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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 -
Journal of Thoracic Oncology : Official... Nov 2012
Topics: Humans; Mesothelioma; Neoplasm Staging; Pleural Neoplasms
PubMed: 23059784
DOI: 10.1097/JTO.0b013e3182730e0e -
American Journal of Industrial Medicine Jan 2012An epidemic of asbestos-related diseases is ongoing worldwide. Mortality from malignant pleural neoplasms in Italy was analyzed, to estimate the health impact of...
BACKGROUND
An epidemic of asbestos-related diseases is ongoing worldwide. Mortality from malignant pleural neoplasms in Italy was analyzed, to estimate the health impact of asbestos at national and local level.
METHODS
Mortality from ICD-9 code 163 was considered, in the time-window 1995-2002, using National Bureau of Statistics data. National and regional standardized rates and municipal Standardized Mortality Ratios (SMR) were calculated. Municipal clusters were identified by applying Spatial Scan Statistics procedure. Relative risks (RR) express the ratio of risk within the cluster to the risk outside the cluster.
RESULTS
The national standardized annual mortality rate was 1.9 per 100,000. Significant clusters corresponded to asbestos-cement industries (Casale Monferrato: RR = 11.63), shipyards (Monfalcone, RR = 7.43), oil refineries (Falconara, RR = 2.52), petrochemical industries (Priolo, RR = 3.81).
CONCLUSIONS
The present study confirms malignant pleural neoplasms mortality as a suitable indicator of asbestos exposure at geographic level. In addition to asbestos-cement industries and shipyards, other industrial settings are associated with pleural neoplasm mortality.
Topics: Adult; Aged; Asbestos; Cluster Analysis; Female; Humans; Incidence; Italy; Male; Mesothelioma; Middle Aged; Occupational Diseases; Occupational Exposure; Pleural Neoplasms; Poisson Distribution; Risk
PubMed: 22025020
DOI: 10.1002/ajim.21015 -
Radiographics : a Review Publication of... May 1996Malignant pleural mesothelioma (MPM) is a rare malignant neoplasm that typically affects individuals occupationally exposed to asbestos through a variety of industries.... (Review)
Review
Malignant pleural mesothelioma (MPM) is a rare malignant neoplasm that typically affects individuals occupationally exposed to asbestos through a variety of industries. The patients experience an insidious onset of symptoms, including dyspnea, chest pain, cough, malaise, and weight loss. The pathologic diagnosis of MPM is difficult, and special stains or immunohistochemical or ultrastructural analysis may be required to differentiate MPM from metastatic adenocarcinoma. The tumor affects both the parietal and visceral pleural surfaces and progresses to encase the lung and invade the lung, mediastinum, and chest wall. Radiologically, MPM manifests as unilateral pleural effusion, pleural nodules, or pleural masses. Imaging studies are useful for diagnosis and staging in patients who are potential surgical candidates. Although a variety of multimodality therapies are available and radical surgical procedures have been developed, the prognosis remains dismal.
Topics: Aged; Humans; Male; Mesothelioma; Pleural Neoplasms; Tomography, X-Ray Computed
PubMed: 8897628
DOI: 10.1148/radiographics.16.3.8897628 -
Histology and Histopathology Sep 2018Diffuse malignant pleural mesothelioma (DMPM) is the most common primary malignant pleural neoplasm still posing major diagnostic, prognostic and therapeutic challenges....
Diffuse malignant pleural mesothelioma (DMPM) is the most common primary malignant pleural neoplasm still posing major diagnostic, prognostic and therapeutic challenges. Plakophilins are structural proteins considered to be important for cell stability and adhesion in both tumor and normal tissues. Plakophilin 3 is a protein present in desmosomes of stratified and simple epithelia of normal tissues with presence in malignant cells of various tumors where it participates in the process of tumorigenesis. The aim of this study was to investigate the expression of plakophilin 3 protein in DMPM, but also to study its prognostic significance and relation to histologically accessible parameters of aggressive growth. Archival samples of tissue with established diagnosis of DMPM and samples of normal pleural tissue were used. Tumor samples were classified into three histological types of DMPM (epithelioid, sarcomatoid and biphasic). Additional subclassification of epithelioid mesotheliomas into nine patterns based on the prevalent histological component of the tumor was then performed. After immunohistochemical staining, cytoplasmic and membrane immunopositivity of tumor cells was assesed by scoring the intensity of the staining from 0 (no staining) to 4 (very strong staining). Prognostic value and expression of plakophilin 3 with consideration to histologically estimated aggression in tumor growth were then statistically analyzed using non- parametric tests. The results demonstrated higher level of plakophilin 3 expression in tumor samples with histologically more aggressive tumor growth, but no significant prognostic value. According to our study, plakophilin 3 appears to be involved in tumor invasion in malignant mesothelioma.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Female; Gene Expression Profiling; Gene Expression Regulation, Neoplastic; Humans; Immunohistochemistry; Lung Neoplasms; Male; Mesothelioma; Mesothelioma, Malignant; Middle Aged; Plakophilins; Pleura; Pleural Neoplasms; Prognosis
PubMed: 29722422
DOI: 10.14670/HH-11-996 -
The Annals of Thoracic Surgery Jul 2022Pleurectomy and decortication serves as a major component of therapy for malignant pleural mesothelioma (MPM), but the procedure is time consuming. We tentatively...
