pleural mesothelioma
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Introduction
Malignant neoplasm of mesothelial cells.
Etiology
- most commonly, but not necessarily a result of asbestos exposure
- prolonged exposure to asbestos is necessary
- no correlation with smoking
Epidemiology
- most commonly occurs in insulation workers
- more common in older individuals
- annual number of deaths from malignant mesothelioma increased from 2479 in 1999 to 2597 in 2015 (~5%), despite regulatory efforts to reduce asbestos exposure[6]
Pathology
- both pleural & peritoneal mesotheliomas occur
- interval between asbestos exposure & mesothelioma is 20-40 years
Microscopic pathology
(patterns)
Immunophenotype
- calretinin +
- vimentin +
- actin +
- cytokeratin:
Genetics
- implicated genes: BCL10
Clinical manifestations
- constant gnawing chest pain
- dyspnea
- painful, slowly growing, exudative pleural effusion
- pleural nodules or masses (occur subsequent to pleural effusion)
- latency of 20-40 years[2]
Laboratory
- pleural fluid analysis: exudative pleural effusion[2]
- histopathology of pleural biopsy
- see ARUP consult[4]
Diagnostic procedures
- pleural biopsy
- thoracostomy or open pleural biopsy is generally necessary
- thorascopic pleural biopsy more sensitive than closed pleural biopsy (90% vs 36%)[2]
- thoracentesis: exudative pleural effusion
Radiology
- high-resolution computed tomography (HRCT)
Differential diagnosis
- adenocarcinoma:
- [CEA, CD15, thyroid transcription factor 1, blood group antigens, TAG-72 antigen] positive in adenocarcinomas, negative in mesotheliomas[3]
Management
- prognosis poor
- surgical resection, radiation, & chemotherapy all yield poor results
- pemetrexed is an option for patients with advanced disease for whom surgical resection is considered inappropriate[5]
- average survival is 6-12 months after diagnosis & 8-14 months after onset of symptoms
More general terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 757-58
- ↑ 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2015, 2018, 2022.
- ↑ 3.0 3.1 Dabbs. Diagnostic Immunohistochemistry. Churchill Livingstone. 2002
- ↑ 4.0 4.1 ARUP Consult: Mesothelioma deprecated reference
- ↑ 5.0 5.1 Scherpereel A, Astoul P, Baas P et al Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J. 2010 Mar;35(3):479-95. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19717482 Free Article
- ↑ 6.0 6.1 Mazurek JM, Syamlal G, Wood JM, Hendricks SA, Weston A. Malignant Mesothelioma Mortality - United States, 1999-2015. MMWR Morb Mortal Wkly Rep 2017;66:214-218 https://www.cdc.gov/mmwr/volumes/66/wr/mm6608a3.htm