Fact-sheet: Diffuse malignant pleural mesothelioma
Updated on 08/04/2017 at 8:37 AM
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Definition
Malignant tumor of the pleural mesothelium.
5-28% of malignant pleural tumors
3 histologic subtypes:
- epithelioid (60%)
- sarcomatoid (15%)
- biphasic (25%)
Clinical features
History of asbestos exposure, possibly associated with smoking.
- Dyspnea
- Chest pain
Radiography
- Increased pleural opacity
- Pleural effusion
- Retraction of a hemithorax (when there is mediastinal pleural involvement).
- Pleural calcifications, inconstant.
CT
- Irregular pleural thickening
- Pleural effusion
- Retraction of a hemithorax (when there is mediastinal pleural involvement).
- Pleural calcifications (20% of cases)
- Involvement of adjacent structures (ribs, mediastinum, pericardium, diaphragm, peritoneum...)
- Calcified pleural plaques indicating asbestos exposure.
- Assessment for contralateral metastatic pleural involvement.
Management
Sampling by video-assisted thoracoscopy or transthoracic needle biopsy for pathologic analysis.
Surgical (pneumonectomy)
Chemotherapy
Radiation therapy
Differential diagnosis
Localized form: - Pleural effusion of other origin (benign asbestos pleurisy) - Benign pleural plaque - Metastasis to pleura - Peripheral bronchogenic carcinoma - Solitary fibrous tumor Diffuse form: - Metastasis to pleura - Pleural fibrosis - Synovial sarcoma