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The American Journal of Case Reports Jan 2023BACKGROUND Epithelioid sarcoma is a rare tumor and that is extremely rare as a primary pleural neoplasm. On imaging, it may appear similar to malignant pleural...
BACKGROUND Epithelioid sarcoma is a rare tumor and that is extremely rare as a primary pleural neoplasm. On imaging, it may appear similar to malignant pleural mesothelioma; thus, it can be difficult to diagnose. CASE REPORT A 64-year-old Asian woman, who had a treatment history of cervix adenocarcinoma, was admitted with dyspnea and right massive pleural effusion. Chest drainage was performed, and malignant cells were found in the pleural effusion. The malignant cells were thought to be metastasized from previous cervical cancer. We continued pleural drainage; however, the volume of the pleural effusion did not decrease. On the 5th hospital day, the chest tube became occluded. Computed tomography showed structures similar to empyema. Pleural irrigation and fibrinolytic therapy did not improve her condition. Empyema curettage was performed on the 14th hospital day. The resected pleura was submitted for pathological examination and showed tumor lesion but not metastatic adenocarcinoma of the cervix. The intrathoracic tumor grew extremely rapidly, and the patient died of respiratory failure on postoperative day 8 (22nd hospital day) before a diagnosis could be made. The final pathological diagnosis obtained on the 34th hospital day was epithelioid sarcoma. CONCLUSIONS For patients who appear to have empyema complicated by neoplastic lesions, a histopathological examination should also be performed to ensure accurate diagnosis. In addition, if a tumorous lesion is detected and it is neither metastatic nor malignant pleural mesothelioma, pleural epithelioid sarcoma should be added to the differential diagnosis in the presence of a rapidly growing and histologically difficult-to-diagnose pleural tumor.
Topics: Female; Humans; Middle Aged; Pleura; Mesothelioma, Malignant; Mesothelioma; Pleural Neoplasms; Pleural Effusion; Adenocarcinoma; Sarcoma
PubMed: 36597286
DOI: 10.12659/AJCR.938696 -
Thoracic Cancer May 2024Tumor recurrence remains the main barrier to survival after surgery for pleural mesothelioma (PM). Soluble mesothelin-related protein (SMRP) and cancer antigen 125...
BACKGROUND
Tumor recurrence remains the main barrier to survival after surgery for pleural mesothelioma (PM). Soluble mesothelin-related protein (SMRP) and cancer antigen 125 (CA-125) are established blood-based biomarkers for monitoring PM. We prospectively studied the utility of these biomarkers after pleurectomy decortication (PD).
METHODS
Patients who underwent PD and achieved complete macroscopic resection with available preoperative SMRP levels were included. Tumor marker levels were determined within 60 days of three timepoints: (1) preoperation, (2) post-operation, and (3) recurrence.
RESULTS
Of 356 evaluable patients, 276 (78%) had recurrence by the end of follow-up interval. Elevated preoperative SMRP levels were associated with epithelioid histology (p < 0.013), advanced TNM (p < 0.001) stage, and clinical stage (p < 0.001). Preoperative CA-125 levels were not significantly associated with clinical covariates. Neither biomarker was associated with survival or disease-free survival. With respect to nonpleural and nonlymphatic recurrences, mean SMRP levels were elevated in patients with pleural (p = 0.021) and lymph node (p = 0.042) recurrences. CA-125 levels were significantly higher in patients with abdominal (p < 0.001) and lymph node (p = 0.004) recurrences. Among patients with all three timepoints available, we observed an average decrease in SMRP levels by 1.93 nmol/L (p < 0.001) postoperatively and again an average increase at recurrence by 0.79 nmol/L (p < 0.001). There were no significant changes in levels of CA-125 across the study timepoints (p = 0.47).
CONCLUSIONS
Longitudinal changes in SMRP levels corresponded with a radiographic presence of disease in a subset of patients. SMRP surveillance could aid in detection of local recurrences, whereas CA-125 could be helpful in recognizing abdominal recurrences.
