A localized malignant mesothelioma of the visceral pleura treated with minimal resection of the lung (original) (raw)
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A case of surgically treated bilateral metachronous malignant pleural mesothelioma
The Turkish Journal of Thoracic and Cardiovascular Surgery, 2019
Bu yazıda, hastanemize sağ plevral efüzyon ve sağ taraflı göğüs ağrısı ile kabul edilen ve torasentez ve plevral biyopsi ile malign plevral mezotelyoma tanısı konulan 59 yaşında bir erkek hasta sunuldu. Hastanın ameliyat edilebilir olduğunun belirlenmesini takiben, sağ parietal plörektomi + perikardiyal rezeksiyon + diyafragma rezeksiyonu uygulandı ve adjuvan tedavi olarak dört siklus sisplatin ve pemetreksed kombinasyonu eklendi. Hasta üç buçuk yıl boyunca herhangi bir problem olmaksızın takip edildi. Bu dönemde, sol taraflı göğüs ağrısı ve sol taraflı efüzyon fark edildi. Torasentez ve plevral biyopside tümör negatif idi. Sonra, evre 1a malign plevral mezotelyoma ile sonuçlanan video yardımlı torakoskopik cerrahi gerçekleştirildi. Torakoskopik parietal plörektomi başarıyla uygulandı. Adjuvan tedavi olarak dört siklus pemetreksed tek ajan terapisi uygulandı. Hasta tümörsüzken birinci ameliyatın 57. ve ikincisinin 21. ayında kronik obstrüktif akciğer hastalığı ve kalp yetmezliği nedeniyle öldü. Bildiğimiz kadarıyla, bu olgu literatürdeki ilk ameliyat edilmiş iki taraflı metakron primer malign plevral mezotelyomadır. Anah tar söz cük ler: Asbestozis; malign plevral mezotelyoma; plevra tümörleri; cerrahi.
A patient with a localized malignant pleural mesothelioma and 15-year disease-free survival
Current Challenges in Thoracic Surgery, 2019
Localized malignant pleural mesothelioma (LMPM) is rare and its natural history is not well known. There is not enough evidence to allow the physician to follow a clear therapeutic plan in everyday clinical practice. This case report is about a 40-year-old female who was being studied because of right scapular pain, neck swelling and shortness of breath that led to identify a mass in the right upper lobe. Because of the rapid growth of the mass, the patient presented acute severe respiratory insufficiency and hypoxaemia resulting in haemodynamic instability that required intubation, mechanical ventilation and vasoactive drug support. With no definitive histo-pathological diagnosis, the patient underwent emergency thoracotomy for en bloc resection of the right upper lobe, the second to fourth ribs and pericostal tissue extending to the paravertebral muscle. The patient had a favourable postoperative course. Routine pathological study of the resected specimen revealed a highly undifferentiated tumour with no further characterization. Electron microscopy revealed a malignant pleural mesothelioma (MPM). In view of the diagnosis, the patient received adjuvant chemo-radiotherapy. The patient remains disease-free 15 years after the operation. The LMPM needs to be differentiated from the diffuse form of MPM. While the latter can rarely be cured, the former can be eradicated with tumour resection en bloc with the involved structures and adjuvant therapy. The purpose of this case report is to draw attention to this localized form of MPM and to the fact that an emergency operation was required with no certain preoperative diagnosis because of the rapid growth of the tumour.
Malignant pleural mesothelioma: a problematic review
Surgical Oncology, 1998
Malignant pleural mesothelioma is a rare tumor that has been di$cult to study. Because of disappointing treatment results, malignant pleural mesothelioma has remained an area of active research and development. A clinicopathologic review is performed in light of several problematic issues involving diagnosis, staging, natural history, and treatment. Multimodality treatment with surgery followed by adjuvant local and systemic therapy remains the most optimal therapy. Many controversial issues still exist in the treatment of malignant pleural mesothelioma. In the ensuing years newer staging systems, better preoperative staging, newer experimental therapies, and the localization of patients at expert centers will undoubtedly have an impact on disease management. : S 0 9 6 0 -7 4 0 4 ( 9 8 ) 0 0 0 1 9 -X
Journal of lung, pulmonary & respiratory research, 2021
Background Malignant pleural mesothelioma (MPM) is a rare primary tumor, developed from the mesothelial cells of the visceral or parietal pleura. The most frequent location is at the pleura (90% of case). The other locations being rarer: peritoneum (5 to 10% of cases), pericardium (0.4% of cases), and very rarely the tunica vaginalis testes. The incidence of this type of tumor varies from country to country in the world; in the United States, 1 the incidence is estimated at 3,200 cases / year, while in France, MPM affects around 800 to 1,000 people each year with an incidence of around 16 cases / million inhabitants / year. 2,3 It is a pathology that is mainly due to exposure to asbestos, whether or not associated with other etiopathogenicfactors. 4-6 MPM is characterized by a long latency period that can go up to 20 to 40 years. 3,7 It has a very poor prognosis with a 5-year relative survival rate of 7%, 8 and a median survival of 8 to 14 months. 