Pleural mesothelioma
Pleural mesothelioma
The Pleuramesothelium is an outgoing of the mesothelial cells (coelomic epithelium) of malignant tumor of the pleura. Disease was first described by the release of asbestos dust inhaled, 1960 in South Africa.
* 1 Causes
* 2 symptoms
* 3 Pathology
* 4 immunohistology
* 5 Differential diagnosis
* 6 Diagnostics
* 7 therapy
* 8 Forecast
* 9 Notes
* 10 Web Links
Pleural mesothelioma Causes
In about half the cases, asbestos can be assumed as the cause. After exposure to asbestos dust or fiber, this tumor is recognized as an occupational disease. demonstrate the exposure is often difficult because a Mesothelioma has a latency period of 20-40 years. Radioactivity and viruses are associated with the name pleural mesothelioma. In association with calcified pleural plaques may be assumed to asbestos exposure.
Symptoms
Cough, shortness of breath and chest pain are the main symptoms of pleural mesothelioma.
Pathology
* Epithelioid mesothelioma (50-60%)
* Sarcomadoides mesothelioma (10-20%)
* Biphasic mesothelioma (mixed and epithelioid type of mesothelioma sarcomadoidem) (20-30%)
The malignant tumor of the pleura is growing following around the lungs, passes into the superficial portions of the lung tissue, and the surrounding tissue (pericardium, diaphragm) one. Often, the mesothelioma is accompanied by a bloody (hemorrhagic) pleural effusion. A metastasis to regional lymph nodes is common.
Immunohistology
* Vimentin (neuroectodermal)
* Calretinin
* BerEp4
* Thrombomodulin
* Zytokeration 5
Pleural mesothelioma Differential diagnosis
* Adenocarcinoma of the lung
Diagnosis
Pleural mesothelioma in the left pleura CT (right). One can see the envelope-shaped thickening of the pleura, which is typical, especially on the side of the mediastinum. Also in the pleural fissure is thickened.
The diagnosis is usually made at a late stage. To confirm the diagnosis an X-ray, CT or MRI of the lung and a bronchoscopy for differential diagnosis of a bronchial carcinoma is done. When thoracentesis in 30-50% of cases, tumor cells can be detected. The highest significance has thoracoscopy with biopsy. To be noted here that about 20% risk of metastasis in the channel by the direct spread of tumor cells (= Impfmetastasen) is.
Pleural mesothelioma Therapy
If only one half of the lungs often occur together pleura is removed (Pleurapneumoektomie). Both chemotherapy and radiation therapy found in this tumor application. Since 2003, pemetrexed is successfully used in chemotherapy, since the end of 2004 is a cost rather than acquisition by health insurance. It can be assumed to extend the life time of about 3 months, which enters through an improvement of general condition in the middle of treatment (approximately 6 meetings every month). A halt or decrease the tumor can not be accepted after that occurs usually progressive, so further growth of the tumor, involvement of lymph nodes and metastases.
Forecast
It is a very aggressive tumor that is usually diagnosed very late. Therefore, the average survival time is 7-16 months after the first symptoms.