Diagnosing mesothelioma

Saturday, August 29, 2009

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung ******** tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).

Typical immunohistochemistry results

Typical immunohistochemistry results

Positive .............................................................................Negative

EMA (epithelial membrane antigen) in a
membranous distribution ....................................................CEA (carcinoembryonic antigen)

WT1 (Wilms' tumour 1) ........................................................B72.3

Calretinin .................................................................................MOC-3 1

Mesothelin-1 ...........................................................................CD15

Cytokeratin 5/6 ......................................................................Ber-EP4

HBME-1 (human mesothelial cell 1) ....................................TTF-1 (thyroid tran******ion factor-1)

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