Value of Vascular Endothelial Growth Factor (VEGF) in Differentiation BetweenMalignant and Non-Malignant Pleural Effusions

Abstract

Pleural effusion is an accumulation of fluid in the pleural space, as a result of excessive transudation or exudation from the pleural surface.It is a sign for many diseases and not a diagnosis, so correct diagnosis remains a major challenge to the clinicians. (Peek GJ et al , 2000). Pleural effusions are quite common and are often due to infections such as pneumonia or heart failure. A pleural effusion can also be a symptom of several types of cancer. The effusion can develop if cancer cells have spread into the pleura, where they can lead to irritation and cause fluid to build up. (Heffner J,2012). Depending on the cause, the excess fluid may be either protein-poor (transudative) or protein-rich (exudative). These two categories help physicians determine the cause of the pleural effusion. (Rubins J, 2005). Vascular endothelial growth factor (VEGF), initially known as vascular permeability factor, is a 34-42 kDhomodimeric protein. VEGF acts mainly at the vascular endothelium, where it can induce morphologic changes, alter gene expression, stimulate cell proliferation and migration, and inhibit apoptosis. The ability of VEGF to induce vascular permeability accounts for its crucial role in pleural fluid formation, and it is also a key angiogenic factor for neoplasm This cytokine also helps in differentiation between malignant and inflammatory pleural effusions.(Grove CS and Lee YC, 2005).

The present study was conducted on 40 patients with pleural effusion of different etiology, admitted to EL-Abassia chest hospital during the period from March 2011 till August 2013. Patients were classified according to their final diagnosis into two groups. - Group A: This group include 20 cases with malignant pleural effusion, 11 males and 9 females, with an age range from 40 to 80 years. This group subdivided into: Group Aa: This group include 10 cases with malignant mesothelioma, 9 males and 1 female, with an age range from 55 to 80 years. Group Ab: This group include 10 cases with secondary malignant pleural effusion, 2 males and 8 females, with an age range from 40 to 80 years. - Group B: This group included 20 cases with non-malignant pleural effusion, 11 males and 9 females, with an age range from 25 to 70 years.