9,10 Late diagnosis, the lack of an effective therapeutic approach and resistance to conventional chemotherapy make this prognosis poor. The objective of this work is to study the main epidemiological, clinical, histological and therapeutic aspects of these tumors and to compare our results with those reported in the literature. Methods In order to describe the epidemiological, clinical, histological, and therapeutic profile of patients with MPM, we conducted a descriptive retrospective study on 8 cases of MPM collected at the medical oncology department of the Hassan II University Hospital in Fez, over a period of 8 years from January 2011 to January 2019. We only included patients treated in our department, aged over 18 years with a diagnosis of MPM made after an histopathological study. Statistical analysis was done by SPSS version 23software, qualitative variables are expressed in frequency and percentage, and quantitative variables are expressed as median and mean. Results Epidemiological data Between January 2011 and January 2019, we included 8 patients with MPM in the medical oncology department of CHU Hassan II in Fez. It represents less than 0.1% of all cancers diagnosed during the study period. The mean age at diagnosis was 53 years with age ranges ranging from 26 to 80 years. There was a slight male predominance with a sex ratio M/F of 1.7. Occupational exposure to asbestos was found in a single patient, smoking was noted in 3 patients (37.5%). The concept of irradiation was not reported nor family cases of pleural mesothelioma. Clinical data All of our patients presented respiratory symptoms dominated by dyspnea (6 patients; 75%), chest pain (5 patients; 62.5%), and
Annals of Thoracic and Cardiovascular Surgery, 2011
Introduction: Pleural malignant mesothelioma is an uncommon but extremely invasive tumor which originates from mesothelial cells and usually occurs after prolonged exposure to asbestos. Different types of surgical and oncological therapeutic methods have been used resulting in various outcomes. The aim of this study was to evaluate, clinicopathologically, 40 patients with pleural malignant mesothelioma and the main factors influencing their prognosis. Methods: In this study, 40 patients with a definitive diagnosis, who had been followed up for at least 3 years were studied according to these: epidemiologic factors, stage and pathological types, treatment method and complications, and by using factors that influence patients survival, we evaluated them statistically. Results: The M/F ratio was l3/1 with an average age of 55 years. Chest pain was the most common symptom. In 55% of patients, the lesions were localized in the left site and most were in Buchart stage I or II. The epithelial form was the most common pathological pattern (62.5%). 47.5% of patients only received radiotherapy and chemotherapy. Of patients who underwent decortication and pleurectomy with adjuvant therapy, extrapleural was performed in 20% of patients, and pneumonectomy, in 17.5%; and 15% refused any type of treatment. One patient died from the surgery. The most common surgical complication was wound infection. The average survival was 10.5 months, and the main factors influencing the survival were physiologic status, pathological form of disease, stage of disease and the pattern of pleural involvement. Conclusion: Because of the low survival after multimodality invasive treatments in mesothelioma, aggressive therapeutic methods were recommended in patients with good physiological status and early clinical stage with a good pathology type.
Malignant Pleura Mesothelioma: Clinical Perspectives
Oncomedicine
Malignant pleural mesothelioma (MPM) is a primary health issue which preoccupies the health professional community worldwide. The main cause of the disease is the environmental exposure to asbestos. Because of the lack of relevant symptomatology, the disease is usually diagnosed at an advanced stage. Despite the progress in the therapeutic means, the mortality of the disease remains high. Τhe optimal approach to the disease consists of the preventive efforts to remove asbestos materials, the early diagnosis and proper early therapeutic treatment. Despite the fact that new cases of MPM are diagnosed, it is believed that the incidence of the disease is declining. In this study an overview of the epidemiology, etiology, mechanisms of pathophysiology and symptomatology of MPM is carried out.
Malignant pleural mesothelioma: a comprehensive review
Cancer control : journal of the Moffitt Cancer Center, 2006
The incidence of malignant mesothelioma continues to increase, but the disease remains difficult to detect early and treat effectively. The authors review the pathogenesis, incidence, clinical presentation, diagnosis, pathology, and both standard and experimental treatments for mesothelioma. When possible, surgery (video-assisted thoracoscopy, pleurectomy/decortication, or extrapleural pneumonectomy) is utilized. Effects on underlying structures limit application of radiation therapy, but some systemic agents are beginning to enhance survival. The disease is expected to increase in incidence till 2020, so awareness of this entity as a possible diagnosis should be heightened. In patients with advanced disease, several newer antitumor agents are already showing a capability of extending survival so it is not unreasonable to expect further progress in this area.
Malignant pleural mesothelioma: Presentation of a case report
Egyptian Journal of Basic and Applied Sciences, 2018
Malignant pleural mesothelioma (MPM) is a rare and highly aggressive intrathoracic neoplasm that typically offer poor prognosis. In general, development of MPM is linked with a history of asbestos exposure. Herein we report a 56-year-old female patient with MPM, who presented with complains of chest pain, cough, shortness of breath and weight loss. The patient's radiological work-up demonstrated right sided plural effusion with circumferential plural thickening and loss of lung volume. Histopathological features in tandem with immunohistochemical (IHC) study were consistent with the diagnosis of MPM. Our study illustrate that MPM is an uncommon and highly aggressive malignancy associated with poor prognosis.