Malignant pleural effusion (MPE) denotes an advanced malignant disease process. Most of the MPE are metastatic involvement of the pleura from primary malignancy at lung, breast, and other body sites apart from lymphomas. The diagnosis of MPE has been traditionally made on cytological examination of pleural fluid and/or histological examination of pleural biopsy tissue that still remains the initial approach in these cases. There has been tremendous advancement in the diagnosis of MPE now a day with techniques i.e. characteristic Ultrasound and computed tomography features, image guided biopsies, fluorodeoxyglucose-positron emission tomography imaging, thoracoscopy with direct biopsy under vision, tumor marker studies and immunocytochemical analysis etc., that have made possible an early diagnosis of MPE. The management of MPE still remains a challenge to pulmonologist and oncologist. Despite having various modalities with better tolerance such as pleurodesis and indwelling pleural catheters etc., for long-term control, all the management approaches remain palliative to improve the quality of life and reduce symptoms. While choosing an appropriate management intervention, one should consider the clinical status of the patient, life expectancy, overall cost, availability and comparative institutional outcomes, etc.

Background:Mediastinum is a “Pandora's box” with many neoplastic and nonneoplastic lesions. The purpose of this study was to analyze our institutional experience of mediastinal lesions on fine-needle aspiration cytology (FNAC) and/or biopsy.Materials and Methods:This study was an analysis of 144 patients who had undergone ultrasound-guided FNAC and/or core biopsy for mediastinal lesions.Results:A total of 144 cases of suspected mediastinal masses were seen, and in 139 cases, tissue diagnosis was attempted. Out of 139 cases, 93 cases were neoplastic in nature (67%), 32 were nonneoplastic (23%), and 14 remained inconclusive (10%). Among neoplastic mediastinal lesions, metastatic carcinoma (37.4%) was the most common neoplastic lesion, followed by non-Hodgkin's lymphoma (12.2%), Hodgkin's lymphoma (7.1%), thymic lesions (3.5%), etc. Among nonneoplastic conditions, tuberculosis was the most common lesion (20.1%). An accurate tissue diagnosis was made in 89.9% cases by FNAC or core biopsy of mediastinal lesions in this study. Procedure-related mortality was nil. Complications were mostly minor and included chest pain in 24.5%, small pneumothorax in 13.6% requiring closed tube thoracostomy in 1.4%, and scanty hemoptysis in 9.3% cases.Conclusion:Neoplastic mediastinal lesions are more common than nonneoplastic lesions, with metastatic carcinoma being the most common cause followed by tuberculosis. A wide variety of lesions observed in this study stress on the importance of cytohistological diagnosis in all cases of mediastinal lesions for the final diagnosis and management planning. A guided FNAC or core biopsy is still accurate, well tolerated, and devoid of major complications.

Synovial sarcoma is highly malignant tumor of soft tissues, occurring chiefly in the extremities and limb girdle with a propensity for local recurrence and sometimes metastases to the lungs. Primary synovial sarcoma arising in the lungs is rare and brain metastasis as presentation is further uncommon. We report a case of primary monophasic synovial sarcoma lung presenting with brain metastasis in a 35-year-old male patient. The diagnosis was made on percutaneous transthoracic needle aspiration from left-sided pulmonary mass and later confirmed by immunohistochemistry. The utility of preoperative diagnosis by percutaneous aspiration cytology is also stressed.

Introduction The most common cancer of India is head and neck, and about 70% of them present in locally advanced or metastatic disease. Palliative radiotherapy is one of the commonly used treatments in such cases. A retrospective study on the outcomes and toxicity of palliative radiotherapy is studied at a tertiary centre. Materials and Methods In this study, 74 patients who underwent palliative radiotherapy at the tertiary centre between Nov 2017 and Oct 2019 were retrospectively analysed. The frequency of different presenting symptoms, radiotherapy regimens, their outcome in form of symptomatic relief and disease status along with toxicity was studied and analysed through the available records.    Results We identified 74 eligible patients. The median age was 48years (range, 26–82). Oropharyngeal primary cancer was the most common primary site. The Eastern Cooperative Oncology Group performance status was 3 or more in 74.4% patients. The radiation regimen used were ranged from 8Gyin single fraction, 20Gy in 4 fractions, 20Gy in 5 fractions, 30Gy in 10 fractions and 60Gy in 30 fractions. 93.2% of them completed their treatment. Pain and swelling were the most common presenting symptoms and 90.6% of them had more than 50% relief, while 46.5% had complete or partial response to the treatment. Conclusion Palliative radiotherapy to the head and neck provides some symptomatic benefit in most patients, there are multiple dose fractionation regimens currently being used for palliative radiation treatment, and consideration should be given to higher dose palliative RT regimens in patients having good performance status to maximize locoregional control and minimize late toxicity, patient with poor performance status will benefit from a hypofractionated palliative radiation treatment.