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Thoracic Surgery Clinics Nov 2020Malignant pleural mesothelioma (MPM) is an asbestos-related neoplasm that can only be treated successfully when correctly diagnosed and treated early. The... (Review)
Review
Malignant pleural mesothelioma (MPM) is an asbestos-related neoplasm that can only be treated successfully when correctly diagnosed and treated early. The asbestos-exposed population is a high-risk group that could benefit from sensitive and specific blood- or tissue-based biomarkers. We review recent work with biomarker development in MPM and literature of the last 20 years on the most promising blood- and tissue-based biomarkers. Proteomic, genomic, and epigenomic platforms are covered. SMRP is the only validated blood-based biomarker with diagnostic, monitoring and prognostic value. To strengthen development and testing of MPM biomarkers, cohorts for validation must be established by enlisting worldwide collaborations.
Topics: Asbestos; Biomarkers, Tumor; Calbindin 2; Extracellular Matrix Proteins; HMGB1 Protein; Humans; Mesothelioma, Malignant; Multidrug Resistance-Associated Proteins; Pleural Neoplasms; Prognosis; Proteomics
PubMed: 33012429
DOI: 10.1016/j.thorsurg.2020.08.001 -
Wiener Klinische Wochenschrift Sep 2016
Topics: Austria; Evidence-Based Medicine; Humans; Mesothelioma; Pleural Effusion, Malignant; Pleural Neoplasms; Treatment Outcome
PubMed: 27457871
DOI: 10.1007/s00508-016-1039-0 -
Annals of Oncology : Official Journal... Aug 2018Malignant pleural mesothelioma (MPM) is a rare malignancy with some unique characteristics. Tumor biology is aggressive and prognosis is poor. Despite more knowledge on... (Review)
Review
Malignant pleural mesothelioma (MPM) is a rare malignancy with some unique characteristics. Tumor biology is aggressive and prognosis is poor. Despite more knowledge on histology, tumor biology and staging, there is still a relevant discrepancy between clinical and pathologic staging resulting in difficult prediction of prognosis and treatment outcome, making treatment allocation more challenging than in most other malignancies. After years of nihilism in the late 80s, a period of activism started evaluating different treatment protocols combined with research driven mainly by academic centers; at the time, selection was based on histology and stage only. This period was important to gain knowledge about the disease. However, the interpretation of data was difficult since selection criteria and definitions varied substantially. Not surprisingly, until now there is no common agreement on best treatment even among specialists. Hence, a review of our current concepts is indicated and personalized treatment should become applicable in the future. Surgery was and still is an issue of debate. In principle, surgery is an effective approach as it allows macroscopic complete elimination of a tumor, which is relatively resistant to medical treatment. It helps to set the clock back and other therapies that have also just a limited effect can be applied sequentially before or after surgery. Furthermore, to date best long-term outcome is reported from surgical series in combination with other modalities. However, part of the community considers surgery associated with too high morbidity and mortality when balanced to the limited life expectancy. This criticism is understandable, since poor results after surgery are reported. The present article will review the indication for surgery and discuss the different procedures available for macroscopic complete resection-such as lung-preserving (extended) pleurectomy/decortication as well as extrapleural pneumonectomy to illustrate that 'The surgeon is still there!'
Topics: Chemotherapy, Adjuvant; Clinical Trials as Topic; Disease-Free Survival; Humans; Lung; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Neoadjuvant Therapy; Neoplasm Staging; Organ Sparing Treatments; Pleura; Pleural Neoplasms; Pneumonectomy; Prognosis; Radiotherapy, Adjuvant; Treatment Outcome
PubMed: 29905765
DOI: 10.1093/annonc/mdy195 -
Advances in Anatomic Pathology Jul 2023Pleural mesotheliomas represent one of the most common diagnostic challenges in thoracic pathology. The diagnosis of pleural mesothelioma weighs heavily on clinical and...
