Primary Endothelioma of the Pleura

1. The rarity of the endothelioma of the pleura is noted; historical and statistical data and various theories as to the origin of this controversial neoplasm are presented.

2. Necropsy findings of which the macroscopic ones seem to be of great value, are described.

3. The clinical picture is described with emphasis on the presence of early axillary pain, absence of fever, presence of a pleural effusion, mostly hemorrhagic in nature, dyspnea which is not relieved by fluid formation or aspiration, thickness of the pleura and its marked resistance to the aspiration needle. The absence of palpable lymph nodes is noteworthy. Vague gastro-intestinal symptoms were found in both of our cases.

4. Two cases are presented, one of which was diagnosed clinically and confirmed by necropsy findings, and another diagnosed on the basis of a biopsy findings.

5. The differential diagnosis with similar diseases is given. In this connection, it is interesting to note the opinion of Ewing,⁸ who believes that in some cases, the endothelioma seems to be connected with pulmonary tuberculosis. Saccione and Coblentz,⁷ whose paper was so frequently quoted here, state that they did not find any tuberculosis in their cases but point out that many authors mention the fact that some patients had either one or several attacks of pleurisy on the involved side and that some of these, of course, may have been of tuberculous origin. It is interesting to note the absence of tuberculous findings in the lungs on necropsy in our case, and the reported acid fast bacilli in the sputum. One should not always accept the presence of acid fast bacilli as the only criterion of the presence of pulmonary tuberculosis.

6. The fatality of the disease and the paucity of therapeutic measures are pointed out.

7. The failure of the aspiration to relieve the dyspnea might be ascribed to the fact that the collapsed lung does not easily re-expand.