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Malignant Pleural Tumors

Bryan M. Burt, MD, David J. Sugarbaker, MD, Richard Whitlock, MD

Key Points

  • Primary pleural tumors, whether benign or malignant, are rare.
  • Benign pleural primary tumors, such as the solitary fibrous tumor of the pleura (SFTP), are very rare.
  • The treatment approach to benign primary pleural tumors is surgical resection, which is curative with complete (R0) resection.
  • Approximately 75% of all pleural lesions represent distant metastatic foci of other primary cancers.
  • The most common malignant pleural primary tumor is malignant pleural mesothelioma (MPM), which carries an overall poor prognosis.
  • •A multimodality approach incorporating surgery, systemic therapy, and/or radiotherapy may extend survival in select patients with MPM confined to the ipsilateral pleural cavity.
  • Macroscopic complete resection (MCR) is a critical endpoint of surgical resection of MPM.
  • Immunotherapy with immune checkpoint blockade has become a standard first-line therapy for patients with unresectable MPM, and is being investigated in the neoadjuvant and adjuvant settings.

Primary tumors of the pleura are rare. The diagnostic process often reveals that suspicious pleural thickening, pleural effusion, or pleural based masses to be a metastatic focus of another primary cancer, principally lung or breast carcinoma. In fact, 75% of suspected pleural tumors are found to be metastatic deposits from non-pleural primary tumors. Occasionally, the diagnosis rests on one of several benign pleural entities, which include solitary fibrous tumor of the pleura (SFTP), lipoma, endothelioma, angioma, pleural cysts, plaques, amyloidosis, or endometriosis, but these benign pleural primary tumors are extraordinarily rare. By far the most common malignant primary pleural tumor is malignant pleural mesothelioma (MPM) - a highly aggressive and often fatal primary tumor the pleura. More has been written about this devastating malignancy than about all other pleural entities combined.

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Last updated: August 26, 2024