| What is most imp benign pleural tumors? | • Benign fibrous tumors. |
| What is most frequent malignant pleural tumors? | Mesothelioma. (most common), Malignant fibrous tumors. |
| What are main fibrous tumors of pleura presentation? | . |
| How is tx of fibrous tumors of pleura? | • Wide local excision, including pulmonary and
pleural resections (lobectomy, pneumonectomy,
etc…).
• Resection of a lesion arising from the parietal
pleura should include the tissue down to the
endothoracic fascia.
• If resection is complete, no indication for
adjuvant therapy (radiation therapy,
chemotherapy) |
| What is mesothelioma? | Different from benign asbestos plaques (more continuous)
• Mean survival: < 1 year.
• Main etiology: asbestos exposure (amiante).
• Male predominance.
• Long latent period (starting of exposure until disease: >20 years).
• Age of appearance: between 50 and 70.
• Incidence: 10 per million inhabitant per year.
Main cause is asbestors, other non asbestos causes: radiation, organic chemicals, chronic inflammation [TB, recurrent diverticulitis, FMF], non specific industrial exposure (shoe industry, petrochemistry, stone cutter, leather factory, Copper, nickle, hereditary predisposition) |
| What are histologic classifications of mesothelioma? | • Epithelial
( Tubulopapillary, Epithelioid IMP, Glandular, Large cell (giant cell), Small cell, Adenoid-cystic ,Signet ring)
• Sarcomatoid (fibrous, sarcomatous, mesenchymal)
• Mixed epithelial-sarcomatoid (biphasic)
• Transitional
• Desmoplastic
• Localized fibrous mesothelioma |
| How is clinical presentation of mesothelioma? | • Early stages: dyspnea (pleural effusion).
• Continuous chest discomfort.
• Advanced stage:
- excruciating chest pain (tumor infiltration of the chest wall and intercostal nerves).
- sense of chest tightness and dyspnea caused by entrapment of the lung by tumor.
- severe and unremitting dyspnea and chest pain
Uncommon sx (cough, weakness, anorexia, fever, hemoptysis, hoaseness, dysphagia, horner's) |
| How is dx of mesothelioma? | • Pleural fluid cytology (positive in 30-50%).
• Pleural biopsy (videothoracoscopic surgery).
• Open surgical pleural biopsy.
• CT scan of the chest and abdomen, and PET scan (diagnose and stage patients).
• Bronchoscopy (exclude a primary lung cancer with endobronchial tumor). |
| How is staging of mesothelioma? | • Stage I: Tumor confined within the the parietal pleura, i.e., involving only ipsilateral pleura, lung, pericardium, and diaphragm.
• Stage II: Tumor invading chest wall or involving mediastinal structures, e.g., esophagus, heart, opposite pleura Lymph node involvement within the chest.
• Stage III:Tumor penetrating diaphragm to involve peritoneum; involvement of opposite pleura Lymph node involvement outside the chest.
• Stage IV: Distant blood-borne metastases |
| How is tx of mesothelioma? | • Surgery. IMP
• Radiation therapy.
• Chemotherapy.
• Immunotherapy.
• Supportive care |
| What is mesothelioma surgery? | • Extrapleural pneumonectomy: en bloc resection of the pleura, lung, ipsilateral hemidiaphragm, and pericardium.
• Pleurectomy-decortication: remove all gross pleural disease without removing the underlying lung, the hemidiaphragm and pericardium are also removed.
• Palliative pleurectomy: limited resection of the parietal pleura to control a pleural effusion by creating a durable pleurodesis. |
| How is right extrapleural pneumonectomy? | Right extrapleural pneumonectomy (Thoracotomy: 5th intercostal space, Extra-pleural anterior dissection, Extra-pleural posterior dissection, Diaphragmatic excision, Pericardial excision, Controlling hilum and stapling its
vascular and bronchial components, Diaphragmatic and Pericardial replacement prostheses) |
| What are results of mesothelioma surgery? | • Operative mortality (according to the center’s experience): 3-30%.
• Two- and five-year survival rates are aproximately 40% and 15%, respectively
Recurrent disease, metastasis |
