Malignant pleural effusion as the initial manifestation of gynecological malignancies

Introduction: About 10% of women with breast cancer and 33% with ovarian cancer develop a malignant pleural effusion (MPE) throughout her illness. However, there are few studies to identify how many of them debut with a MPE as the first symptom of gynecological (Gy) malignancies. Objective: To analyze the characteristics of patients with MPE as debut of gynecologic malignancy. Material and Methods: retrospective and multicenter study of a period of five years. We included all consecutive patients with MPE as debut of unknown neoplasm and we studied which had a gynecological origin. A descriptive analysis of epidemiological and clinical variables, diagnostic procedures, characteristics of the pleural fluid (PF), histology and presence of distant metastases was performed. Results: A total of 161 women developed a MPE as the first manifestation of unknown neoplasm. 28 of them (17%) corresponded to Gy cancer: 6 breast and 22 ovarian cancers. Mean age was 65. The most common symptom was dyspnea(82%), followed by extrathoracic symptoms(53.6%), weight loss (36%), cough (32%) and chest pain (25%). Thoracentesis was performed in all the patients and 89% had a positive citology. A blind pleural biopsy was performed in 6 patients (4 positive) and one thoracoscopy was made. 64% of the MPE with ovarian cancer were located at the right hemithorax. There were 23 adenocarcinoma (2 breast and 21ovarian) and 5 carcinomas (4 breast and 1ovarian). Other metastases were noticed in 20 patients (71%). Conclusions: In this context, MPE is a rare form of presentation of breast cancer. In our series ovarian adenocarcinoma was the most frequent primary tumor. Ovarian metastasis showed preference for the right hemithorax.