Mesothelioma is a malignant (more often) tumor growing from mesothelial tissue, with areas of fusiform sarcomatoid cells and adenomatous tissue. As a rule, the tumor is found in the pleura and peritoneum, less often in the testicle and joints. It grows as a thick layer covering the internal organs, and consists of spindle-shaped cells and fibrous tissue.
Mesothelioma is an aggressive malignant tumor that develops on the surface of the pleura and sometimes grows locally. However, more often it diffusely spreads along the inner surface of the pleura and penetrates into the pericardium.
Usually at patients pleural effusion is observed and bilateral tumor is sometimes formed. In some cases, primary peritoneal mesothelioma develops, which does not affect the pleura; at the same time, in patients with a primary lesion of the pleura, symptoms of peritoneal damage sometimes appear. In the past, most patients with mesothelioma had long-term exposure to asbestos, and tumor development is usually preceded by a long latent period, sometimes up to 20 years.
ICD-10 • C45 Mesothelioma • D19 Benign neoplasm of mesothelial tissue
Risk factors :
- prolonged exposure to asbestos,
- Benign mesothelioma – non-metastasizing mesothelioma in the form of a node on a stalk or broad base.
- Malignant mesothelioma (coelomic cancer, sarcomatous endothelioma) is characterized by infiltrating growth and a tendency to early metastasis.
- Pleural mesothelioma (ICD-10. C45.0 Pleural mesothelioma)
- shortness of breath (associated with exudative pleurisy),
- chest pain (due to tumor growth in the intercostal space),
- cough and hemoptysis, weight loss.
- survey radiography of the chest;
- pleural puncture, effusion evacuation and its cytological examination;
- thoracoscopy and tumor biopsy.
TNM classification including direct germination
- N2 – metastases in the lymph nodes of the mediastinum on the side of the lesion and / or bifurcation (subcarinal)
- N3 – metastases in the lymph nodes:
- mediastinum or root of the lung on the opposite side;
- preskalnye or supraclavicular (on any side).
- Stage I: T1–2N0M0
- Stage II: T1–2N1M0
- Stage III
- Stage IV
- T1–4N0- 3M1.
- Radical treatment is possible only with surgical removal of limited forms of mesothelioma, which is rarely possible.
- The scope of the operation can vary from excision of the pleura tumor with underlying tissues to pleuropulmonaryectomy, which, however, does not improve long-term results.
- The main method of treatment for most patients is polychemotherapy various combinations of drugs using platinum (standard schemes have not been developed), including intrapleural administration of drugs. Pleural punctures or microdrainage.
- Thiotepa 20 mg in 6–8 ml of 0.9% sodium chloride intrapleurally 1–2 times/week
- Pleurodesis: thoracoscopy with talc spray or tetracycline treatment to obliterate the pleural cavity.
- Radiation therapy is of low efficiency.
The prognosis is unfavorable; the tumor grows rapidly, early metastasizes to the lymph nodes of the mediastinum.
Localized fibrous mesothelioma
Localized fibrous mesothelioma (solitary fibrous tumor) is formed mainly from the visceral pleura. Most of these tumors are benign, which determines a very favorable prognosis • Clinical picture: chest discomfort, severe shortness of breath, hypertrophic pulmonary osteoarthropathy syndrome with arthralgia of the hands, elbows and knees, “drumsticks” (develop later) • Treatment: tumor resection, symptomatic treatment of hypertrophic pulmonary arthropathy.
Peritoneal mesothelioma occurs more frequently in men over 50 years of age and is usually associated with asbestos exposure and presents with abdominal enlargement, abdominal pain, nausea, vomiting, and weight loss • Diagnosis is by detection of malignant cells in exudate and biopsy specimens obtained by paracentesis, biopsy, or laparotomy • Treatment of localized forms of mesothelioma consists in its radical surgical removal, with diffuse forms, surgical treatment is not indicated, radiation or chemotherapy is used, or a combination thereof; therapy is rarely effective.
Testicular mesothelioma (testicular adenoma, testicular adenofibroma, testicular tumor adenomatous) – mesothelioma emanating from the serous membrane of the testicle, its epididymis and spermatic cord, is characterized by benign growth with the appearance of glandular cavities.
Mesothelioma of the joint
Mesothelioma of the joint (synovioma, synovial endothelioma) – a tumor emanating from the cells of the tendon sheaths or synovial mucous bags • Benign synovioma (giant cell tumor of the tendon sheaths, tendon giantoma, giant cell synovioma, xanthomatous synovioma, synovioendothelioma, tendosinovit nodosum) – benign tumor finger), consisting of fibroblasts and giant cells •
Malignant synovioma (synovial sarcoma, synovial sarcoendothelioma, malignant synovialoma) comes from the elements of the tendon sheaths, articular and mucous bags.