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Journal of the National Medical... May 2016Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of vascular origin that can arise in multiple and varied tissue sites. Pleural epithelioid hemangioendothelioma... (Review)
Review
Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of vascular origin that can arise in multiple and varied tissue sites. Pleural epithelioid hemangioendothelioma (PEH), a subtype of EHE, is particularly less reported. Herein, we describe a case of PEH presented with left-sided back pain in a 68-year-old female, and her chest CT scan revealed thickening of the left pleura and left pleural effusion, the histological diagnosis was confirmed by both conventional examination and immunohistochemistry. A literature search utilizing PubMed, Embase, Ovid and Cochrane, Wanfang and Chinese National Knowledge infrastructure (CNKI) for PEH was conducted to investigate the characteristics of the disease, 26 related articles were retrieved and 40 cases of PEH were reported. According to available literature, the average age at presentation is 51.8 years and the disease occurred more often in men than women. The etiology of the disease remained unknown. Chest pain, cough, and dyspnea were the common symptoms. Computed tomography usually revealed pleural effusion and pleural thickening. Histological examinations revealed mainly epithelioid cells. Immunohistochemical stains were positive for vascular endothelial markers. PEH tends to have more aggressive behavior than tumors in other locations, thus effective treatment has not yet been established until now. Further studies are needed to analyze the prognostic factors, clinical features and treatment of PEH.
Topics: Aged; Chest Pain; Female; Hemangioendothelioma, Epithelioid; Humans; Pleural Effusion; Pleural Neoplasms
PubMed: 27372473
DOI: 10.1016/j.jnma.2016.05.001 -
Radiographics : a Review Publication of... Oct 2014Malignant pleural mesothelioma (MPM) is the most common primary malignancy of the pleura and is associated with asbestos exposure in approximately 80% of patients. The... (Review)
Review
Malignant pleural mesothelioma (MPM) is the most common primary malignancy of the pleura and is associated with asbestos exposure in approximately 80% of patients. The patient prognosis is poor, with a median survival of 9-17 months after diagnosis. However, improved survival and decreased morbidity and mortality have been demonstrated when the diagnosis is made in the early stages of disease and specific treatment strategies are implemented. A staging system that focuses on the extent of primary tumor (T), lymph node involvement (N), and metastatic disease (M) has been devised by the International Mesothelioma Interest Group and emphasizes factors related to overall survival. Radiologists should recognize the manifestations of MPM across multiple imaging modalities, translate these findings into the updated staging system, and understand the effects of appropriate staging on treatment and survival. Computed tomography (CT) remains the primary imaging modality used to evaluate MPM and efficiently demonstrates the extent of primary tumor, intrathoracic lymphadenopathy, and extrathoracic spread. However, additional imaging modalities, such as magnetic resonance (MR) imaging of the thorax and positron emission tomography (PET)/CT with fluorodeoxyglucose, have emerged in recent years and are complementary to CT for disease staging and evaluation of patients with MPM. Thoracic MR imaging is particularly useful for identifying invasion of the chest wall, mediastinum, and diaphragm, and PET/CT can accurately demonstrate intrathoracic and extrathoracic lymphadenopathy and metastatic disease.
Topics: Contrast Media; Humans; Lung Neoplasms; Lymphatic Metastasis; Mesothelioma; Mesothelioma, Malignant; Multimodal Imaging; Neoplasm Staging; Pleural Neoplasms; Risk Factors
PubMed: 25310424
DOI: 10.1148/rg.346130089 -
Advances in Respiratory Medicine 2020Malignant pleural mesothelioma (MPM) is a relatively rare, but highly lethal cancer of the pleural mesothelial cells. Its pathoge-nesis is integrally linked to asbestos... (Review)
Review
Malignant pleural mesothelioma (MPM) is a relatively rare, but highly lethal cancer of the pleural mesothelial cells. Its pathoge-nesis is integrally linked to asbestos exposure. In spite of recent developments providing a more detailed understanding of the pathogenesis, the outcomes continue to be poor. To date, trimodality therapy involving surgery coupled with chemotherapy and/or radiotherapy remains the standard of therapy. The development of resistance of the tumor cells to radiation and several che-motherapeutic agents poses even greater challenges in the management of this cancer. Ionizing radiation damages cancer cell DNA and aids in therapeutic response, but it also activates cell survival signaling pathways that helps the tumor cells to overcome radiation-induced cytotoxicity. A careful evaluation of the biology involved in mesothelioma with an emphasis on the workings of pro-survival signaling pathways might offer some guidance for treatment options. This review focuses on the existing treatment options for MPM, novel treatment approaches based on recent studies combining the use of inhibitors which target different pro-survival pathways, and radiotherapy to optimize treatment.
