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MALIGNANT MESOTHELIOMA

MALIis a rarely seen insidious tumour that is typically presenting with progressive disease. Ptn with MPM usually presenting gradually with non-speci

MALIGNANT MESOTHELIOMA (MPM).


 

MPM is a rarely seen insidious tumour that is typically presenting with progressive disease.  Ptn with MPM usually presenting gradually with non-specific Sms e.g., chest pain, SOB, cough, hoarseness, or dysphagia that can be seen with advanced intrathoracic disease. Chest radiological testing typically declares unilateral pleural thickening+ pleural effusion. Cigarette smoking cannot be considered a risk factor for evolution of the MPM.

Initial assessment of ptns with suspected MPM may include:

1)    CT chest with contrast,

2)    Closed pleural biopsy. &

3)    Pleural effusion thoracentesis.

However, with an insufficient sampling to establish a Dgx, surgical intervention via 👉 video-monitored thoracoscopic biopsy or an open thoracotomy should be proceeded.

Dgx of MPM can be established via morphologic + immunohistochemical finding of a cytologic or surgical sampling. DD of MPM may include

       I.        Benign lesions e.g., inflammatory reaction,

     II.        Malignant lesions, e.g., secondaries of other solid tumours.

-       The finding of stromal invasion on biopsy DD mesothelioma from benign causes, on the other hand, immunohistochemistry can DD mesothelioma from other types of malignancy. 

mesothelioma symptoms mesothelioma definition mesothelioma cancer mesothelioma commercial mesothelioma causes mesothelioma meaning mesothelioma treatment mesothelioma asbestos
MALIGNANT MESOTHELIOMA

 mesothelioma symptoms mesothelioma definition mesothelioma cancer mesothelioma commercial mesothelioma causes mesothelioma meaning mesothelioma treatment mesothelioma asbestos MALIGNANT MESOTHELIOMA

With an established Dgx of pleural mesothelioma, an integrated positron emission tomography = (PET) in addition to CT (PET-CT) for primary staging evaluation are advised. Ptns with imaging-proved lesional resectability, an extended lesional staging before final surgery is advised. In particular, laparoscopy + peritoneal lavage to recognise subdiaphragmatic extension that can be followed by mediastinoscopy.

Prognosis of MPM is quite poor, with total survival of almost 9-17 mo after Dgx. However, few ptns may be cured. A variety of biomarkers may be selectively increased in ptns with mesothelioma that includes: 👉

1)    Fibulin-3,  

2)    Osteopontin,

3)    Soluble mesothelin-related peptide (s),

(Those are not currently used in the MPM Dgx).

 

 

MALIGNANT MESOTHELIOMA

mesothelioma symptoms mesothelioma definition mesothelioma cancer mesothelioma commercial mesothelioma causes mesothelioma meaning mesothelioma treatment mesothelioma asbestos MALIGNANT MESOTHELIOMA

MPM is usually arising from a mesothelial surface of the pleura, peritoneum, tunica vaginalis, or pericardial lining. MPM is the most reported type and usually difficult to manage as most ptns mostly presented very late.

 

Clinical picture: MPM is mostly presented at the age of 60 y & older, typically presented decades post asbestos exposure then gradually deteriorated, non-specific pulmonary Sms. Sms may include gradually presented non-specific Sms e.g., chest discomfort, SOB, coughing, hoarseness, night sweating, or dysphagia that seen with sever intrathoracic disease. Remote metastasis is less commonly seen but may rarely affect the bone, liver, or CNS. Systemic Sms e.g., fatigue & weight loss may also be observed, especially with advanced lesions. Sms may be observed for months or more before Dgx has been established.

 

Rarely, ptns with MPM may present with acute Sms of locally invasive of vital organs. Involvement of e.g., brachial plexus or spinal cord compression 👉 focal neurologic lesions. Growth invading the diaphragm may induce bowel obstruction, leading to abdominal pain, distension, as well as vomiting. Impeding SVC may induce Sms of head fullness and facial oedema. Cardiac affection may induce arrhythmias or HF. Other rarely seen presentations of MPM may include paraneoplastic syndrome (seen in with advanced lesions seen early with more typical Sms). Reported paraneoplastic manifestations may include DIC, migrating thrombo-phlebitis, thrombocytosis, hypoglycaemic episodes, neurologic deficits, kidney disease, as well as hypercalcaemia.

 

Scherpereel A, Opitz I, Berghmans T, et al. ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma. Eur Respir J 2020; 55.

 

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