الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Inspite of every effort after meticulous clinical
evalution and Complete available investigations, there
may be sOme difficulty in differentiation between
tuberculous and malignant pleural effusions. The present
study evaluates the efficiency of studying serum and
pleural fluid proteins, immunoglobulins IgG, IgM and IgA
and differential cell counts as a SUbstitutes Or as a
diagnostic aids for differentiation between tUberculous
and malignant pleural effUsions.
This study inclUdes twenty patients where the
diagnosis Of. tuberculous and malignant pleural effUsions
were settled. These patients Were subdiVided into two
groups each one contained 10 patients.
Group 1- patients With tUberculous pleural effUsion
which consisted of 6 males and 4 females With age 18-25 years.
Gro up 11- pati ents wi \:;h’ malignant pleural effUsion
which consisted of 5 males and 5 females with age 26-6u
years.
All patients were SUbjected to the fOllOwing:
1- Olinical evaluation.
2- Flain x-rayon chest and heart be~ore QDd after aspiration.
l~.
3- Repeated sputum cytological ex~mination for malien~nt
cells.
4- Thoracocentesis and examination of pleural fluid IOr
gross appearance, cytologic~l examinations(for malignant
cells, mesotheli~l cells ana leucocytes), total protein
content, pH and glucobe content.
5- Determination 01” immunoglObulins IgG, IgM and IgA levels
by single radial immunodi1”fusion on plates(Behring) (76,77)
in the serum ana in pleural 1”luid.
6- Paper electrophoresis 01” til e serum and pleural fluid by
cellulose acetate method. (78)
The previous mentioned stUdies revealed the fOllowing results:
Immuno glo bUl1ns:
The mean values in the aerue of tuberculous group were:
IgG 2487 mg/dl j:. S.D. 740.601 (1}20 - 3750)
IgM 238.8 mg/dl j:. S.D. 100.819(105 - 405).
19A 325 mg/dl j:. S.D. 1~7.973( 95 - 560).
The mean values in the serum of malignant group were:
IgG 1874 mg/dl j:. S.D. 603.770 (1230-3100).
IgM 141-3 mg/dl j:. S.D. 51.448 (78-219).
IgA 335 mg/dl + S.D. 138.203 (145-600).
The mean values in tuberculous pleural flUid were:
IgG 172} mg/dl ::!:. S.D • .567.823 (840 - 2700).
Igil 12.5 mg/ell ::!:. S. D. .57.2,58 (.50 - 218).
IgA 189.9 mg/dl::!:.S.D. 92.676 (54 - 298).
The mean values in malignant pleural flUid were:
IgG 1272 mg/dl ::!:. S. D. 4,58.010 (780-2230)
I gil 75.7 mg/dl::!:.S.D. 29.174 08 -~)
IgA 17}.8 mg/dl::!:.S.D. 65.811 (80 - 288).
Immunoglobulins IgG. IgM and IgA were present in lower
concentrations in pleural fluid than in the serum as they
were diluted by big amount of pleural flUid With considerable
overlap in their concentrations in pleural flUid ana in
the serum in tuberculous and malignant cases.
IgIl was the only immunoglobUlin that had significant
lowering value(P <0.05) in the serua and the pleural flUid
in malignant cases than in tuberculous cases. I~s lOWer
value in the pleural flUid was due to its lower aecua level
and rate of diffusion in malignant than in tUberculous cases.
ImmunoglobUlins had hi5her levels in tuberculous than
in malignant effUsions due to big increase in permiability
of capilla~es caused by irritation under the condition of
bacterial affection and bacterial toXins which causes
drastic endothelial injury.
IgG and 19A had no significant difference between
the two groups (F> 0.05).
Total protein content Clndpaper e~ectrophoresis.
The mean values in the serum of tubercUlous group were:
Tota~ protein content 7.25 gm/100 ~ ~ 0.519.
