Pleural invasion in non-small cell lung cancer

Pleural invasion is a recognized adverse prognostic factor in non-small cell lung cancer. Here, we document a case of non-small cell lung cancer in a 66-year-old male presenting with direct invasion of the tumor through lung pleura into the mediastinum. Pleural invasion can proceed past the elastic layer of the visceral pleura, classified as PL1. Less commonly, invasion to the surface of the visceral pleura or parietal pleura can occur and is classified as PL2 and PL3 respectively. PL2 invasion is associated with increased mortality; patients have lower overall survival compared to those without visceral pleural invasion (HR=2.447, 95% CI 0.336,0.579) and those with only PL1 invasion (HR=1.287, 95% CI 1.114, 1.487). Treatment of non-small cell lung cancer with pleural invasion includes surgery, chemotherapy, radiation, and immunotherapy.