Pleurectomy and decortication serves as a major component of therapy for malignant pleural mesothelioma (MPM), but the procedure is time consuming. We tentatively applied a carbon dioxide (CO) blower into pleurectomy and decortication for a patient with local relapse of MPM. The blower can help increase the potential subpleural place thanks to the positive pressure by CO, while the mist of saline could clean the potential bleeding to increase visibility. Thereby, the procedure was greatly facilitated in a more precise manner, with blood loss of 100 mL and acceptable postoperative air leak and thorax drainage. Therefore, a CO blower may be considered in pleurectomy and decortication for MPM.
Topics: Carbon Dioxide; Humans; Mesothelioma; Mesothelioma, Malignant; Neoplasm Recurrence, Local; Pleural Neoplasms; Treatment Outcome
PubMed: 34715083
DOI: 10.1016/j.athoracsur.2021.09.046 -
Respiration; International Review of... 2018Pleural mesothelioma (PM) is a rare, highly lethal tumor. A definite consensus on its management has yet to be established.
BACKGROUND
Pleural mesothelioma (PM) is a rare, highly lethal tumor. A definite consensus on its management has yet to be established.
OBJECTIVES
To assess management, overall survival (OS), and their predictors in a cohort of patients from Lombardy, the largest Italian region (about 10 million inhabitants).
METHODS
Through a record linkage between Lombardy health care administrative databases, we identified patients diagnosed with PM in 2006-2011 without history of cancer, evaluating their management. OS from PM diagnosis was estimated using the Kaplan-Meier method. Predictors of OS and of treatment were assessed using Cox regression models with time-dependent covariates when appropriate.
RESULTS
Out of 1,326 patients, 754 (56.9%) received treatment for PM: 205 (15.5%) underwent surgery, and 696 (52.5%) used chemotherapy. Surgery was spread across several hospitals, and most patients diagnosed in nonspecialized centers (70%) underwent surgery in the same centers. Age at diagnosis was a strong inverse determinant of surgery. Determinants of receiving chemotherapy were younger age, a more recent first diagnosis, and first diagnosis in a specialized center. OS was 45.4% at 1 year, 24.8% at 2 years, and 9.6% at 5 years (median 11 months). OS decreased with age, and was higher for those who underwent surgery, but not for those treated with chemotherapy.
CONCLUSIONS
Management of PM varied widely in clinical practice, and significant predictors of treatment were younger age and recent diagnosis, though a high proportion of patients were not treated. Patients were treated in various hospitals, indicating the importance of concentrating serious rare neoplasms in Comprehensive Cancer Centers (as recognized by the Italian Health Ministry).
Topics: Aged; Aged, 80 and over; Female; Humans; Italy; Male; Medical Record Linkage; Mesothelioma; Middle Aged; Pleural Neoplasms
PubMed: 29421798
DOI: 10.1159/000486578 -
Seminars in Thoracic and Cardiovascular... 2009Trimodality treatment of malignant pleural mesothelioma with cytoreductive surgery followed by radiation and chemotherapy has resulted in long-term survival for a select... (Review)
Review
Trimodality treatment of malignant pleural mesothelioma with cytoreductive surgery followed by radiation and chemotherapy has resulted in long-term survival for a select group of patients. Knowledge of the similarities and differences between the two operations that have evolved-extrapleural pneumonectomy and pleurectomy/decortication-is prerequisite to understanding the complex issues associated with patient selection, diagnosis, pathologic staging, preoperative assessment, perioperative management, and adjuvant treatment. Both operations are technically complex and should only be performed at experienced high-volume centers.
Topics: Anesthesia; Chemotherapy, Adjuvant; Clinical Competence; Humans; Mesothelioma; Neoplasm Staging; Patient Selection; Pleural Neoplasms; Pneumonectomy; Radiotherapy, Adjuvant; Thoracic Surgical Procedures; Treatment Outcome
PubMed: 19822285
DOI: 10.1053/j.semtcvs.2009.07.007 -
The American Journal of Pediatric... 1989Seventeen cases of pediatric malignant neoplasm with pulmonary and/or pleural lesions shown by chest radiography at initial diagnosis were reviewed and analyzed....
Seventeen cases of pediatric malignant neoplasm with pulmonary and/or pleural lesions shown by chest radiography at initial diagnosis were reviewed and analyzed. Respiratory symptoms such as dyspnea, tachypnea, and chest pain were observed on admission in approximately one-half of them. The initial chest radiography showed pleural lesions in 7 of the 17, pulmonary lesions in 8, and both pulmonary and pleural lesions in 2. Unilateral or bilateral pleural fluids were observed in all of the seven patients with pleural lesions, and malignant cells were confirmed in the pleural fluid of all patients. The radiographic patterns of the eight patients with pulmonary lesions were solitary nodule in two, multiple nodules in two, diffuse miliary nodules in three, and diffuse honeycomb in one. Histological examination of the pulmonary lesion was performed in six patients at the initial diagnosis or after death, while in the remaining two primary or other metastatic sites were examined. The two patients with both pulmonary and pleural lesions showed multiple nodules or infiltrates with pleural fluid on chest radiography. Increased malignant cells were detected in the pleural fluid of both patients. In all cases, the lesions gradually or rapidly disappeared with multidrug chemotherapy. The review confirms the need for a combination of complete radiographic and pathological analysis at the time of initial diagnosis of malignant neoplasm in children to distinguish other causes such as infectious complications.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Lung Neoplasms; Male; Neoplasms; Pleural Neoplasms; Radiography
PubMed: 2782553
DOI: No ID Found -
International Journal of Radiation... Oct 2009
Review
Topics: Biopsy, Needle; Brachytherapy; Humans; Mesothelioma; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Seeding; Palliative Care; Pleural Neoplasms; Radiotherapy, Adjuvant
PubMed: 19735859
DOI: 10.1016/j.ijrobp.2009.06.037