PATHOLOGICAL APPROACH TO PLEURAL MALIGNANT MESOTHELIOMA


Pathological Approach to Pleural Malignant Mesothelioma


Vanessa Fonseca-Ferrer, MD; Luis Gerena-Montano, MD , Héctor A. Nieves Figueroa, MD; William Rodriguez-Cintrón, MD

VA Caribbean Healthcare System, San Juan P.R; Pulmonary and Critical Care Medicine


Exposure to asbestos can lead to asbestosis or malignancy 10-40 years after initial exposure [1]. Although its use has been banned in multiple countries, past occupational exposure leads to most cases that we see in present time.  Malignant mesothelioma is an insidious and rare neoplasm that can arise from mesothelial surface cells, being Malignant Pleural Mesothelioma (MPM) the most common type. Lifetime risk of developing mesothelioma among asbestos workers can be as high as 10 percent and latency period is approximately 30-40 years since time of exposure to development of disease [2]. Annual incidence in the united states is approximately 3,300 cases per year [3]. Median overall survival of patients with advanced unresectable disease is approximately 12 months [4]. Clinical suspicion should arise in patients with previous exposure to asbestos who present with pleural thickening and/or effusion with associated respiratory symptoms. Most symptoms are nonspecific such as chest pain, dyspnea, cough and night sweats. Initial evaluation includes chest x-ray, contrast enhanced CT of the chest to find pleural abnormalities, thoracentesis and closed pleural biopsy. However, difficulties establishing diagnosis have been illustrated on studies where thoracentesis and pleural fluid cytology only yields diagnosis in 26% of cases. The diagnosis, then, is established by morphologic and immunohistochemistry findings of cytologic and surgical specimens.


Keywords: Pathological Approach; Pleural Malignant Mesothelioma

Free Full-text PDF


How to cite this article:
Vanessa Fonseca-Ferrer, Luis Gerena-Montano, Héctor A. Nieves Figueroa, William Rodriguez-Cintrón. Pathological Approach to Pleural Malignant Mesothelioma.American Journal of Histology and Cytology, 2022, 5:14. DOI: 10.28933/ajohc-2021-11-1505


References:

1. Centers for Disease Control and Prevention (CDC). Asbestosis-related years of potential life lost before age 65 years–United States, 1968-2005. MMWR Morb Mortal Wkly Rep. 2008 Dec 12;57(49):1321-5. PMID: 19078920.
2. Selikoff IJ, Hammond EC, Seidman H. Latency of asbestos disease among insulation workers in the United States and Canada. Cancer. 1980 Dec 15;46(12):2736-40. doi: 10.1002/1097-0142(19801215)46:12<2736::aid-cncr2820461233>3.0.co;2-l. PMID: 7448712.
3. Teta MJ, Mink PJ, Lau E, Sceurman BK, Foster ED. US mesothelioma patterns 1973-2002: indicators of change and insights into background rates. Eur J Cancer Prev. 2008 Nov;17(6):525-34. doi: 10.1097/CEJ.0b013e3282f0c0a2. PMID: 18941374.
4. Vogelzang NJ, Rusthoven JJ, Symanowski J, et al: Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 21:2636-2644, 2003
5. Price B. Analysis of current trends in United States mesothelioma incidence. Am J Epidemiol. 1997 Feb 1;145(3):211-8. doi: 10.1093/oxfordjournals.aje.a009093. PMID: 9012593.
6. Pathology and Genetics: Tumors of the Lung, Pleura, Thymus, and Heart, IARC, 2004.
7. Kindler HL, Ismaila N, Armato SG 3rd, Bueno R, Hesdorffer M, Jahan T, Jones CM, Miettinen M, Pass H, Rimner A, Rusch V, Sterman D, Thomas A, Hassan R. Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2018 May 1;36(13):1343-1373. doi: 10.1200/JCO.2017.76.6394. Epub 2018 Jan 18. PMID: 29346042; PMCID: PMC8058628.


Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details)


CC BY 4.0
This work and its PDF file(s) are licensed under a Creative Commons Attribution 4.0 International License.