to one third of pleural biopsies performed during medical thoracoscopy (MT) are labelled as non-specific pleuritis (NSP). The histological diagnosis of NSP has long been worrisome for pulmonologists, with the potential to evolve into a life-threatening condition. The aim of this study was to identify clinical and biological predictors for patients with a diagnosis of NSP to guide clinical decisions. Methods: Baseline, procedural and follow-up data of NSP patients were retrospectively analysed to identify potential outcome predictors. Results: Of the 272 patients who underwent MT, 192 (71%) were diagnosed with malignancies, 9 (3%) with benign diseases and 71 (26%) with NSP. At follow-up, 17% were diagnosed with malignant disease and 21% with a benign condition and 62% remained idiopathic. A thoracoscopist’s evaluation of the pleural appearance reported a PPV of 28% and an NPV of 91% to predict malignancy. Patients with a subsequent diagnosis of malignancy tended to have a higher volume of fluid drained than those with persistently idiopathic NSP [2.7 litres (L) vs. 1.6 L p = 0.06]. A lymphocytic pleural effusion was more common in the malignant and idiopathic groups (63% and 60%, respectively) than the benign group (16%; p = 0.06 and p = 0.01). The three groups had a similar rate of effusion recurrence. Overall survival was higher in patients with idiopathic pleural effusion than in those with malignant (p = 0.04) or benign disease (p = 0.008). Conclusions: NSP diagnosis hides a malignancy in one in five cases, underlying the importance of closely following up these patients. The volume of drained pleural fluid, cell count and thoracoscopist’s impression may guide clinicians in the challenging management of patients with NSP. Full article

Background and Objectives: Discrimination between various causes of exudative pleural effusion (PE) remains a major clinical challenge, and to date, definitive biochemical markers for this discrimination remain lacking. An increasing number of studies have reported that serum C-reactive protein (CRPs), pleural fluid CRP (CRPpf), and CRPpf/CRPs ratio (CRPr) are useful for the differential diagnosis of exudative PE; however, their efficacy rate is not similar in these studies. The majority of these studies were conducted on small groups of subjects, and the efficacy of the gradient between CRPs and CRPpf (CRPg—calculated as CRPs—CRPpf) in this differentiation has not been previously investigated. This study aims to evaluate the efficacy rate of CRPs, CRPpf, CRPg, and CRPr in the differential diagnoses of various causes of exudative PE in a relatively large cohort of patients. Materials and Methods: The research group included 282 subjects with exudative PE—146 had parapneumonic effusion (PPE), 126 had malignant pleural effusion (MPE), and 10 had tuberculous pleural effusion (TPE). The values are presented as mean ± SD. Results: The mean CRPs level was significantly higher in the PPE group compared to the MPE group (p < 0.0001) and the TPE group (p < 0.001), and also significantly higher in the TPE group than in the MPE group (p = 0.0009). Similarly, the mean CRPpf level was significantly higher in the PPE group than in the MPE group (p < 0.0001) and the TPE group (p = 0.04), and also significantly higher in the TPE group than in the MPE group (p < 0.0001). The mean CRPg level was significantly higher in the PPE group than in both the MPE group (p < 0.0001) and the TPE group (p < 0.002). The mean CRPr level did not differ significantly among these groups of exudate. Conclusions: CRPs, CRPpf, and CRPg are effective in the differential diagnosis of exudative PE, while CRPr was not effective in this regard. The main limitation of this study is that the sample size of the TPE group is very small. Full article

Hyaloserositis, also known as the icing sugar phenomenon, may be commonly observed during autopsies; however, it is not a well-documented topic with varying nomenclature and etiology, which can be generally defined as an organ being covered with a shiny, fibrous hyaline membrane. In our work, we present the case of a 71-year-old female patient with alcohol-induced liver cirrhosis and subsequent ascites and recurrent peritonitis. During the autopsy, a cirrhotic liver and an enlarged spleen were observed, both exhibiting features consistent with hyaloserositis, accompanied by acute fibrinopurulent peritonitis. Histological examination revealed the classical manifestation of hyaloserositis, further proven by Crossmon staining. The cause of death was concluded as hepatic encephalopathy. During our literature review, a total of seven cases were found. It must be emphasized that no publication describing hyaloserositis from the perspective of a pathologist was discovered. Regarding etiology, abdominal presentations were most commonly caused by serohepatic tuberculosis, while pleural manifestation was observed following trauma. Hyaloserositis may prove to be a diagnostic difficulty in imaging findings, as it can mimic malignancy; therefore, a scientific synthesis is necessary. Full article

