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pleural mesothelioma

Malignant neoplasm of mesothelial cells. Etiology: 1) most commonly, but not necessarily a result of asbestos exposure 2) prolonged exposure to asbestos is necessary 3) no correlation with smoking Epidemiology: 1) most commonly occurs in insulation workers 2) more common in older individuals 3) 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: 1) both pleural & peritoneal mesotheliomas occur 2) interval between asbestos exposure & mesothelioma is 20-40 years Microscopic pathology: (patterns) 1) epithelial 2) biphasic 3) sarcomatoid 4) desmoplastic Immunohistochemistry: - calretinin + - vimentin + - actin + - cytokeratin: - CK1,2,3,4,9,10,11,12,13,15,16 - - CK5,6,7,8,14,17,18,19 +/- - CK20 rare + Genetics: - implicated genes: BCL10 Clinical manifestations: 1) constant gnawing chest pain 2) dyspnea 3) painful, slowly growing, exudative pleural effusion 4) pleural nodules or masses (occur subsequent to pleural effusion) 5) latency of 20-40 years [2] Laboratory: - pleural fluid analysis: exudative pleural effusion [2] - histopathology of pleural biopsy - see ARUP consult [4] Special laboratory: - 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) - nodular pleural thickening - exudative pleural effusion Differential diagnosis: - adenocarcinoma: - [CEA, CD15, thyroid transcription factor 1, blood group antigens, TAG-72 antigen] positive in adenocarcinomas, negative in mesotheliomas [3] Management: 1) prognosis poor 2) surgical resection, radiation, & chemotherapy all yield poor results 3) pemetrexed is an option for patients with advanced disease for whom surgical resection is considered inappropriate [5] 4) average survival is 6-12 months after diagnosis & 8-14 months after onset of symptoms

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asbestosis

General

mesothelioma pleural neoplasm

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 757-58
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2015, 2018, 2022.
  3. Dabbs. Diagnostic Immunohistochemistry. Churchill Livingstone. 2002
  4. ARUP Consult: Mesothelioma deprecated reference
  5. 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: 19717482 Free Article
  6. 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

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OMIM 156240 images related to pleural mesothelioma