VAI TRÒ CỦA NỘI SOI MÀNG PHỔI TRONG CHẨN ĐOÁN NGUYÊN NHÂN TRÀN DỊCH MÀNG PHỔI: BÁO CÁO CA BỆNH UNG THƯ BIỂU MÔ TUYẾN DI CĂN MÀNG PHỔI

Abstract

Pleural effusion can result from various benign or malignant conditions. Cytological analysis of pleural fluid is the initial diagnostic approach, but its sensitivity remains limited (58.2%). Medical thoracoscopy is an important procedure for diagnosing the cause of pleural effusion, allowing direct visualization and precise biopsy of lesions. We report a case illustrating the critical role of medical thoracoscopy in diagnosing pulmonary adenocarcinoma with pleural metastasis. A 64-year-old female patient presented with cough and dyspnea. Chest radiography revealed a large left pleural effusion. Pleural fluid cytology showed malignant cells but was insufficient for definitive diagnosis or molecular testing. Pleuroscopy revealed multiple infiltrative nodules suggestive of malignancy. Histopathology and immunohistochemistry (CK7/TTF1/Napsin A/HBME-1 positive; CK5/6/Calretinin/WT1 negative) confirmed the diagnosis of metastatic pulmonary adenocarcinoma to the pleura. This clinical case highlights the value of medical thoracoscopy in establishing a definitive diagnosis and providing adequate tissue samples for molecular testing, which is crucial for guiding targeted therapy.