In this review I hope to cover two critical areas, namely the mechanism of formation of malignant pleural effusions and the treatment of malignant pleural effusions via pleurodesis. The pathogenesis of malignant pleural effusions involves several steps. These allow the malignant cell to separate from the primary tumor, dock onto the area of the metastatic site, transmigrate through the pleural membrane and initiate autocrine proliferation. The role of several factors including integrins and hyaluronan will be described. I will use the role of the glycosaminoglycan, hyaluronan, and its interaction with the CD44 receptor to illustrate the mechanisms of metastatic tumor formation on the pleural surface.
Since talc pleurodesis remains the mainstay of treatment for malignant pleural effusions, this review will discuss the inflammatory responses induced by talc and the mechanisms of talc induced fibrosis. The concept that the normal mesothelium plays a critical role in the development of pleural fibrosis will be introduced. The possibility that talc may serve other functions besides the induction of pleural fibrosis will be discussed.
1 Herrn Prof. Dr. R. Loddenkemper, Berlin, zum 60. Geburtstag gewidmet
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