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Biphasic Mesothelioma


Presentation

  • Primary peritoneal mesothelioma generally presents with vague abdominal symptoms and usually presents late in the disease's course. Frequently, patients are diagnosed in advanced stages, and the prognosis is very poor.[liebertpub.com]
  • MPM can present as three histologic subtypes: epithelioid, sarcomatoid, or biphasic. We present a case of an 85-year-old Caucasian female with a history of occupational asbestos exposure.[ncbi.nlm.nih.gov]
  • Case Presentation A 41-year-old Caucasian man presented to our institution with left lateral chest pain for approximately one year.[ncbi.nlm.nih.gov]
  • Biphasic Cell Type Characteristics When a patient presents symptoms that are typically presented in varying forms of cancer, a biopsy is performed and collected tissues are studied under a microscope.[mesotheliomahelpnow.com]
  • Abstract Objective: Presentation of a case of biphasic pleural mesothelioma with reference to difficulties concerning differential diagnosis from reactive mesothelial proliferations.[jtd.amegroups.com]
Difficulty Walking
Pseudotumor
  • Cholangiocarcinoma or inflammatory pseudotumor was suspected from CT findings.[wjgnet.com]
Anemia
  • Initial laboratory studies revealed normocytic normochromic anemia and arterial blood gas analysis consistent with acute respiratory alkalosis. The comprehensive metabolic panel, lipase, troponins and EKG were unremarkable.[ncbi.nlm.nih.gov]
Constitutional Symptom
  • The patient denied constitutional symptoms, nausea, vomiting, diarrhea, or constipation.[ncbi.nlm.nih.gov]
Hoarseness
  • Symptoms of Biphasic Mesothelioma The symptoms of biphasic cell type mesothelioma are chest pain, pleural effusions, shortness of breath, hoarseness, night sweats, and back pain. Symptoms such as fatigue and weight loss, may also be present.[mesolawyerscare.org]
Respiratory Distress
  • Physical examination showed no acute respiratory distress, mild bibasilar crackles greater on the right side, diffuse abdominal tenderness and right costovertebal angle tenderness.[ncbi.nlm.nih.gov]
Abdominal Tenderness
  • Physical examination showed no acute respiratory distress, mild bibasilar crackles greater on the right side, diffuse abdominal tenderness and right costovertebal angle tenderness.[ncbi.nlm.nih.gov]
Back Pain
  • pain, reduced sensation opening his bowels and some difficulty walking reduced proprioception in his leg.[omicsonline.org]
  • Symptoms of Biphasic Mesothelioma The symptoms of biphasic cell type mesothelioma are chest pain, pleural effusions, shortness of breath, hoarseness, night sweats, and back pain. Symptoms such as fatigue and weight loss, may also be present.[mesolawyerscare.org]
  • Some of the most common symptoms include lower back pain, trouble swallowing, shortness of breath, swollen arms and face, and pain in the chest area.[mesotheliomahelp.org]
  • pain Frequent urination due to compression/pressure of large-sized tumors Fainting or feeling faint, dizziness Swelling in the lower legs Weight loss There are no signs and symptoms during the initial stages of tumor growth and development.[dovemed.com]

Workup

  • The patient had multiple previous visits to the emergency department with similar complaints and negative workups.[ncbi.nlm.nih.gov]
  • The identification of nonepithelioid subtypes of malignant pleural mesotheliomas may require extensive workup, exhausting the limited material in core/FNA biopsies.[ncbi.nlm.nih.gov]
  • A referral for thoracoscopy is warranted if the diagnosis is considered and the initial workup is not diagnostic. Savic S, Franco N, Grilli B, Barascud Ade V, Herzog M, Bode B, et al.[emedicine.medscape.com]
Right Pleural Effusion
  • CT of the chest showed a large loculated right pleural effusion with adjacent pleural thickening. CT abdomen and pelvis was negative for other neoplastic findings.[ncbi.nlm.nih.gov]
Hypercholesterolemia
  • The past medical history was significant for essential hypertension, hypercholesterolemia, rheumatoid arthritis, and asthma; and surgical history significant for uterine benign tumor removal and unilateral oophorectomy 40 years prior.[ncbi.nlm.nih.gov]

