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Mesothelioma

Pleural Mesothelioma

Mesothelioma is a highly aggressive tumor that carries a very poor prognosis. It predominantly arises from the pleura, whereas the peritoneum is the second important location. Typical symptoms are nonspecific, such as a nonproductive cough, dyspnea, and localized chest pain in the case of pleural mesothelioma, whereas abdominal pain, anorexia, weight loss, and swelling of the abdomen are reported with peritoneal tumors. The diagnosis rests on a thorough clinical assessment, imaging studies, and a biopsy followed by a histopathological examination and immunohistochemical staining.


Presentation

The clinical presentation of mesothelioma is rather insidious and a very late diagnosis is made in most patients due to the nonspecific nature of complaints [1] [2]. It is established that up to 4 months pass from the onset of symptoms before the tumor is recognized [3], which significantly reduces survival rates. Mesotheliomas are much more likely to occur in men, primarily due to its association with occupational exposure to asbestos and other known carcinogens (the male-to-female ratio is established at 5:1) [2] [4]. The clinical presentation depends on the location of the tumor, with the two main locations being the pleura (the most common) and the peritoneum [1] [2] [3] [4]. In the majority of cases suffering from pleural mesothelioma, a nonproductive cough that is often accompanied by dyspnea, fatigue, diaphoresis, and focal chest pain in some people are notable complaints [1] [2] [5]. Rarely, scoliosis toward the ipsilateral side or splinting may develop due to the expansive nature of the tumor [1]. Conversely, abdominal pain, swelling, anorexia, profound losses in body weight, as well as ascites are manifestations of peritoneal mesothelioma [3]. In some patients, the diagnosis is made incidentally [3].

Fatigue
  • In the majority of cases suffering from pleural mesothelioma, a nonproductive cough that is often accompanied by dyspnea, fatigue, diaphoresis, and focal chest pain in some people are notable complaints.[symptoma.com]
  • […] symptoms: Abdominal pain, bowel irregularity, general fatigue, seizures Pericardial Symptoms include: Irregular heartbeat Shortness of breath Chest pain General fatigue Weight loss Diagnosis Many patients are diagnosed with mesothelioma after exhibiting[mesotheliomaguide.com]
  • Pericardial mesothelioma symptoms include the following: Heart palpitations, irregular heartbeat Pain in the chest Inexplicable difficulty breathing (dyspnea) Sweating or fever Fatigue Because this form of mesothelioma so rarely affects patients, its[mesotheliomasymptoms.com]
  • Temporary side effects include nausea, vomiting, hair loss, and fatigue. The physician may prescribe medication to reduce the nausea and vomiting.[asbestosnetwork.com]
  • Early signs of pleural mesothelioma include: Trouble breathing Long-lasting cough Pain under the rib cage or in the abdomen Pain while breathing Weight loss and fatigue Diagnosis Images may be taken of your bodily structures.[uvahealth.com]
Abdominal Pain
  • Conversely, abdominal pain, swelling, anorexia, profound losses in body weight, as well as ascites are manifestations of peritoneal mesothelioma. In some patients, the diagnosis is made incidentally.[symptoma.com]
  • Our patient presented with abdominal pain and surgery showed a large subserous mass (12.0   11.4   9.8 cm) combined with a small intramural solid nodule (2.0   1.0   1.0 cm), and multiple minute neoplastic growth on the ovary.[ncbi.nlm.nih.gov]
  • Herein, we present a case of BFM in a 2-year-old male child, who presented to our hospital with abdominal pain and a lump in the abdomen.[ncbi.nlm.nih.gov]
  • A chest wall mass, weight loss, sweating, abdominal pain and ascites (due to peritoneal involvement) are less common presentations.[orpha.net]
Increased Abdominal Girth
  • Symptoms of peritoneal mesothelioma are unspecific, the most frequent being increased abdominal girth, pain and weight loss [ 2 ]; usually diagnosis occurs late. Treatment includes the combination of debulking surgery and i.p. chemotherapy.[web.archive.org]
Localized Chest Pain
  • Typical symptoms are nonspecific, such as a nonproductive cough, dyspnea, and localized chest pain in the case of pleural mesothelioma, whereas abdominal pain, anorexia, weight loss, and swelling of the abdomen are reported with peritoneal tumors.[symptoma.com]
Vascular Disease
Short Arm
  • Deletion mapping of the short arm of chromosome 3 in human malignant mesothelioma. Genes Chromosom. Cancer 9, 76–80 (1994). 14. Murthy, S.S. & Testa, J.R.[nature.com]
Epididymal Mass
  • Left hydrocelectomy was performed and pathological analysis of the epididymal mass revealed a well-differentiated papillary mesothelioma. We discuss the sonographic and pathological findings of this rare neoplasm.[ncbi.nlm.nih.gov]
Scrotal Pain
  • Most patients with WDPM suffer from scrotal pain or swelling, but hydrocele seems to be the most common presenting symptom. These lesions are usually not aggressive and are accompanied by an indolent clinical behavior.[ncbi.nlm.nih.gov]