Topics: Antineoplastic Combined Chemotherapy Protocols; Asbestos; Clinical Trials as Topic; Humans; Mesothelioma, Malignant; Neoplasm Staging; Pleural Neoplasms; Radiotherapy, Adjuvant
PubMed: 32869268
DOI: 10.5603/ARM.a2020.0103 -
Seminars in Roentgenology Oct 2023
Topics: Humans; Pleural Neoplasms
PubMed: 37973271
DOI: 10.1053/j.ro.2023.07.002 -
Cancer Research and Treatment Oct 2019Lung cancers presenting as subsolid nodule commonly have peripheral location, making the cancer-pleura relationship noteworthy. We aimed to evaluate the effect of...
PURPOSE
Lung cancers presenting as subsolid nodule commonly have peripheral location, making the cancer-pleura relationship noteworthy. We aimed to evaluate the effect of pleural attachment and/or indentation on visceral pleural invasion (VPI) and recurrence-free survival.
MATERIALS AND METHODS
Patients who underwent curative resection of lung cancer as subsolid nodules from April 2007 to January 2016 were retrospectively evaluated. They were divided into four groups according to their relationship with the pleura. Clinical, radiographical, and pathological findings were analyzed.
RESULTS
Among 404 patients with malignant subsolid nodule, 120 (29.7%) had neither pleural attachment nor indentation, 26 (6.4%) had attachment only, 117 (29.0%) had indentation only, and 141 (34.9%) had both. VPI was observed in nodules of 36 patients (8.9%), but absent in nonsolid nodules and in those without pleural attachment and/or indentation. Compared to subsolid nodules with concurrent pleural attachment and indentation, those with attachment only (odds ratio, 0.12; 95% confidence interval [CI], 0.02 to 0.98) and indentation only (odds ratio, 0.10; 95% CI, 0.03 to 0.31) revealed lower odds of VPI. On subgroup analysis, the size of the solid portion was associated with VPI among those with pleural attachment and indentation (p=0.021). Such high-risk features for VPI were associated with earlier lung cancer recurrence (adjusted hazard ratio, 3.31; 95% CI, 1.58 to 6.91).
CONCLUSION
Concurrent pleural attachment and indentation are risk factors for VPI, and the odds increase with larger solid portion in subsolid nodules. Considering the risk of recurrence, early surgical resection could be encouraged in these patients.
Topics: Aged; Female; Humans; Lung Neoplasms; Male; Middle Aged; Multiple Pulmonary Nodules; Neoplasm Invasiveness; Odds Ratio; Pleural Neoplasms; Pneumonectomy; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 30913858
DOI: 10.4143/crt.2019.057 -
Pathology, Research and Practice Dec 2021A middle-aged female with history of multinodular goiter, Hashimoto disease, and chronic vitamin B12 deficiency presented with palpitations and subsequent exertional... (Review)
Review
A middle-aged female with history of multinodular goiter, Hashimoto disease, and chronic vitamin B12 deficiency presented with palpitations and subsequent exertional dyspnea. Initial radiographic analysis suggested mediastinal cavernous hemangioma, but biopsy showed features consistent with pleural hemangioma. Pleural hemangioma should be considered among the differential diagnoses for recurrent unilateral pleural effusion. Pleural hemangioma should be distinguished from other more common entities including the similarly benign pulmonary hemangioma and the more aggressive pleural hemangioendothelioma.
Topics: Female; Hemangioma; Humans; Middle Aged; Pleural Effusion, Malignant; Pleural Neoplasms
PubMed: 34695620
DOI: 10.1016/j.prp.2021.153650 -
Current Opinion in Pulmonary Medicine Jul 2017To review the latest developments in surgery for malignant pleural mesothelioma both in patient selection, surgical technique, and strategy. (Review)
Review
PURPOSE OF REVIEW
To review the latest developments in surgery for malignant pleural mesothelioma both in patient selection, surgical technique, and strategy.
RECENT FINDINGS
The International Association for the Study of Lung Cancer mesothelioma staging project has produced data to inform the 8th tumour node metastasis revision. The difficulty in clinical N staging and clinical T staging are highlighted and the importance of tumour volume is recognized. New imaging techniques can be utilized to assess tumour volume. The transition from extrapleural pneumonectomy to lung-sparing pleurectomy/decortication has extended the role of cancer-directed surgery into a more elderly population. More aggressive multimodality regimes, including induction radiotherapy are available to a selected population and adjuvant radiotherapy and chemotherapy are feasible in the elderly majority. Additional chemotherapy should not be delayed in those with poorer prognosis node positive, nonepithelioid disease.
SUMMARY
Radical surgery for malignant pleural mesothelioma can achieve significant survival when targeted in those with the best prognosis by careful staging. It can be made more accessible by lung preservation without compromising outcome. It should be part of multimodality therapy.