Malignant mediastinal tumors are a group representing some of the most demanding oncological challenges for early, multi-level, and successful management. The timely identification of any suspicious clinical symptomatology is urgent in achieving an accurate, staged histological diagnosis, in order to follow up with an equally detailed medical therapeutic plan (interventional or not) and determine the principal goals regarding efficient overall treatment in these patients. We report a case of a 24-year-old male patient with an incident-free prior medical history. An initial chest X-ray was performed after the patient reported short-term, consistent moderate chest pain symptomatology, early work fatigue, and shortness of breath. The following imaging procedures (chest CT, PET-CT) indicated the presence of an anterior mediastinal mass (meas. ~11 cm × 10 cm × 13 cm, SUV: 8.7), applying additional pressure upon both right heart chambers. The Alpha-Fetoprotein (aFP) blood levels had exceeded at least 50 times their normal range. Two consecutive diagnostic attempts with non-specific histological results, a negative-for-malignancy fine-needle aspiration biopsy (FNA-biopsy), and an additional tumor biopsy, performed via mini anterior (R) thoracotomy with “suspicious” cellular gatherings, were performed elsewhere. After admission to our department, an (R) Video-Assisted Thoracic Surgery (VATS) was performed, along with multiple tumor biopsies and moderate pleural effusion drainage. The tumor’s measurements had increased to DMax: 16 cm × 9 cm × 13 cm, with a severe degree of atelectasis of the Right Lower Lobe parenchyma (RLL) and a pressure-displacement effect upon the Superior Vena Cava (SVC) and the (R) heart sinus, based on data from the preoperative chest MRA. The histological report indicated elements of a combined, non-seminomatous germ-cell mediastinal tumor, posthuberal-type teratoma, and embryonal carcinoma. The imminent chemotherapeutic plan included a “BEP” (Bleomycin^®/Cisplatin^®/Etoposide^®) scheme, which needed to be modified to a “VIP” (Cisplatin^®/Etoposide^®/Ifosfamide^®) scheme, due to an acute pulmonary embolism incident. While the aFP blood levels declined, even reaching normal measurements, the tumor’s size continued to increase significantly (DMax: 28 cm × 25 cm × 13 cm), with severe localized pressure effects, rapid weight loss, and a progressively worsening clinical status. Thus, an emergency surgical intervention took place via median sternotomy, extended with a complementary “T-Shaped” mini anterior (R) thoracotomy. A large, approx. 4 Kg mediastinal tumor was extracted, with additional RML and RUL “en-bloc” segmentectomy and partial mediastinal pleura decortication. The following histological results, apart from verifying the already-known posthuberal-type teratoma, indicated additional scattered small lesions of combined high-grade rabdomyosarcoma, chondrosarcoma, and osteosarcoma, as well as numerous high-grade glioblastoma cellular gatherings. No visible findings of the previously discovered non-seminomatous germ-cell and embryonal carcinoma elements were found. The patient’s postoperative status progressively improved, allowing therapeutic management to continue with six “TIP” (Cisplatin^®/Paclitaxel^®/Ifosfamide^®) sessions, currently under his regular “follow-up” from the oncological team. This report underlines the importance of early, accurate histological identification, combined with any necessary surgical intervention, diagnostic or therapeutic, as well as the appliance of any subsequent multimodality management plan. The diversity of mediastinal tumors, especially for young patients, leaves no place for complacency. Such rare examples may manifest, with equivalent, unpredictable evolution, obliging clinical physicians to stay constantly alert and not take anything for granted. Full article

Malignant pleural effusion (MPE) can lead to pleural organization with loculation and impaired drainage. This condition is becoming increasingly more common due to advancements in cancer therapy and extended patient survival. Factors such as repeated thoracentesis through an indwelling pleural catheter (IPC), intrapleural bleeding, and tumor progression contribute to MPE organization. Loculated MPE causes breathlessness and reduced quality of life, and current therapies, including intrapleural fibrinolytic or enzymatic therapy (IPFT/IET), have limitations in efficacy and safety. Identifying new therapeutic targets is crucial for improving treatment outcomes. Research is needed to understand the role of profibrogenic factors in pleural neoplasia, their regulation, and their impact on different stages of pleural organization. The development of a rabbit model of organizing MPE could provide insights into underlying mechanisms and novel interventions. Comparative studies of pleural tissues and effusions from MPE patients and other forms of pleural organization may reveal valuable information. Cellular and molecular profiling, assessment of biomarkers, and personalized IPFT dosing are potential areas of investigation. Suppression of PAI-1 activity and the role of hyaluronic acid in malignant mesothelioma are also important research directions. Understanding the profibrogenic capacity of pleural mesothelial cells undergoing mesenchymal transition (MesoMT) and identifying key contributors and effectors involved in this process are essential for developing effective treatments for loculated MPE. Full article

Background: The benefit of surgery for malignant pleural mesothelioma is highly debated, as few robust clinical trials show its effectiveness. Objective: To examine the long-term survival of patients with malignant pleural mesothelioma who underwent surgical treatment combined with neoadjuvant chemotherapy versus those who received chemotherapy alone. Methods: We analyzed a historical cohort of 122 patients diagnosed with mesothelioma, confirmed through histopathological examination. We compared the clinical and laboratory characteristics of the surgery and chemotherapy groups at baseline. We calculated Kaplan–Meier survival curves and used Cox’s proportional hazards model to evaluate the relationship between surgery and mortality. Results: Surgery was performed in 16 out of 122 cases. Pleurectomy/decortication (PD) represented 8 cases, while extrapleural pneumonectomy (EPP) accounted for the remaining 8 cases. At five years, survival rates for those who underwent surgery compared to chemotherapy alone were 53% (95% CI 15–81%) versus 23% (95% CI 10–40%), respectively. Survival among those who had PD was 67%, compared to 40% for those who had EPP. Surgical treatment was associated with improved survival, with a hazard ratio (HR) of 0.34 (95% CI 0.19–0.61) after adjusting for factors such as age over 65, the duration from symptom onset to diagnosis, hemoglobin levels below 10 g, a neutrophil-to-lymphocyte ratio over 6, and ECOG scores greater than 2. Conclusions: Mesothelioma surgery, whether it be PD or EPP, enhances patients’ survival compared to chemotherapy. PD produces better outcomes than EPP. Full article