Pleural tumours and tumour-like lesions

Our plain-English summary of Pleural tumours and tumour-like lesions, by F. Aluja Jaramillo, F. Gutierrez, S. Bhalla (Clinical Radiology, 2018).

The study

• Authors: F. Aluja Jaramillo, F. Gutierrez, S. Bhalla
• Journal: Clinical Radiology
• Published: 2018;73(12):1014-1024
• Type of article: Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

There are various neoplasms and tumour-like conditions of the pleura. Mesothelioma is perhaps the most widely recognised; however, there are many others that are more common and should be considered. Understanding the similarities and differences can be helpful in managing the patient with a newly found pleural lesion. We will discuss clinical symptoms at presentation and describe the imaging findings associated with these tumours, starting with conventional radiology, and correlating with computed tomography and combined positron-emission tomography (PET)/computed tomography (CT). Finally, imaging characteristics that help differentiation between the benign and malignant varieties will be reviewed.

Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

In plain English

This article is a pictorial review by radiologists, not a study of patients or of asbestos exposure. Using example scan images (CT, combined PET/CT, MRI and scintigraphy), the authors described how tumours and tumour-like conditions of the pleura, the lining around the lungs, appear on imaging. They covered malignant tumours (pleural mesothelioma, malignant fibrous tumour of the pleura, metastases, liposarcoma, lymphoma and thymoma), benign tumours (lipoma and localised fibrous tumour of the pleura), and conditions that can look like tumours, such as amyloidosis, endometriosis, splenosis and changes after trauma or treatment. Citing earlier publications, the review stated that pleural mesothelioma is strongly associated (40 to 80%) with asbestos exposure. It said risk rises with the duration and intensity of exposure, and that the delay from exposure to disease can range from 20 to 50 years. It also said pleural plaques are present in at least 20% of mesothelioma cases on CT. It described localised fibrous tumour of the pleura as not related to asbestos exposure. The authors concluded that pleural lesions with malignant features require biopsy, while those with benign features may benefit from follow-up.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Pictorial review: a narrative description of imaging findings, drawing on earlier publications and illustrated with example images. No original data were collected or analysed.
• Who was studied: No study population. The review covers pleural tumours and tumour-like conditions in general, illustrated with images from individual patients. The number of patients and how they were selected are not stated.
• Exposure: Asbestos was not studied directly. It is mentioned as background in describing pleural mesothelioma, and localised fibrous tumour of the pleura is described as not related to asbestos exposure. No fibre types are named.
• Main results:
  • The review describes pleural mesothelioma as the most common primary malignancy of the pleura. Only metastatic disease from cancers elsewhere is more common among malignancies of the pleura.
  • Citing earlier publications, the review states that pleural mesothelioma is strongly associated (40 to 80%) with asbestos exposure. It says risk increases with the duration and intensity of exposure, and that the latency from exposure to disease can range from 20 to 50 years.
  • Citing earlier publications, the review states that the incidence of pleural mesothelioma in patients with a history of asbestos exposure is 10%.
  • On CT, the initial finding in pleural mesothelioma is often a fluid build-up on one side of the chest. Pleural plaques, some with calcifications, tend to be present in at least 20% of cases. Nodular pleural thickening, or thickening that rings the lung and is more than 1 cm thick, is described as suggestive of mesothelioma.
  • Localised fibrous tumour of the pleura is described as a rare benign tumour, making up less than 5% of all pleural tumours, and as not related to asbestos exposure.
  • Several other conditions are described as possibly resembling mesothelioma on imaging: pleural amyloidosis (which, like mesothelioma and metastases, shows increased activity on PET/CT), pleural thymoma, and pleural lymphoma. For lymphoma, the authors write that disease outside the pleura may be the key to telling it apart from mesothelioma.
• The authors' conclusion: The authors concluded that pleural tumours range from benign to malignant and that each has certain distinguishing features. In their view, pleural lesions with malignant features require biopsy, while lesions with benign features may benefit from follow-up.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Neoplasm, Pleura, Mesothelioma.

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• Integrated positron emission tomography-computed tomography does not accurately stage intrathoracic disease of patients undergoing trimodality therapy for malignant pleural mesothelioma — J. Pilling, J.A. Dartnell, et al. (2010)
• Whole-Body MRI: Comparison of Its Capability for TNM Staging of Malignant Pleural Mesothelioma With That of Coregistered PET/MRI, Integrated FDG PET/CT, and Conventional Imaging — Y. Ohno, M. Yui, et al. (2019)
• 18F-FDG PET/CT in the management of patients with malignant pleural mesothelioma being considered for multimodality therapy: experience of a tertiary referral center — H.S. Elliott, U. Metser, et al. (2018)
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