Related articles: Pleural mesothelioma
Definition
Pleural mesothelioma is a malignant neoplasm of the pleura, strongly associated with occupational exposure to asbestos (or asbestos).
Asbestos fibers are extremely thin and penetrate through the respiratory tract. At the level of the pulmonary alveoli, the inhaled particles trigger an immune response: macrophages absorb these foreign bodies and locally release cytokines and growth factors that stimulate an inflammatory reaction. This leads to the deposition of collagen and, finally, to interstitial fibrosis (asbestosis).
Asbestos fibers can also exert a directly toxic and indirectly mutagenic action for pleura and lung tissue. The time between exposure to asbestos and the appearance of mesothelioma can be very long, in the order of several decades.
Other factors that may predispose to the development of this neoplasm are some genetic alterations, chest irradiation and previous pulmonary infections (especially those supported by the SV40 virus).
Most common symptoms and signs *
- Anemia
- Anorexia
- Arrhythmia
- Ascites
- Asthenia
- Cachexia
- Catarrh
- Cyanosis
- Language difficulties
- Dysphagia
- Dysphonia
- Dyspnoea
- Drumstick fingers
- Abdominal pain
- Chest pain
- Edema
- hemoptysis
- Hemoptysis
- Temperature
- Shortness of breath
- Hypoxia
- Solitary pulmonary nodule
- Pallor
- Paralysis of the vocal cords
- Weight loss
- thrombocytopenia
- pneumothorax
- Hoarseness
- Reduction of respiratory noise
- Water retention
- Sweating
- Tachycardia
- Cardiac tamponade
- Cough
- thrombocytosis
- Pericardial effusion
- Pleural effusion
Further indications
Mesothelioma can grow locally or metastasize to lymph nodes, heart, peritoneum, liver and kidneys. At the onset, the symptoms are rare. As the disease progresses, dyspnea and chest pain appear, and there is a nodular thickening of the pleura. Invasion of the chest wall and the involvement of neighboring structures can cause persistent cough, low-grade fever, weight loss, sweating, hoarseness, dysphagia, vocal cord paralysis, abdominal pain and ascites. In most cases, there are effusions in the space between the two pleural sheets, typically unilateral, broad and hemorrhagic.
Long-term survival is rare.
The mesothelioma assessment includes a thorough medical history, with particular attention to occupational exposure to asbestos fibers, a complete physical examination and chest X-ray.
Often, this tumor is difficult to diagnose and usually requires a pleural biopsy or cytological examination of the pleural fluid. Staging is performed with a chest CT scan, a mediastinoscopy and an MRI scan.
Unfortunately, pleural mesothelioma is a very aggressive malignancy: surgical and chemotherapy options have limited benefits and often do not significantly prolong survival. The main goals of the therapy are relief of pain and dyspnea from pleural effusion by pleurodesis or pleurectomy. If the tumor is at an early stage, surgical resection of the tumor mass may be attempted.
