Malignant Mesothelioma : Types, Prognosis, Diagnosis and Treatment

Malignant Mesothelioma : ( Mesothelioma meaning in Hindiमेसोथेलियोमा )

 

Terminologies : Let’s know about some terminologies first before going to the main article as they are exclusively used in Medical sciences.
1. Mesothelium : Thin layer of protective tissue that covers the outer surface of many internal organs such as the heart, abdomen and lung.
2. Mesothelioma meaning : Cancer arising from the mesothelium.
3. Pleura : Protective lining around lung ( mesothelium lining of lung ).
4. Peritoneum : Protective lining of the abdominal cavity ( mesothelium lining of abdominal cavity ).
5. Pericardium : Mesothelium layer around heart.

Introduction :

Mesothelioma is a type of cancer arising from mesothelium. Three out of every four cases of mesothelioma begin in pleura. Apart from pleura it also arises from peritoneum, pericardial layer and around testis. 

Types

MOST COMMON FORM OF MESOTHELIOMA IS : PLEURAL MESOTHELIOMA
LEAST COMMON FORM OF MESOTHELIOMA IS : TESTICULAR MESOTHELIOMA
Prognosis : Mesothelioma is an aggressive cancer and spreads quickly. Only 9% of patients can survive 5 years after diagnosis.

Mesothelioma pathology outlines :

  1. Risk factor : Mesothelioma is caused by toxicity of asbestosis.
  2. Latent period : 25-40 years
  3. Occupational history : Most of the patients has a history of working in a shipping industry.
  4. Gender Predilection : Male > Female
  5. Genetics : Mutation in p53
  6. Histopathology : H & E stain – 1) Spindle cells Types of histology of mesothelioma

 

                                                  2) Epitheloid cells

                                                 3) Sarcomatoid cells

7. Mesothelioma immunohistochemistry : Calretinin
8. Electron microscopy : Long slender microvilli or tonofilaments

         9. Mesothelioma histology : Malignant Mesothelioma histology

 


Mesothelioma vs adenocarcinoma pathology outlines :

Malignant Mesothelioma Lung Adenocarcinoma
Asbestosis exposure for 25-40 years Exposure for 10-30 years
Calretinin Positive Calretinin Negative
Vimentin Positive Vimentin Negative
TTF 1 Negative TTF 1 Positive

Electron Microscopy : Long Slender Microvilli

Short Plump Villi

   


Malignant Mesothelioma Symptoms ( Mesothelioma Causes ):
1) Pleural mesothelioma cancer :Location of mesothelioma
i) Coughing often painful
ii) Unintended weight loss
iii) Shortness of breath
iv) Chest pain under rib cage
v) Fatigue
In severe cases
– Pneumothorax
– Lung collapse
– Tumor under the skin of the chest
2) Peritoneal mesothelioma cancer :
i) Abdominal swelling
ii) Pain in abdomen
iii) Unintended weight loss
iv) Fever
v) Night sweat
vi) Poor appetite
vii) Constipation
viii) Vomiting
In severe cases
– Trouble swallowing
– Swelling of neck and face
3) Pericardial mesothelioma cancer :
i. Shortness of breath
ii. Low Blood Pressure
iii. Chest Pain
iv. Extreme fatigue
v. Palpitation


   Diagnosis :

If symptoms resemble for  Malignant Mesothelioma , history of asbestos exposure is taken and physical examination is done. Next, Chest X-ray followed by CT Scan/ MRI is required. Mesothelioma radiology features is seen like pleural opacity on chest X-Ray, pleural thickening on  CT scan. Biopsy from the lesion is taken for confirmation of diagnosis.
Types of biopsy done in case of mesothelioma :Mesothelioma radiology
i. FNAC ( Fine needle aspiration cytology)
ii. Thoracoscopy
iii. Laparoscopy
iv. Thoracotomy
v. Laparotomy
Staging : Malignant Mesothelioma staging is done by determining the extent to which the cancer has developed by growing and spreading. It is staged from I – IV. Stage I is when mesothelioma is confined to mesothelium itself and Stage IV is when the cancer has spread to lung and other organs.
Treatment of Malignant Mesothelioma  : Treatment depends upon the location, stage, age and general  health of the patient.
i. Surgery : Surgery is done if the cancer is detected in the early stage
ii. Radiation therapy
iii. Chemotherapy

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This Article Written By Dr. Manaj Mondal (M.B.B.S)

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