Pleural carcinosis caused by extrathoracic malignancies

Most of malignant tumors at an advanced stage can affect the pleural cavity creating malignant pleural effusion (MPE). Pleural carcinosis secondary to extrathoracic malignancies has not been extensively reported, and different treatments have been described. Although 40% of all cases of MPE are due to lung cancer, the second-most common is breast cancer (25%), lymphoma (10%), ovarian cancer (5%), and gastrointestinal cancers (5%). For approximately 5% to 10% of MPE, no primary tumor can be found (cancer of unknown primary). Definite evidence of a MPE can be obtained by cytological or histological confirmation of cancer cells. Uniportal surgery increases diagnostic accuracy as large biopsies could be taken and used to perform supplementary tests for more advanced management such as immunotherapy or hormone receptor status for breast cancer. Conventional thoracic treatments such as thoracocentesis, chest tube drainage, pleurodesis, video-assisted thoracic surgery (VATS) procedure have shown extremely limited effect on quality of life and long-term survival which ranges between 4–12 months. New technology procedures such as hyperthermic intrathoracic chemotherapy (HITHOC) or immunotherapy have shown some potentiality. With an eye toward the future, the main aim of this article is to provide a summary of the well-known treatments for pleural carcinosis caused by extrathoracic malignancies with the main intention to contribute to clarify decisions making.