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MesotheliomaBy ScholarRx
Updated May 27, 2021
access_time14 min
Learning Objectives (4)
After completing this brick, you will be able to:
● Describe the work-up and treatment of mesothelioma.
● 1
● Describe the cellular origin and gross and microscopic appearance of
mesothelioma. Explain the difference between epithelioid type,
sarcomatoid type, and mixed-type mesothelioma.
● 2
● Describe the association between asbestos and mesothelioma, and
list occupations that have the highest risk for development of
mesothelioma; describe the common presenting signs and
symptoms, course, and prognosis of patients with mesothelioma.
● 3
● Define mesothelioma.
● 4
cableCASE CONNECTION
GB is a 70-year-old man who you are seeing for evaluation of cough
and weight loss. His son, SB, is interpreting for his father, who is not
fluent in English. SB tells you, “My father has had a cough for several
months. Lately he has lost weight; you see how his pants are too big
and his neck is thin. He didn’t want to see a doctor because it would
be expensive and there would be a lot of tests that he wouldn’t like.”
You thank SB for helping you speak with GB. You learn that he has
,been a lifelong smoker and worked as a miner in another country. On
exam, he coughs sometimes when he takes deep breaths. There are
crackles in both lung bases. You look for clubbing and notice he has
thick, strong hands that give you a hint of how hard GB has worked.
SB asks, “Does he need tests?”
How will you approach GB’s diagnostic work-up? Consider your
answer as you read, and we’ll revisit at the end of the brick.
What Is Mesothelioma?
Mesothelioma is a cancer derived from the epithelial component of
serosa—the tissue lining the body cavities and organs. This lining is
found in the thoracic cavity (pleura), the mediastinum (pericardium),
and the abdominopelvic cavity (peritoneum). The inner layer that
lines the organ is called visceral mesothelium; the outer layer that
lines the cavity wall is called parietal mesothelium. Although
mesothelioma can occur in many areas of the body, the pleura is by
far the most common location and that will be our focus here.
You might expect mesotheliomas to be benign tumors based on their
name. But they are actually malignant. This confusion stems from the
fact that most malignant tumors end in the suffix -carcinoma or
-sarcoma. Examples include fat tumors (benign: lipoma; malignant:
liposarcoma), smooth muscle tumors (benign: leiomyoma; malignant:
leiomyosarcoma), and glandular tumors (benign: adenoma; malignant:
adenocarcinoma). Despite the misnomer, mesotheliomas are
malignant tumors of the mesothelium.
,Pleural mesothelioma is a rare malignancy, with a declining annual
incidence; about 3200 cases are now diagnosed in the United States
each year. The single greatest risk factor for development of
mesothelioma is asbestos exposure. In the past, asbestos was used
widely throughout the United States as a flame retardant because of
its resistance to heat and fire and as an insulator because of its
electrical insulation properties. It was commonly found in
construction, wire insulation, and numerous other materials and
textiles.
Asbestos is no longer used in construction, but it is still present in
older buildings and easily inhaled during demolition. The most at-risk
occupations for asbestos exposure include construction workers,
shipyard workers, factory workers, and firefighters. Although cases
are declining in the United States, they are on the rise in other
industrialized nations.
peopleCLINICAL CORRELATION
Mesothelioma is a common complication of asbestos exposure.
Patients with chronic asbestos inhalation can also develop asbestosis.
Asbestosis is characterized by diffuse fibrosis of the pulmonary
interstitium, which can be seen on pulmonary function testing as
reduced diffusion capacity, restricted lung volumes, and decreased
lung compliance. Asbestosis management focuses on maximizing
respiratory function and monitoring for malignancy.
, What Is the Typical Clinical
Presentation?
The typical pulmonary mesothelioma patient is an elderly man
presenting with shortness of breath, chest pain, cough, and weight
loss. It most often occurs late in life because there is typically a
latency period of decades from asbestos exposure to disease
development. Most patients are diagnosed at 65 years or older, and the
highest rates are seen in people older than 80 years. It also occurs
predominately in men, who have almost five times the incidence of
women. The onset tends to be slow and insidious, with an average of
2-3 months between the start of symptoms and diagnosis. For those
who are asymptomatic, pleural effusions (fluid buildup within the
pleural space), pleural plaques (collagen fiber deposition), and pleural
calcifications may be found incidentally on chest imaging (Figure 1
and Figure 2).
QUIZ
Figure 1
Credit: ©ScholarRx
QUIZ
Figure 2
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