Topics: Humans; Male; Female; CA-125 Antigen; Aged; Pleural Neoplasms; Middle Aged; Biomarkers, Tumor; Mesothelioma; Neoplasm Recurrence, Local; Mesothelin; Mesothelioma, Malignant; Prospective Studies; Adult; Aged, 80 and over; GPI-Linked Proteins; Lung Neoplasms
PubMed: 38627917
DOI: 10.1111/1759-7714.15264 -
Annals of Oncology : Official Journal... Mar 2006
Review
Topics: Antineoplastic Combined Chemotherapy Protocols; Clinical Trials as Topic; Combined Modality Therapy; Humans; Medical Oncology; Mesothelioma; Neoplasm Staging; Pleural Neoplasms
PubMed: 16608972
DOI: 10.1093/annonc/mdj912 -
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 -
Chest Aug 1999Malignant pleural mesothelioma is a neoplasm that is commonly fatal and for which there are no widely accepted curative approaches. Mesothelioma is unresponsive to most... (Review)
Review
Malignant pleural mesothelioma is a neoplasm that is commonly fatal and for which there are no widely accepted curative approaches. Mesothelioma is unresponsive to most chemotherapy and radiotherapy regimens, and it typically recurs even after the most aggressive attempts at surgical resection. Multimodality approaches have been of some benefit in prolonging survival of very highly selected subgroups of patients, but they have had a relatively small impact on the majority of the patients diagnosed with this disease. As the incidence of pleural mesothelioma peaks in the United States and Europe over the next 10 to 20 years, new therapeutic measures will be necessary. This review will discuss the roles of chemotherapy, radiotherapy, surgery, and combined modality approaches in the treatment of pleural mesothelioma, as well as scientific advances made in the past decade that have led to the development of experimental techniques, such as photodynamic therapy, immunotherapy, and gene therapy, that are currently undergoing human clinical trials. These promising new avenues may modify the therapeutic nihilism that is rampant among clinicians dealing with mesothelioma.
Topics: Combined Modality Therapy; Genetic Therapy; Humans; Immunotherapy; Mesothelioma; Photochemotherapy; Pleural Neoplasms; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 10453882
DOI: 10.1378/chest.116.2.504 -
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 -
The European Respiratory Journal Oct 1998The incidence of malignant pleural mesothelioma (MPM) has risen for some decades and is expected to peak between 2010 and 2020. Up to now, no single treatment has been... (Review)
Review
The incidence of malignant pleural mesothelioma (MPM) has risen for some decades and is expected to peak between 2010 and 2020. Up to now, no single treatment has been proven to be effective and death usually occurs within about 12-17 months after diagnosis. Perhaps because of this poor prognosis, early screening has incited little interest. However, certain forms may have a better prognosis when diagnosed early and treated by multimodal therapy or intrapleural immunotherapy. Diagnosis depends foremost on histological analysis of samples obtained by thoracoscopy. This procedure allows the best staging of the pleural cavity with an attempt to detect visceral pleural involvement, which is one of the most important prognostic factors. Although radiotherapy seems necessary and is efficient in preventing the malignant seeding after diagnostic procedures in patients, there has been no randomized phase III study showing the superiority of any treatment compared with another. However, for the early-stage disease (stage I) a logical therapeutic approach seems to be neoadjuvant intrapleural treatment using cytokines. For more advanced disease (stages II and III) resectability should be discussed with the thoracic surgeons and a multimodal treatment combining surgery, radiotherapy and chemotherapy should be proposed for a randomized controlled study. Palliative treatment is indicated for stage IV. In any case, each patient should be enrolled in a clinical trial.
Topics: Asbestos; Combined Modality Therapy; Female; Humans; Immunotherapy; Incidence; Male; Mesothelioma; Pleural Neoplasms; Prognosis; Risk Factors; Survival Rate
PubMed: 9817178
DOI: 10.1183/09031936.98.12040972 -
BMC Pulmonary Medicine Apr 2018Malignant pleural mesothelioma (MPM) is marked by its difficult diagnosis and poor prognosis. Medical thoracoscopy (MT) is an effective and safe procedure for the...
BACKGROUND
Malignant pleural mesothelioma (MPM) is marked by its difficult diagnosis and poor prognosis. Medical thoracoscopy (MT) is an effective and safe procedure for the diagnosis of exudative pleural effusions and many factors associated with poor prognosis of MPM. We conducted this study to investigate the value of MT for diagnosing of MPM and to identify prognostic factors for MPM patients.