Topics: Combined Modality Therapy; Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Neoplasm Staging; Patient Selection; Pleura; Pleural Neoplasms; Pneumonectomy; Radiotherapy, Adjuvant; Thoracic Surgical Procedures; Treatment Outcome
PubMed: 28590338
DOI: 10.1097/MCP.0000000000000389 -
Cancer Reports (Hoboken, N.J.) Sep 2022Malignant mesothelioma is a rare neoplasm associated with asbestos exposure. Characterizing treatment patterns and outcomes of older patients with advanced malignant...
BACKGROUND
Malignant mesothelioma is a rare neoplasm associated with asbestos exposure. Characterizing treatment patterns and outcomes of older patients with advanced malignant pleural mesothelioma (MPM) is important to understand the unmet needs of this population.
AIM
To evaluate the demographic and clinical characteristics, treatment patterns, and outcomes among older patients diagnosed with advanced MPM in the United States between 2007 and 2013.
METHODS
This was a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data linked with Medicare claims. We included patients who were age 66 or older at the time of their primary MPM diagnosis between 2007 and 2013 and followed them through 2014. Treated patients who received first-line chemotherapy with pemetrexed and platinum within 90 days of diagnosis, second-line, or third-line therapy were identified for evaluation of outcomes.
RESULTS
There were 666 older patients with advanced MPM, of whom 82% were male, 87% White, 78% stage IV, and 70% had no mobility limitation indicators at diagnosis. There were 262 patients who received first-line chemotherapy for advanced MPM, most of whom (80%; n = 209) received pemetrexed-platinum. Of these 209 patients, 41% (n = 86) initiated second-line therapy, and 26% (n = 22) initiated third-line therapy. Median overall survival for the cohort of 209 patients was 7.2 months. Patients with epithelioid histology had better median overall survival (12.2 months) compared with other histologies (4.4-5.6 months). Within 90 days of diagnosis of advanced MPM, 78% of patients were hospitalized, 52% visited an emergency department, and 21% had hospice care. The 2-year cost of care was over $100 000 for all patients with advanced MPM treated with first-line pemetrexed-platinum.
CONCLUSIONS
Although first-line systemic anticancer treatment was generally consistent with guidelines (e.g., pemetrexed-platinum), poor patient outcomes highlight the need for effective treatment options for older patients with advanced MPM.
Topics: Aged; Female; Humans; Male; Medicare; Mesothelioma; Mesothelioma, Malignant; Pemetrexed; Platinum; Pleural Neoplasms; Retrospective Studies; United States
PubMed: 34698447
DOI: 10.1002/cnr2.1568 -
Radiologia Apr 2024Mesothelioma is an infrequent neoplasm with a poor prognosis that is related to exposure to asbestos and whose peak incidence in Europe is estimated from 2020. Its... (Review)
Review
BACKGROUND AND OBJECTIVES
Mesothelioma is an infrequent neoplasm with a poor prognosis that is related to exposure to asbestos and whose peak incidence in Europe is estimated from 2020. Its diagnosis is complex; imaging techniques and the performance of invasive pleural techniques being essential for pathological confirmation. The different diagnostic yields of these invasive techniques are collected in the medical literature. The present work consisted of reviewing how the definitive diagnosis of mesothelioma cases in our centre was reached to check if there was concordance with the data in the bibliography.
MATERIALS AND METHODS
Retrospective review of patients with a diagnosis of pleural mesothelioma in the period 2019-2021, analysing demographic data and exposure to asbestos, the semiology of the radiological findings and the invasive techniques performed to reach the diagnosis.
RESULTS
Twenty-six mesothelioma cases were reviewed. 22 men and 4 women. Median age 74 years. 9 patients had a history of asbestos exposure. Moderate-severe pleural effusion was the most frequent radiological finding (23/26). The sensitivity of the invasive techniques was as follows: Cytology 13%, biopsy without image guidance 11%, image-guided biopsy 93%, surgical biopsy 67%.
CONCLUSIONS
In our review, pleural biopsy performed with image guidance was the test that had the highest diagnostic yield, so it should be considered as the initial invasive test for the study of mesothelioma.
Topics: Male; Humans; Female; Aged; Mesothelioma; Pleural Neoplasms; Asbestos; Pleural Effusion; Diagnostic Imaging
PubMed: 38642958
DOI: 10.1016/j.rxeng.2023.03.005 -
Archivos de Bronconeumologia Aug 2021
Topics: Exudates and Transudates; Gelatin; Humans; Mesothelioma; Mesothelioma, Malignant; Pleural Effusion, Malignant; Pleural Neoplasms
PubMed: 35699034
DOI: 10.1016/j.arbr.2020.01.015