Pleura

C38.4WHO Vol. 5

Thorax (Respiratory & Mediastinum)

Prognosis

This section is being prepared by our editorial process.

🔬 Histological Types

📚 Latest Research

2026-09-07

Long-term outcomes and patterns of failure in patients with thymic malignancies treated with surgery and radiation therapy.

Icht O, et al

A retrospective study of 360 patients with surgically treated thymic malignancies found that tumor invasiveness — especially vascular invasion (odds ratio 6.0; 95% CI 2.3–15.7) — was the strongest predictor of recurrence, and that peri-operative radiation therapy was associated with improved overall survival after statistical adjustment (hazard ratio 0.49; 95% CI 0.26–0.90; p = .02). Among the 175 patients (48.6%) who received peri-operative radiation, 62 (35.4%) experienced recurrence, with the pleura being the most common site (76%) and in-field recurrences being rare (5%), indicating effective local control but a persistent challenge of pleural relapse. Histologic subtype did not predict recurrence, suggesting that vascular invasion — rather than tumor type — should guide risk stratification decisions. The authors conclude that prospective trials are needed to confirm the survival benefit of peri-operative radiation and to develop better strategies against pleural failure.

Cancer

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2026-09-05

Indwelling pleural catheter enabling safe air travel in malignant pleural effusion with pneumothorax ex vacuo.

Lachal F, et al

A man with pleural mesothelioma and malignant pleural effusion complicated by pneumothorax ex vacuo was able to safely undertake a domestic flight after a specific in-flight management protocol was developed around his indwelling pleural catheter (IPC). Pneumothorax of any cause is typically a contraindication to air travel due to the risk of intrapleural air expansion at altitude, yet pneumothorax ex vacuo — arising from non-expandable lung — is a common complication in malignant pleural effusion that can ground terminally ill patients. This case demonstrates that in carefully selected patients with a functioning IPC, air travel may be feasible with an appropriate emergency management protocol in place. Beyond its clinical significance, the case highlights the importance of enabling terminal patients to fulfil meaningful personal goals, such as a final family trip.

BMJ case reports

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2026-09-01

Sarcomatoid Mesothelioma Revealed After Treatment for Tuberculous Pleurisy: A Case Report.

Nagayama D, et al

An 83-year-old man was initially misdiagnosed and treated for tuberculous pleurisy before a CT-guided percutaneous biopsy with fluorescence in situ hybridization (FISH) analysis ultimately confirmed sarcomatoid mesothelioma — one of the most aggressive subtypes of malignant pleural mesothelioma. The case illustrates how sarcomatoid mesothelioma can mimic tuberculous pleurisy through lymphocyte-predominant exudative pleural effusion and a positive Interferon-Gamma Release Assay, leading to significant diagnostic delay. Within just 2 months of an inconclusive surgical biopsy showing only fibrosis and scattered spindle cells, the patient developed a rapidly growing chest wall mass with bone invasion, underscoring the tumour's aggressive behaviour. Clinicians are urged to maintain a high index of suspicion for malignancy in treatment-refractory pleurisy, pursue prompt repeat biopsies, and consult pathologists regarding FISH testing even when initial results are negative.

Respirology case reports

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