Treatment

  • There are two types of treatment: Traditional Treatments – Traditional treatments include chemotherapy, radiation, and surgery.[mesotheliomasymptoms.com]
  • If the biphasic tumor contains more epithelioid cells, a patient has more treatment options, because epithelioid cells are more responsive to treatment than sarcomatoid cells.[mesotheliomagroup.com]
  • Biphasic Mesothelioma Treatments Treatments are very similar between all three cell types of mesothelioma.[flintlaw.com]
  • Typically, care professionals will use multimodal treatment, incorporating a combination of treatment options.[mesotheliomadiagnosis.com]
  • In those cases, the three most common types of treatment are also offered for pain relief. Symptoms and Treatments Like other forms of asbestos cancer, the histology does not influence the symptoms.[mesotheliomaspecialists.org]

Prognosis

  • Biphasic Cell Type Prognosis When it comes to mesothelioma prognosis, there are many variables that determine factors such as life expectancy and survival rate.[mesotheliomahelpnow.com]
  • A biphasic patient has many options to improve their prognosis. Learn more about treatment options, clinical trials and how to improve your prognosis in our free guide.[mesotheliomagroup.com]
  • When determining a prognosis for mesothelioma, cell type is another variable that is used to predicting a prognosis.[asbestos.net]
  • The poorer prognosis may partially be influenced by PD-L1 levels.[asbestos.com]
  • The prognosis of biphasic mesothelioma depends on how many cells are epithelioid and how many cells are sarcomatoid. More epithelioid cells correspond to more treatment options and a better prognosis.[mesotheliomaveterans.org]

Etiology

  • (Etiology) The exact cause and mechanism of formation of Malignant Biphasic Mesothelioma is unknown.[dovemed.com]
  • Mesotheliomas have a complex etiology in which environmental carcinogens (asbestos and erionite), ionizing radiation, therapeutic radiation (thorotrast), viruses (simian virus, SV40), chronic pleural irritation, and genetic factors act alone or in concert[cap.org]
  • The other etiological factors include simian virus 40 and history of prior irradiation. [10] It has an insidious onset with clinical presentation ranging from pleuritic chest pain, dyspnea, cough, fatigue, and weight loss. [11] All three cases of pericardial[indianjcancer.com]

Epidemiology

  • Asbestos: Risk Assessment, Epidemiology, and Health Effects. Taylor & Francis: Boca Raton, 2006. Galateau-Salle, F. Pathology of Malignant Mesothelioma. Springer-Verlag London Limited: London, 2006. Pass, I., Vogelzang, N. & Carbone, M.[asbestos.com]
  • Definition / general Mixed / biphasic: both epithelioid and sarcomatoid components, each at least 10% May represent epithelial mesenchymal transition process ( Mod Pathol 2012;25:86 ) Epidemiology Biphasic pattern occurs in 30%, less common than epithelioid[pathologyoutlines.com]
  • Mesothelioma epidemiology, carcinogenesis, and pathogenesis. Curr Treat Options Oncol. 2008 Jun. 9(2-3):147-57. [Medline]. [Full Text]. Wei B, Jia X, Ye B, Yu J, Zhang B, Zhang X, et al.[emedicine.medscape.com]
Sex distribution
Age distribution

Prevention

  • Genetics 2016 We analyzed transcriptomes (n 211), whole exomes (n 99) and targeted exomes (n 103) from 216 malignant pleural mesothelioma… (More) Jeff Unger Diabetes, metabolic syndrome and obesity… 2012 Hypoglycemia is the rate-limiting factor that often prevents[semanticscholar.org]
  • This is done to prevent a misdiagnosis and to distinguish biphasic mesothelioma from other diseases. There are reported cases of biphasic mesothelioma being misdiagnosed based on a biopsy alone.[mesotheliomaadvocate.com]
  • […] symptoms Radiation therapy to shrink tumors and relieve pain Clinical trials with combinations of chemotherapy, radiation and experimental therapies Cytoreduction to remove tumors in the abdomen Chemotherapy sent to the chest or abdominal cavity to prevent[mesotheliomaveterans.org]
  • The square epithelioid cells tend to replicate quickly, but in doing so, they pile on top of each other forming masses that prevent them from spreading quickly around the body.[asbestos.net]
  • Preventing a Misdiagnosis Doctors use advanced tests such as immunohistochemistry to distinguish biphasic mesothelioma from other diseases that are easily confused with this cancer.[asbestos.com]

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