Mesothelioma

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Epidemiology 4 Pathology 5 Immunophenotype 6 Genetics 7 Clinical-manifestations 8 Diagnostic-procedures 9 Radiology 10 Complications 11 Differential-diagnosis 12 Management 13 More General Terms 14 Additional Terms 15 Internet Database 16 References

Introduction

• Malignant neoplasm of mesothelial cells.

Etiology

• most commonly, but not necessarily a result of asbestos exposure
• prolonged exposure to asbestos is necessary
• no correlation with smoking

Epidemiology

• most commonly occurs in insulation workers
• more common in older individuals

Pathology

• both pleural & peritoneal mesotheliomas occur
• interval between asbestos exposure & mesothelioma is 30-40 years Microscopic pathology (patterns):
• epithelial
• biphasic
• sarcomatoid
• desmoplastic

Immunophenotype

• calretinin + vimentin + actin + cytokeratin: CK1,2,3,4,9,10,11,12,13,15,16 - CK5,6,7,8,14,17,18,19 +/- CK20 rare +

Genetics

• implicated genes: BCL10

Clinical-manifestations

• constant gnawing chest pain
• dyspnea
• painful exudative pleural effusion
• pleural nodules or masses (occur subsequent to pleural effusion)

Diagnostic-procedures

• pleural biopsy

• thoracostomy or open pleural biopsy is generally necessary

Radiology

• high-resolution computed tomography ( HRCT)

• nodular pleural thickening

Complications

• 
  
• disease interaction(s) of cancer with Alzheimer's disease

Differential-diagnosis

• adenocarcinoma: [CEA, CD15, thyroid transcription factor 1, blood group antigens, TAG-72 antigen] positive in adenocarcinomas, negative in mesotheliomas [3]

Management

• prognosis poor
• surgical resection, radiation, & chemotherapy all yield poor results
• pemetrexed is an option for patients with advanced disease for whom surgical resection is considered inappropriate [5]
• average survival is 6-12 months after diagnosis & 8-14 months after onset of symptoms

More General Terms

• sarcoma
• pleural neoplasm

Additional Terms

• asbestosis

Internet Database

OMIM: 156240

References

1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 757-58
2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
3. Dabbs. Diagnostic Immunohistochemistry. Churchill Livingstone. 2002
4. Malignant Mesothelioma: NIH Institute and Center Resources [1]
5. National Guideline Clearinghouse Surgical management of malignant pleural mesothelioma: a clinical practice guideline. (Program in Evidence-based Care) ngc-guideline: [2]
   - The use of chemotherapy in patients with advanced malignant pleural mesothelioma: a clinical practice guideline. (Program in Evidence-based Care ) ngc-guideline: [3]
   - Pemetrexed for the treatment of malignant pleural mesothelioma. National Institute for Health and Clinical Excellence (NICE). ngc-guideline: [4]
   - Lung cancer and cancer of the pleura. In: Pulmonary (acute & chronic). Work Loss Data Institute ngc-guideline: [5]
   - Malignant pleural mesothelioma. Alberta Health Services, Cancer Care ngc-guideline: [6]

mesothelioma