% of albumin 49.8 ~ 2.20
% Of a~pha a globulin 4.5 + 1.27
% of alpha a glObulin 14.1~0.n8
% of beta glObulin 13.2 ~ 1’;’2
% of gammaglObulin 18. 3 ~ 4.001
The mean values in the serum of malignant group were:
Total protein content 6.991 g/100 cal ~ 0d73
% of albumin 51.;’ z; 1.95
% of alpha 1 glObulin 4.1 t 0.788
% of alpha 2 glObulin 15.6 ~ 2.413
% of beta globulin 12.8 t 1.317
% of gammaglobUlin 16.2 ~ 1.619
The mean values in tuberculous pleural fluid were:
Total protein cuntent 4.92 gm/100 ml ~ 0.793
% of albumin 51.{ t 4.669
% of alpha 1 glObulin 6.2 t 1.135
% of alpha 2 glObulin 11.;’ + 1.337
% of beta glObulin 12.7 t 0.675
% of gammaglobulin 18.1 + 4.701
The mean values in maligw:Illtpleural fluid were:
Total protein content 4.;f) gm/ 100 lll1:!:. 0.767
% of albUlllin 54.4 :!:2..759
% of alpha 1 globulin 503 :!:. 0.675
% of alpha 2 globulin 11.7 :!:. 2.312
% of beta globulin 12.5:!:. 1.841
% of galllllgllaobulin 16.1:!:. 1.595
Both of tuberculous ana malignant p Leuz-aj,effusion
were exudates as total protein content more than 3 t;7’amand
ratio of pleural fluid protein to serUlllprotein was mOre
than 0.5 (0.68 in tUberculous cases and 0.63 in maliEnQnt
cases).
AlthOUgh non of total protein content Or protein
fractions of paper electrophoresib had statistical significance
(1’>0.05) in differentiation between tuberoulous
and malignant gro ups , there was Cl.fJparentenCienc,yof
increased alpha 2 globulin in the serum of malignant cases
and increased 01’ ga’JlIgJlBObulin. in ae.cum of tuberculous
cases.
C,ytol0gical examination of the pleural fluid.
Tuberculous pleural effusion.
All cases showed absent malignant cells with abundant
l,ymphoc,ytes which were the predOminant leucoc,ytes in the
pleural fluid with few pol,ylllOq>hsin two cases only.
Mesothelial cells either absent (in 5 cases) or scanty
(in other 5 cases).
Malignant pleural effusion
Six patients had malignant cells in their pleural
fluids. The mesothelial cells were abundant in all cases.
Lymphocytes were the main leucocytes in all cases which
accompanied With few pol,ymorphs in three cases only.
Cli.NCLUI:>IO.N
This thesis deals with the efficacy of determination
of immunoglobulins IgG, Igl/i and 19A, paper electrophoresis
fractions as well as differential cell counts in the diagnosis
and in the differentiation between tUberculous and malignant
pleural effusions.
All the three immunoglobulins IgG, If94 and 19A were
present in smaller amounts in pleural fluid than in the serum.
- IgM had statistically significant lowerin~ value (1’<0.05)
in the serum and the pleural :t:luidin maligncm.t than in
tUberculous cases while IgG and 19A had no statistically
significant values (P >0.05) between thelil.
- The significant decrease in I~ in malignant cases than in
tuberculous cases cannot be accepted as a diagnostic criteria
because of marked overlap ifi its values in the serUm and
pleural fluid in both gro ups.
The electrophoretic pattern of the pleural fluid is essentially
an image to that of the serum in tuberculous and malignant
cases.
- There was an apparent increase in alpha ~ glObulin in the
serum of malignant cases and in ~aWlllaglObulin in the
serum of tuberculous cases without statistically significant
difference between them.
- The presence of malignant cells was the most important
cytolOgical finding in definite diagnosis of malignant
pleural effusion.
- Mesothelial cells had a respectable value in the differentiation
between tuberculous and malignant effusions.
Absence Or scanty mesothelial cells in pleural flUid was
in favour of the diagnosis of tuberculous effusion While
abundant mesothelial cells was in favour of the d1 agnosis
of malignant effusion.
Leucocytic count of the p.Leur-a.L flUid was of limited
value as both tuberculous and malignant pleural flUid had
excess lymphocytes.