METHODS
From July 2005 through June 2014, a total of 833 patients with undiagnosed pleural effusions underwent MT and pleural biopsies were taken. Clinical data of all patients with MPM were retrospectively analyzed, and those with complete follow-up data were analyzed for prognostic factors.
RESULTS
Eventually, MPM was the final diagnosis in 40 patients. Diagnostic efficiency of MT for MPM was 87.5%, since diagnosis of MPM failed to be established in 5 patients during the initial MT. Median survival was 17.1 mo (95% confidence interval: 13.6-20.7 mo). MT findings of pleural adhesion and plaques were adverse prognostic factors for MPM. In addition, old age, male gender, smoking history, histological type, poor staging, no treatment, low total protein level in pleural fluid, and computed tomographic findings such as pulmonary consolidation or infiltration, mediastinal lymphopathy, pulmonary mass or nodules, and pleural nodularity were also poor prognostic factors for MPM.
CONCLUSIONS
MT is safe with a high positive rate in the diagnosis of MPM, and pleural adhesion and plaques seen under MT may be the adverse prognostic factors for MPM. Multiple clinical characteristics can affect the survival of MPM patients.
Topics: Adult; Aged; Biopsy; China; Disease Progression; Female; Humans; Lung Neoplasms; Male; Mesothelioma; Mesothelioma, Malignant; Middle Aged; Neoplasm Staging; Outcome Assessment, Health Care; Pleura; Pleural Effusion, Malignant; Pleural Neoplasms; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; Thoracoscopy; Treatment Outcome
PubMed: 29615010
DOI: 10.1186/s12890-018-0619-3 -
Annals of Oncology : Official Journal... Oct 2010
Review
Topics: Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Diagnostic Imaging; General Surgery; Humans; Mesothelioma; Neoadjuvant Therapy; Pathology, Molecular; Pleural Neoplasms; Radiotherapy
PubMed: 20943637
DOI: 10.1093/annonc/mdq471 -
Asian Pacific Journal of Cancer... 2011To examine the clinical characteristics and outcomes of malignant pleural mesothelioma (MPM) in Singapore. (Review)
Review
AIM
To examine the clinical characteristics and outcomes of malignant pleural mesothelioma (MPM) in Singapore.
METHODS AND MATERIALS
A retrospective case note review of patients diagnosed with MPM between 1997 and 2007. Overall survival (OS), locoregional recurrence-free survival (LRS) and metastasis-free survival (MFS) were estimated using Kaplan Meier method and comparison were done using log rank test. Multivariate analysis was not done due to the small number of patients.
RESULTS
There were 39 patients diagnosed with MPM. Fifty-nine percent of patients presented with Stage III and IV disease. Eight (21%) patients had surgery with 2 patients receiving trimodality treatment and adjuvant chemotherapy respectively. Three patients received adjuvant RT and one patient had no adjuvant therapy. Twelve patients received palliative RT or chemotherapy. Median follow-up was 27.0 weeks. Median overall survival (OS) for all patients was 8.0 months (95% CI 6.3-9.7). One-year and 2-year OS were 25.6% and 6.4% respectively. Thirty-eight patients died of progressive disease and one patient died of other cause. Locoregional recurrences and distant metastases occurred in 3/8 and 5/8 surgically treated patients respectively. Overall, distant metastases occurred in 44% of patients. Surgery did not affect survival outcomes although patients with dual modality treatment showed a trend towards improved survival. Epithelioid tumours had better prognosis (median OS 10.2 months) compared to biphasic (median OS 8.0 months) and sarcomatoid tumours (median OS 1.4 months).
CONCLUSION
Future management of MPM will need to emphasize on both locoregional and systemic control and hence, inclusion of patients in clinical trials for multimodality treatment should be encouraged.
Topics: Adult; Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Humans; Kaplan-Meier Estimate; Male; Mesothelioma; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Pleural Neoplasms; Retrospective Studies; Singapore; Treatment Outcome
PubMed: 21875258
DOI: No ID Found