Mesothelioma of the Lung

Mesothelioma of the Lung



Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos.[1] In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart).

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Signs and symptoms

Mesothelioma that affects the pleura can cause these signs and symptoms:

· chest wall pain

· pleural effusion, or fluid surrounding the lung

· shortness of breath

· fatigue or anemia

· wheezing, hoarseness, or cough

· blood in the sputum (fluid) coughed up

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

· abdominal pain

· ascites, or an abnormal buildup of fluid in the abdomen

· a mass in the abdomen

· problems with bowel ********

· weight loss

In severe cases of the disease, the following signs and symptoms may be present:

· blood clots in the veins, which may cause thrombophlebitis

· disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs

· jaundice, or yellowing of the eyes and skin

· low blood sugar level

· pleural effusion

· pulmonary emboli, or blood clots in the arteries of the lungs

· severe ascites

A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.

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Diagnosing mesothelioma

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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Screening

There is no universally agreed protocol for screening people who have been exposed to asbestos. However some research indicates that the serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma.

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