Clinical characteristics of histiocytic pleural effusion

연구배경 및 목적 : 호중구성, 림프구성, 호산구성 흉수의 임상적 특성과 원인에 대하여 많은 연구가 되어 있다. 임상에서 흉수가 있는 환자를 진료하면서 조직구성 흉수를 드물지 않게 경험하였다. 하지만 조직구성 흉수에 대한 연구는 거의 되어 있지 않았다. 따라서 본 연구의 목적은 후향적으로 조직구성 흉수의 임상적 특성과 원인을 알아보고자 한다. 연구방법 : 조직구성 흉수의 정의는 흉수액의 백혈구 분획 중 조직구가 50% 이상을 차지할 때로 정의하였다. 2010년 1월부터 2019년 12월까지 울산대학교병원에서 흉강 천자와 흉수 검사를 시행한 18세 이상 환자를 후향적으로 울산대학교병원 임상정보연구시스템(uICE)를 이용하여 연구대상을 선정하고 데이터를 추출하였다. 그 결과, 지난 10년 동안 18세 이상 흉수 검사를 시행한 3279명의 환자 중에서 295명 (9.0%)이 조직구성 흉수로 확인되었다. 그 중에서 Light’s criteria를 이용해 삼출액과 여출액으로 분류하여, 삼출성 조직구성 흉수 201명을 연구대상으로 분석하였다. 연구결과 : 201명의 삼출성 조직구성 흉수 환자의 주요 원인은 악성 흉수 (n = 102 [50.7%]), 부폐렴성 흉수 (n = 9 [4.5%]), 결핵성 흉막염 (n = 9 [4.5%]) 이었다. 102명의 악성 흉수 환자에서 주요 원인 암은 폐암 (n = 42 [41.2%]), 유방암 (n = 16 [15.7%]), 위암 (n = 11 [10.8%])이었다. 폐암 중에서 선암 (n = 34 [81.0 %])이 가장 흔한 조직학적 형태였다. 결론 : 본 연구에서 삼출성 조직구성 흉수의 주요 원인은 악성 흉수이며, 특히 폐암이 가장 흔한 원인 암이었다. 따라서 임상에서 흉수 환자를 진료할 때, 조직구가 흉수액 검사의 백혈구 분획에서 우세한 경우에 악성 흉수의 가능성을 반드시 고려해야 하겠다. |Introduction: There have been many studies on the clinical characteristics of neutrophilic, lymphocytic, and/or eosinophilic pleural effusions. While caring for patients with pleural effusion, we found that histiocytic pleural effusion (HisPE) was not uncommon. However, few studies have explored HisPE. The purpose of the present study was to determine the clinical characteristics and etiologies of HisPE. Methods: In this retrospective study, we defined HisPE when histiocytes were accounting for 50% or more of pleural fluid white blood cells. Using a clinical data warehouse, patients with HisPE among all patients aged >18 years who underwent thoracentesis and pleural fluid analysis between January 2010 and December 2019 at Ulsan University Hospital were enrolled. A total of 295 (9.0%) of 3279 patients who underwent thoracentesis were identified as HisPE patients. Among them, 201 patients with exudative HisPE were included. Clinical characteristics and etiologies were extracted from medical records and analyzed. Results: Among the 201 patients with exudative HisPE, the major causes were malignant pleural effusion (n = 102 [50.7%]), parapneumonic effusion (n = 9 [4.5%]), and tuberculous pleurisy (n = 9 [4.5%]). In the 102 patients with malignant pleural effusion, the main types of cancer were lung (n = 42 [41.2%]), breast (n = 16 [15.7%]), and stomach cancer (n = 11 [10.8%]). Among lung cancers, adenocarcinoma (n = 34 [81.0%]) was the most common histology. Conclusions: The leading cause of exudative HisPE was malignancy, particularly lung cancer. Physicians should consider the possibility of malignant disease if histiocytes are predominantly present in pleural effusion.Maste

The Impact of Cryotherapy on Airway Stenosis : in vivo, ex vivo, and in vitro studies