Pleural mesotheliomas represent one of the most common diagnostic challenges in thoracic pathology. The diagnosis of pleural mesothelioma weighs heavily on clinical and radiologic information. In addition, in the past, before the era of immunohistochemistry, the diagnosis was aided with the use of special histochemical stains-PAS, D-PAS, and mucicarmine, which now very much have been replaced by immunohistochemical stains. In the era of immunohistochemistry, a combination of carcinomatous epitopes and positive mesothelioma markers has become paramount in the diagnosis of mesothelioma, and more recently the use of molecular techniques has become another ancillary tool in supporting such a diagnosis. At the same time, the treatment and clinical outcome of these patients may in some measure be determined by the histopathological features of the tumor and one that also over the years has changed from a palliative type to surgery, chemotherapy, radiotherapy, or a combination of these types. The histopathological growth patterns of mesothelioma are also wide, and in some cases may mimic other tumors that may be primary or metastatic to the pleura. Therefore, the assessment of the diagnosis of mesothelioma is one that requires a global view of the different factors including clinical, radiologic, pathologic-including immunohistochemistry and molecular diagnosis.
Topics: Humans; Mesothelioma; Mesothelioma, Malignant; Pleural Neoplasms; Immunohistochemistry; Diagnosis, Differential; Biomarkers, Tumor
PubMed: 36689647
DOI: 10.1097/PAP.0000000000000390 -
Archives of Pathology & Laboratory... Aug 2018- Pleural pathology has been dominated by discussions relating to the diagnosis, prognosis, etiology, and management of malignant mesothelioma. However, there exists a... (Review)
Review
CONTEXT
- Pleural pathology has been dominated by discussions relating to the diagnosis, prognosis, etiology, and management of malignant mesothelioma. However, there exists a diverse group of other neoplasms that involve the pleura; the most common by far is metastatic carcinoma, usually of pulmonary origin. Other metastatic tumors of varied histogenesis do occur but are less common. Primary pleural neoplasms other than diffuse malignant mesothelioma are either uncommon or rare and have received less attention.
OBJECTIVE
- To provide a review of those diverse tumors that can involve the pleura other than mesothelioma in order to facilitate their accurate diagnosis.
DATA SOURCES
- Review of relevant literature published via PubMed and other search engines.
CONCLUSIONS
- A wide variety of tumors can involve the pleura. In most cases, the approach of considering the morphologic features with appropriate immunohistochemistry, in the correct clinical context, allows for a confident diagnosis. For a number of those soft tissue tumors that are well recognized in the pleura, such as solitary fibrous tumor, desmoid-type fibromatosis, synovial sarcoma, and epithelioid hemangioendothelioma, novel markers now exist based on an understanding of the individual tumors' molecular characteristics. Primary pleural lymphomas are rare with poor prognosis. They represent localized specific diffuse large B-cell lymphomas, with either post-germinal center B-cell or plasma cell lineage, arising in the context of either immunodeficiency or immune sequestration and with viral infection.
Topics: Biomarkers, Tumor; Diagnosis, Differential; Humans; Mesothelioma; Pleural Neoplasms
PubMed: 30040453
DOI: 10.5858/arpa.2017-0537-RA -
Respiratory Medicine Oct 2015A tumorlike condition of the pleura is any nonmalignant lesion of the pleura or within the pleural space that could be confused with a pleural tumor on initial imaging.... (Review)
Review
A tumorlike condition of the pleura is any nonmalignant lesion of the pleura or within the pleural space that could be confused with a pleural tumor on initial imaging. Tumorlike conditions of the pleura are relatively rare compared with neoplastic lesions such as mesotheliomas and metastases. Imaging-based diagnosis of these conditions can be difficult due to the similarity of appearance. Thus, recognition of certain imaging patterns and interpretation of these patterns in the clinical context are important. Pleural endometriosis, thoracic splenosis, thoracolithiasis, foreign bodies, pleural pseudotumors and pleural plaques are significant examples of focal tumorlike conditions discussed in this article. Computed tomography is the mainstay imaging technique for the primary assessment of pleural disease, but other imaging methods, such as magnetic resonance imaging and positron-emission tomography, can be of great support in the diagnosis.