Workup

The diagnostic workup should start with a meticulous clinical assessment. A detailed history must cover the onset of symptoms and their progression, as well as occupational details and whether exposure to asbestos or other harmful chemicals exists. During the physical examination, dullness on percussion due to a pleural effusion or diminished breathing sounds may be detected in the case of pleural mesotheliomas [1], in which case imaging studies need to be employed. Although plain radiography is a useful first-line study for the evaluation of the chest, more advanced studies, such as computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS), mediastinoscopy, laparoscopy, and positron emission tomography (PET) are recommended, primarily because they are able to determine the stage and aid in designing the optimal therapeutic strategy [1] [2] [3] [6]. To make a definite diagnosis, however, a sample of the tumor must be obtained for a histopathological examination. Because pleural cytology is not useful in the case of mesothelioma, fine-needle aspiration biopsy (FNAB), often guided by CT, or video-assisted thoracoscopy (which shows superior results compared to FNAB) are viable techniques that are used in practice [1] [2]. Immunohistochemical staining should include calretinin, as it carries a sensitivity rate of 95% and a specificity rate of 87% [2]. Other important markers are cytokeratin, mesothelin, and D2-40 [1] [2] [7].

Pleural Exudate
  • Lung cancer and malignant pleural exudate developed after a long latency cumulative retention time of asbestos fibers.[ncbi.nlm.nih.gov]

Treatment

  • When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial.[cancer.gov]
  • As a result, multimodality treatment regimens have been developed.[doi.org]

Prognosis

  • Prognosis, symptoms and treatment options vary by type.[asbestos.com]
  • Patients should discuss their individual case with a mesothelioma specialist to better understand their prognosis. Prognosis How a disease will progress. A prognosis can be good or bad and may have a survival time estimate.[mesothelioma.com]
  • For more information, view Malignant Mesothelioma Symptoms, Tests, Prognosis, and Stages.[cancer.gov]
  • A patient’s prognosis is often based on stage, cell type and their overall health. Women and younger patients have a better life expectancy than older men. There are several steps patients can take to improve their prognosis.[mesotheliomaguide.com]
  • Treatment can extend your prognosis by years. One pericardial mesothelioma patient lived 5 years after their diagnosis thanks to receiving targeted treatment. No matter your disease or prognosis,there may be hope.[mesotheliomaveterans.org]

Etiology

  • Etiology and pathogenesis of BCM remain unclear. Familial Mediterranean fever (FMF) is an inherited disorder characterized by episodes of fever, and abdominal, chest and/or joint inflammation.[ncbi.nlm.nih.gov]
  • All of these alternative etiologies account for a small proportion of tumors, and most mesotheliomas not clearly attributable to asbestos exposure are spontaneous (idiopathic).[ncbi.nlm.nih.gov]
  • CONCLUSIONS: This study offers a practical approach for estimating the economic impact of mesothelioma, and provides empirical evidence of the huge economic burden linked to this disease, with its high etiologic fraction.[ncbi.nlm.nih.gov]
  • Cases of peritoneal mesothelioma have also been reported following exposure to erionite and Thorotrast, providing further evidence of common etiological factors with the pleural form of the disease.[ncbi.nlm.nih.gov]
  • (See Etiology, Presentation, and Workup.)[emedicine.com]

