Letter to the Editor
Hematic Pleural Effusion in a 17-Year-Old Woman
Derrame pleural hemático en mujer de 17 años de edad
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She was treated the same month with resection of the mass and, one month later, was operated again for local recurrence. She subsequently received a 3-month course of radiation therapy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Five months after the initial diagnosis, the patient was referred to our respiratory medicine department due to a 1-week history of dyspnea. On physical examination, she showed signs of pleural effusion in the lower two-thirds of the left hemithorax, so a diagnostic thoracocentesis was performed. The pleural fluid sample was consistent with uncomplicated exudate with mildly predominant mononuclear cells and a very low glucose level. Pathology study results were negative. In the 6 days following her first visit to the clinic, she required 2 evacuating thoracocentesis procedures for increased dyspnea, so she was hospitalized for further study. On day 7 after admission, in view of her progress, a medical diagnostic and therapeutic thoracoscopy was considered, but this was abandoned due to deterioration of her general condition, and poorly controlled dyspnea. Her clinical progress over the following 24<span class="elsevierStyleHsp" style=""></span>h worsened and she became moribund. Sedation was administered and the patient died on day 8 of admission, from respiratory failure.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In view of the lack of a confirmed diagnosis of the left pleural effusion in a patient with the above-mentioned history, an autopsy was requested, which revealed multiple pleural implants (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The definitive diagnosis was anaplastic ependymoma (WHO grade III), with tumor recurrence in the frontal lobe of the brain and extended metastatic disease, primarily in the pleura and also in the peritoneal serous membrane, subcutaneous tissue of the cranial vault, and the meninges.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Ependymoma is one of the rarer glial tumors that typically occur within or adjacent to the ependymal cells lining the ventricles of the brain. It accounts for 3%–9% of all neuroepithelial tumors. Four histological subtypes have been described: classic, anaplastic, myxopapillary, and subependymoma.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> It occurs equally in both sexes and mean age at diagnosis is 5 years. The most widely accepted therapeutic option to date is complete surgical resection followed by adjuvant radiation therapy. This generally yields a 5-year survival rate of 60%–89%, in contrast to incomplete resection, for which 5-year survival is less than 50% (21%–49%). Chemotherapy has also been applied; initial response is good in most cases but not all.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Despite advances in diagnostic and therapeutic techniques, 50% of cases present recurrence or disease progression.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Extracranial metastasis is uncommon in these tumors (0.5%–0.98% of cases).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The main sites are the lymphoid organs and viscera (particularly the lung). Time between the appearance of the primary tumor and metastatic involvement is usually about 8 years, although it can be shorter.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, our patient's presentation and progress is similar to the pattern observed in the literature to date, although the time between appearance of the primary tumor and respiratory symptoms was shorter, so her death, 6 months after diagnosis, was earlier. Her disease also appeared to be more aggressive than cases reported by other authors, with metastasis in the surgical site and in distant sites, developing within a very short period of time. Thus, in the case of anaplastic ependymoma WHO grade III, pleuropulmonary involvement must be taken into consideration as a possible complication, even shortly after the appearance of the intracranial lesion, as was the case in our patient.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vázquez-Gandullo E, Bravo Nieto JM, Alwakil Olbah M. Derrame pleural hemático en mujer de 17 años de edad. Arch Bronconeumol. 2015;51:525–526.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 683 "Ancho" => 995 "Tamanyo" => 191688 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of the thoracic cavity during autopsy: multiple nodular neoplastic implants are seen in the visceral pleura, along with a moderate amount of serous, bloody pleural fluid.