Cases of Pleural Carcinomatosis Undergoing Panpleuropneumonecto

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The mechanism of the spread of pleural carcinomatosis was studied pathologically. Materials used were 14 panpleuropneumonectomied cases, which consisted of 12 cases of primary adenocarcinoma of the lung, and one case each of malignant thymoma and malignant diffuse epithelial mesothelioma. In the early stage of dissemination, malignant cells were implanted on the pleural surface from the primary tumor and grew as small nodules mainly in the submesothelial layer. All the small nodules examined were covered by a thin layer of fibrous tissue. In cases of severe pleural dissemination, these small nodules grew in size and became adherent each other to produce remarkable pleural thickening. Upon further progression, extrapleural invasion and lymphatic vessel permeation were observed. Mediastinal lymph node metastases were positive in 10 out of 11 cases. However, 3 cases with a slight degree of dissemination had no metastases either in the hilum or intrapulmonary lymph nodes, indicating that subpleural lymphatics were connected directly to the mediastinal lymph nodes.<BR>Pleural carcinomatosis should be treated not only for desquamated cancer cells in the pleural cavity but also for subpleural cancer tissue. Panpleuropneumonectomy is considered to be an effective treatment for the early stage of pleural dissemination of lung cancer, malignant thymoma, and malignant mesothelioma.
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