Epidemiology

  • Key Words Asbestos Malignant Mesothelioma Chrysotile Asbestos-Related Diseases Environmental Epidemiology Occupational Epidemiology Selected Abbreviations and Acronyms SMR standardized mortality ratio View full text Copyright 2011 Elsevier Inc.[annalsofepidemiology.org]
  • Epidemiology of malignant mesothelioma- -an outline. Ann Occup Hyg 2010;54:851-7. McDonald C. eds. Epidemiology of Work Related Diseases. London: BMJ Books, 2000. Virta RL.[doi.org]
  • Although SV40 can induce mesotheliomas in animals, in humans the epidemiologic data are against a causative role.[ncbi.nlm.nih.gov]
  • Although asbestos has been known for several decades to cause peritoneal mesothelioma, in addition to the pleural form of the disease [ 4 ], no detailed review of the epidemiological features of this disease has been published recently. descriptive epidemiology[web.archive.org]
  • Google Scholar 14 Artvinli M, Baris YI: Malignant mesotheliomas in a small village in the Anatolian region of Turkey: An epidemiologic study. JNCI 1979 ;63(1): 17 –22.[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Eighty percent of MPM arises from the mesothelial lining of the parietal pleura. It is specifically unknown how asbestos induces MPM at the molecular level.[cancertherapyadvisor.com]
  • Assessment of its results would provide solid evidence about the value of this approach in early diagnosis, and possibly stratification based on pathophysiological condition and cancer risk.[doi.org]
  • Soon after it was reported that the alterations in the expression of microRNA in various cancers could be critical to the understanding of cancer pathophysiology ( 12 ), and that many microRNAs are frequently encoded at fragile sites and common breakpoint[doi.org]
  • Didier Jean and Marie-Claude Jaurand, Causes and pathophysiology of malignant pleural mesothelioma, Lung Cancer Management, 10.2217/lmt.15.21, 4, 5, (219-229), (2015). V. Panou, M. Vyberg, U.M. Weinreich, C. Meristoudis, U.G. Falkmer and O.D.[doi.org]

Prevention

  • Includes causes, prevention, genetics, treatment options and clinical trials. Mayo Clinic: Mesothelioma Includes a description of mesothelioma and provides information about symptoms, causes, risk factors, complications, treatments and drugs.[curlie.org]
  • Treatment Pleural mesothelioma is usually treated with: Chemotherapy —use of drugs to kill cancer cells Radiation —use of radiation to kill cancer cells and shrink tumors Surgery Combination of these three treatments Prevention The only known way to prevent[web.archive.org]
  • Control of asbestos exposure remains the main approach to prevent peritoneal mesothelioma.[ncbi.nlm.nih.gov]
  • Causes, Risk Factors, and Prevention Learn about the risk factors for malignant mesothelioma and what you might be able to do to help lower your risk. Early Detection, Diagnosis, and Staging Know the signs and symptoms of malignant mesothelioma.[cancer.org]
  • Zhejiang Province, China. 2 Department of Pathology, Yuyao People's Hospital, Yuyao, Zhejiang Province, China. 3 Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China. 4 Yuyao Center of Disease Control and Prevention[ncbi.nlm.nih.gov]

References

Article

  1. Mott FE. Mesothelioma: A Review. Ochsner J. 2012;12(1):70-79.
  2. Porpodis K, Zarogoulidis P, Boutsikou E, et al. Malignant pleural mesothelioma: current and future perspectives. J Thorac Dis. 2013;5(Suppl 4): S397-S406.
  3. Bridda A, Padoan I, Mencarelli R, Frego M. Peritoneal Mesothelioma: A Review. Medscape General Medicine. 2007;9(2):32.
  4. Nasreen N, Khodayari N, Mohammed KA. Advances in malignant pleural mesothelioma therapy: targeting EphA2 a novel approach. Am J Cancer Res. 2012;2:222-234.
  5. Muers MF, Stephens RJ, Fisher P, et al. Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet 2008;371:1685-1694.
  6. Pickhardt PJ, Bhalla S. Primary neoplasms of peritoneal and sub-peritoneal origin: CT findings. Radiographics. 2005;25:983–995.
  7. Husain AN, Colby TV, Ordóñez NG, et al. Guidelines for pathologic diagnosis of malignant mesothelioma: a consensus statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med. 2009;133(8):1317–1331.

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Last updated: 2019-07-11 22:25