Introduction: Cryotherapy is a promising technique for the treatment of benign central airway stenosis (BCAS). However, its underlying mechanisms remain unclear. This study investigated the effects of cryoablation on stenosis recurrence using in vivo, ex vivo, and in vitro models. Methods: Fourteen pigs underwent induction of airway stenosis and divided into two groups: balloon dilatation only (BD) and balloon dilatation with cryoablation (BD + C) (n = 7). The pigs were observed in vivo using bronchoscopy and computed tomography. Postmortem ex vivo analyses of pig tracheal samples included histopathology, Western blot, and quantitative RT-PCR (qPCR). In vitro studies using human lung fibroblasts (MRC-5 cells) assessed fibrosis-related markers and cellular responses to cryotherapy using Western blot, qPCR, immunocytochemistry, and migration assays. Results: In vivo observation revealed reduced stenosis progression in the BD + C group [final stenosis (%), mean ± standard error (SE): 68.4 ± 7.1 vs 81.4 ± 5.2, p = 0.209]. The ex vivo analysis of pig trachea samples revealed significantly lower histopathology for inflammation, epithelial denudation, and fibrosis (sum of semi-quantitative scores, mean ± SE: 3.7 ± 0.5 vs 7.3 ± 0.5, p = 0.004), as well as reduced fibrosis-related marker expression, including collagen I and III, fibronectin, α-smooth muscle actin (α-SMA), and transforming growth factor-β1 (TGF-β1) in the BD + C group at both the protein and mRNA levels. Furthermore, in vitro studies using TGF-β1-treated MRC-5 cells exposed to freezing conditions showed significantly reduced expression of collagen I and α-SMA, and significantly impaired migration compared to the controls. Conclusion: Cryoablation may inhibit stenosis progression by reducing TGF-β1-regulated extracellular matrix deposition and inhibiting fibrosis. These findings provide mechanistic insights into the potential therapeutic benefits of cryotherapy for the management of BCAS.|연구배경 및 목적 : 냉동요법은 양성 중심 기도 협착 치료에 유망한 결과를 보여왔으나, 그 기전은 여전히 불분명하다. 본 연구는 생체 내, 생체 외, 시험관 내 모델을 사용하여 냉동소거(消去)술 (cryoablation)이 협착 재발에 미치는 영향을 조사하고자 하였다. 연구방법 : 14마리의 돼지를 대상으로 기도 협착을 유도한 후, 풍선 확장술만 시행한 군 (BD, n = 7)과 풍선 확장술과 냉동소거술을 함께 시행한 군 (BD + C, n = 7)으로 배정하였다. 3−4주 동안 기관지 내시경과 전산화단층촬영 (CT)을 통해 생체 내 관찰을 진행하였다. 돼지 기관 샘플에 대한 생체 외 분석으로는 조직병리학적 검사, 웨스턴 블롯, 정량적 RT-PCR (qPCR)을 실시하였다. 인간 폐 섬유아세포(MRC-5 세포)를 이용한 시험관 내 연구에서는 섬유화 관련 표지자와 냉동요법에 대한 세포 반응을 웨스턴 블롯, qPCR, 면역세포화학 (immunocytochemistry), 세포이동분석 (cell migration assay)을 통해 평가하였다. 연구결과 : BD + C 군에서 협착 진행이 덜한 경향을 보였다 [최종 협착률(%), 평균 ± 표준오차: 68.4 ± 7.1 vs 81.4 ± 5.2, p = 0.209]. 돼지 기관 샘플의 생체 외 분석 결과, BD + C 군에서 염증, 상피 탈락, 섬유화에 대한 조직병리학적 점수가 유의하게 낮았으며 (반정량적 점수의 합계, 평균 ± 표준오차: 3.7 ± 0.5 vs 7.3 ± 0.5, p = 0.004), collagen I, collagen III, fibronectin, α- smooth muscle actin (α-SMA), transforming growth factor-β1 (TGF-β1)을 포함한 섬유화 관련 표지자의 발현이 단백질과 mRNA 수준 모두에서 일관되게 감소하는 경향을 보였다. TGF-β1을 처리한 MRC-5 세포를 이용한 시험관 내 연구에서는 냉동 조건에 노출된 세포에서 collagen I과 α-SMA의 발현이 유의하게 감소하였고, 세포 이동성이 현저히 저하되었다. 결론 : 냉동소거술은 TGF-β1와 관련된 세포외 기질의 침착을 감소시키고 섬유화를 억제함으로써 협착 진행을 억제하는 것으로 보인다. 이 연구를 통해 양성 중심 기도 협착 치료에서 냉동요법의 작용 기전과 치료 효과를 확인할 수 있었다.Docto