Topics: Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Mesothelioma; Middle Aged; Neoplasm Metastasis; Pleural Diseases; Pleural Neoplasms; Positron-Emission Tomography; Tomography, X-Ray Computed
PubMed: 26094051
DOI: 10.1016/j.rmed.2015.06.004 -
Seminars in Ultrasound, CT, and MR Dec 2021Malignant pleural mesothelioma is a rare tumor arising from the pleural mesothelial cells. Imaging plays a crucial role in the diagnosis, staging, and management of... (Review)
Review
Malignant pleural mesothelioma is a rare tumor arising from the pleural mesothelial cells. Imaging plays a crucial role in the diagnosis, staging, and management of patients with mesothelioma. Accurate staging to stratify patients into homogeneous groups is required to evaluate the effectiveness of multimodality therapeutic regimens. CT and PET/CT are recommended for the initial staging of MPM. MRI adds value to further assess invasion of the tumor into the diaphragm, chest wall, and mediastinum. This review will discuss pearls and pitfalls in the imaging of mesothelioma with emphasis on the roles of CT, MRI, and PET/CT.
Topics: Humans; Mesothelioma, Malignant; Neoplasm Staging; Pleural Neoplasms; Positron Emission Tomography Computed Tomography; Tomography, X-Ray Computed
PubMed: 34895610
DOI: 10.1053/j.sult.2021.04.011 -
Seminars in Nuclear Medicine Nov 2022Malignant mesothelioma is an aggressive tumor originating from the mesothelial cells and presenting in general with a very poor prognosis. The pleural localization... (Review)
Review
Malignant mesothelioma is an aggressive tumor originating from the mesothelial cells and presenting in general with a very poor prognosis. The pleural localization represents the prevailing disease site, while peritoneal involvement is commonly rare. The WHO classifies mesotheliomas into epithelioid, biphasic, and sarcomatoid histotypes, having diverse outcome with the sarcomatoid or biphasic forms showing the poorest prognosis. Given the peculiar rind-like pattern of growth, mesothelioma assessment is rather challenging for medical imagers. Conventional imaging is principally based on contrast-enhanced CT, while the role of functional and metabolic imaging is regarded as complementary. By focusing essentially on the staging and restaging role of [18F]FDG PET/CT in malignant mesotheliomas, the present review will summarize the available data present in literature and provide some hints on alternative imaging and future perspectives. Given the prevailing incidence of pleural disease, the majority of the information will be addressed on malignant pleural mesothelioma, although a summary of principal characteristics and imaging findings in patients with peritoneal mesothelioma will be also provided.
Topics: Humans; Mesothelioma, Malignant; Pleural Neoplasms; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Mesothelioma
PubMed: 35965111
DOI: 10.1053/j.semnuclmed.2022.07.005 -
The Journal of Thoracic and... Aug 2023
Topics: Humans; Mesothelioma, Malignant; Mesothelioma; Pleural Neoplasms; Pleura
PubMed: 36732146
DOI: 10.1016/j.jtcvs.2023.01.002 -
Thoracic Surgery Clinics Feb 2018Pleural metastasis is a common occurrence in up to 30% of patients with metastatic cancer. When lung entrapment and loculation of fluid occur, treatment is more... (Review)
Review
Pleural metastasis is a common occurrence in up to 30% of patients with metastatic cancer. When lung entrapment and loculation of fluid occur, treatment is more difficult and we have named this condition "oncothorax." The malignant adhesions that entrap the lung in an oncothorax are not typically amenable to surgical decortication. The standard approach for managing these patients is to place an indwelling catheter. Other options may include pleurectomy and decortication, intrapleural hyperthermic chemoperfusion, and intrapleural photodynamic therapy. However, these procedures should be provided selectively depending on patient performance status, extent of metastatic disease, and level of experience.
Topics: Antineoplastic Agents; Catheters, Indwelling; Drainage; Humans; Hyperthermia, Induced; Perfusion; Photochemotherapy; Pleural Neoplasms; Thoracic Surgical Procedures
PubMed: 29150040
DOI: 10.1016/j.thorsurg.2017.08.009