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actualización sobre la biología molecular de los gliomas: hacia una clasificación patomolecular de los gliomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.A. Idoate" 1 => "J. 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Dhellemmes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Child Nerv Syst" "fecha" => "2005" "volumen" => "21" "paginaInicial" => "221" "paginaFinal" => "226" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A retrospective analysis of recurrent intracranial ependymoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Antony" 1 => "K.E. Wong" 2 => "M. Patel" 3 => "A.J. Olch" 4 => "G. McComb" 5 => "M. Krieger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/pbc.24996" "Revista" => array:6 [ "tituloSerie" => "Pediatr Blood Cancer" "fecha" => "2014" "volumen" => "61" "paginaInicial" => "1195" "paginaFinal" => "1201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24615997" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgements" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">Our thanks to Drs A. Pereira-Vega, J. Fernandes de Córdoba-Gamero, J.A. Maldonado-Pérez, R. Ayerbe-García and the rest of the Respiratory Medicine Department of the Hospital Juan Ramón Jiménez, and to Dr Muñoz-Carmona of the Department of Radiation Therapy of the Hospital Juan Ramón Jiménez, Huelva.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000010/v1_201509302252/S1579212915002827/v1_201509302252/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000010/v1_201509302252/S1579212915002827/v1_201509302252/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002827?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 6 | 12 |
| 2024 October | 54 | 16 | 70 |
| 2024 September | 71 | 17 | 88 |
| 2024 August | 83 | 35 | 118 |
| 2024 July | 51 | 21 | 72 |
| 2024 June | 116 | 41 | 157 |
| 2024 May | 74 | 33 | 107 |
| 2024 April | 40 | 34 | 74 |
| 2024 March | 35 | 18 | 53 |
| 2024 February | 29 | 20 | 49 |
| 2023 March | 15 | 2 | 17 |
| 2023 February | 53 | 22 | 75 |
| 2023 January | 54 | 26 | 80 |
| 2022 December | 56 | 29 | 85 |
| 2022 November | 56 | 21 | 77 |
| 2022 October | 79 | 37 | 116 |
| 2022 September | 55 | 34 | 89 |
| 2022 August | 52 | 38 | 90 |
| 2022 July | 42 | 42 | 84 |
| 2022 June | 101 | 36 | 137 |
| 2022 May | 55 | 30 | 85 |
| 2022 April | 45 | 22 | 67 |
| 2022 March | 30 | 30 | 60 |
| 2022 February | 50 | 33 | 83 |
| 2022 January | 67 | 37 | 104 |
| 2021 December | 57 | 32 | 89 |
| 2021 November | 58 | 44 | 102 |
| 2021 October | 45 | 38 | 83 |
| 2021 September | 36 | 40 | 76 |
| 2021 August | 61 | 27 | 88 |
| 2021 July | 26 | 35 | 61 |
| 2021 June | 72 | 41 | 113 |
| 2021 May | 51 | 26 | 77 |
| 2021 April | 153 | 71 | 224 |
| 2021 March | 109 | 26 | 135 |
| 2021 February | 88 | 20 | 108 |
| 2021 January | 48 | 15 | 63 |
| 2020 December | 42 | 25 | 67 |
| 2020 November | 43 | 13 | 56 |
| 2020 October | 45 | 15 | 60 |
| 2020 September | 39 | 10 | 49 |
| 2020 August | 34 | 12 | 46 |
| 2020 July | 30 | 22 | 52 |
| 2020 June | 38 | 12 | 50 |
| 2020 May | 32 | 11 | 43 |
| 2020 April | 48 | 26 | 74 |
| 2020 March | 24 | 16 | 40 |
| 2020 February | 34 | 21 | 55 |
| 2020 January | 39 | 24 | 63 |
| 2019 December | 34 | 18 | 52 |
| 2019 November | 32 | 22 | 54 |
| 2019 October | 24 | 10 | 34 |
| 2019 September | 22 | 10 | 32 |
| 2019 August | 29 | 14 | 43 |
| 2019 July | 30 | 23 | 53 |
| 2019 June | 27 | 14 | 41 |
| 2019 May | 36 | 27 | 63 |
| 2019 April | 40 | 46 | 86 |
| 2019 March | 35 | 25 | 60 |
| 2019 February | 35 | 18 | 53 |
| 2019 January | 36 | 22 | 58 |
| 2018 December | 31 | 19 | 50 |
| 2018 November | 57 | 21 | 78 |
| 2018 October | 114 | 28 | 142 |
| 2018 September | 30 | 10 | 40 |
| 2018 May | 57 | 0 | 57 |
| 2018 April | 46 | 4 | 50 |
| 2018 March | 81 | 7 | 88 |
| 2018 February | 58 | 5 | 63 |
| 2018 January | 108 | 6 | 114 |
| 2017 December | 114 | 3 | 117 |
| 2017 November | 26 | 6 | 32 |
| 2017 October | 33 | 4 | 37 |
| 2017 September | 27 | 11 | 38 |
| 2017 August | 32 | 10 | 42 |
| 2017 July | 28 | 11 | 39 |
| 2017 June | 41 | 18 | 59 |
| 2017 May | 55 | 14 | 69 |
| 2017 April | 41 | 10 | 51 |
| 2017 March | 21 | 4 | 25 |
| 2017 February | 14 | 11 | 25 |
| 2017 January | 34 | 4 | 38 |
| 2016 December | 30 | 8 | 38 |
| 2016 November | 40 | 9 | 49 |
| 2016 October | 38 | 14 | 52 |
| 2016 September | 69 | 17 | 86 |
| 2016 August | 40 | 8 | 48 |
| 2016 July | 29 | 10 | 39 |
| 2016 May | 0 | 12 | 12 |
| 2016 April | 1 | 1 | 2 |
| 2016 March | 4 | 0 | 4 |
| 2016 February | 0 | 3 | 3 |
| 2016 January | 0 | 8 | 8 |
| 2015 October | 0 | 2 | 2 |
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