The mechanical characteristics and performance evaluation of a newly developed silicone airway stent (GINA stent)

Central airway obstruction (CAO) can be attributed to several benign or malignant conditions. Although surgery is the preferred therapeutic option for the management of CAO, bronchoscopic treatment can be performed in scenarios where the surgical procedure is not possible. Recent years have witnessed several improvements in the field of bronchoscopic treatment, especially with regard to airway stents. Current research involves new attempts to overcome the existing shortcomings pertaining to the stents (migration, mucostasis, and granulation tissue formation). The authors have recently developed a new silicone airway stent (GINA stent) with an anti-migration design, dynamic structure that enables the reduction of stent cross-sectional area, and radio-opacity. The present study aimed to evaluate the mechanical characteristics and performance of the novel GINA stent using a porcine tracheal stenosis model. In the current study, all the tests involved the comparison of the GINA stent [outer diameter (OD, mm): 14; length (L, mm): 55] with the Dumon stent (OD: 14; L: 50). The mechanical tests were performed using a digital force gauge, in order to determine the anti-migration force, expansion force, and flexibility. The present study evaluated the short-term (3 weeks) performance of the two stents after implantation [GINA (n=4) vs. Dumon (n=3)] in the porcine tracheal stenosis model. The results pertaining to the comparison of the mechanical properties of the GINA and Dumon stents are stated as follows: anti-migration force (18.4 vs. 12.8 N, P=0.008); expansion force (11.9 vs. 14.5 N, P=0.008); and flexibility (3.1 vs. 4.5 N, P=0.008). The results pertaining to the comparison of the short-term performance of the GINA and Dumon stents are stated as follows: mucus retention (0/4 vs. 0/3); granulation tissue formation (0/4 vs. 0/3); and migration (1/4 vs. 2/3). The GINA stent displayed better mechanical properties and comparable short-term performance, compared to the Dumon stent

Histiocytic pleural effusion: the strong clue to malignancy

Background There have been many studies on the clinical characteristics of neutrophilic, lymphocytic, and/or eosinophilic pleural effusion. While caring for patients with pleural effusion, we found that histiocytic pleural effusion (HisPE) was not uncommon. However, few studies have explored HisPE. The purpose of the present study was to determine the clinical characteristics and etiologies of HisPE. Methods In this retrospective study, HisPE was defined as pleural fluid white blood cells comprised of >= 50% histiocytes. Using a clinical data warehouse, patients with HisPE among all patients aged >18 years who underwent thoracentesis and pleural fluid analysis between January 2010 and December 2019 at Ulsan University Hospital were enrolled. A total of 295 (9.0%) of 3279 patients who underwent thoracentesis were identified as HisPE patients. Among them, 201 with exudative HisPE were included. Clinical characteristics and etiologies were extracted from medical records and analyzed. Results Among the 201 patients with exudative HisPE, the major causes were malignant pleural effusion (n = 102 [50.7%]), parapneumonic effusion (n = 9 [4.5%]), and tuberculous pleurisy (n = 9 [4.5%]). In the 102 patients with malignant pleural effusion, the main types of cancer were lung (n = 42 [41.2%]), breast (n = 16 [15.7%]), and stomach cancer (n = 11 [10.8%]). Among lung cancers, adenocarcinoma (n = 34 [81.0%]) was the most common histology. Conclusions The leading cause of exudative HisPE was malignancy, particularly lung cancer. Physicians should consider the possibility of malignant disease if histiocytes are predominantly present in pleural effusion