All are true regarding mesothelioma except?
Correct Answer: Bilaterally symmetrical
Description: • Malignant mesothelioma is MC tumor of the pleura
• In 20% of malignant mesotheliomas, the tumor arises from peritoneum
• Exposure to asbestos is the major known risk factor
• More common in males, most common after 40 years of age.
• Three types: Epithelial, sarcomatous, and biphasic
• Epithelial types are associated with a more favorable prognosis
Pathophysiology
• Physical characteristics of specific fibers (referred to as serpentine or amphibole) have been shown to be important.
• Serpentine fibers: Large and curly, not able to travel beyond larger airways.
• Straight amphibole fibers: In particular the crocidoliteQ fibers navigate distally into the pulmonary parenchyma, most clearly associated with mesotheliomas.
• Latency period between asbestos exposure and the development of mesothelioma is at least 20 years.
• Multicentric tumor with multiple pleura-based nodules coalescing to form sheets of tumor (but not bilaterally symmetrical)
• Natural history of the disease in untreated patients culminates in death due to local extension.
Clinical Features
• Most patients present with dyspnea and chest pain.
• Over 90% have a pleural effusion.
Diagnosis
• Results of thoracentesis are diagnostic in <10% of patients.
• Chest X-ray: Pleural effusion, generalized pleural thickening and shrunken hemithorax.
• Thoracoscopy or open pleural biopsy with special staining of tumor samples is required to differentiate mesotheliomas from adenocarcinomas.
Management
• No effective therapy
• Treatment options: Supportive care only, surgical resection, and multimodality approaches (using a combination of surgery, chemotherapy, and radiation therapy).
Category:
Surgery
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