Saturday, September 9, 2017

Malignant Pleural Mesothelioma: A Comprehensive Review


Mesothelioma is a rare tumor of mesothelial cells along the pleura. Pleural mesothelioma is rarely localized, benign and easily resect-able for healing. A variant of malignant pleural mesothelioma a localized fibrous tumor of the pleura, which is probably based on a different layer of cells of the pleura, and is usually completely resectable. For purposes of this review is that the most common and most aggressive diffuse malignant pleural mesothelioma (MPM) is discussed.


United States, MPM occurs in about 2,500 people a year, with nearly 200 people diagnosed each year in Florida, and 19% are almost 72 000 cases are expected to occur women1 United States over the next 20 years. In Western Europe, 5,000 patients die from the disease each year. Worldwide, the incidence is rising and it is expected that by the year 2020.2 culmination However, most doctors MPM only a few times to encounter in their careers. His Historically, median survival without treatment was 6 months, which explains the palliative approach of oncologists who treat patients with MPM taken.
Malignant Pleural Mesothelioma: A Comprehensive Review

malignant mesothelioma has been identified, but the link between asbestos and MPM 1870.3 was discovered in South Africa until 1960, when the first convincing evidence of a relationship between mesothelioma and exposure to both accidental and occupational asbestos reported.2, 4 only the second half of the 20th Century, as mesothelioma and lung cancer were also separated entities.2 Thanks to the extraordinary flame retardant properties of asbestos, the substance was common to United States and Europe used in an uncontrolled manner, usually in the shipbuilding industries and construction, between 1940 and 1979, limited the U.S. government to use them. During this period, an estimated 40% of the total, or about 27 million people who have been exposed to asbestos. Although the industrial use has been largely eliminated, asbestos is still present in many buildings, where it is commonly used as insulation and fire retardant. Manmade disasters and natural that could destroy these buildings therefore still exposed to asbestos million Lions. An estimated 10 million New Yorkers were potentially exposed to this carcinogen during the World Trade Center disaster of September 11, 2001, in which the asbestos-laden dust filled the air.

Pleural thickening, benign pleurisy with effusion, and asbestosis. It is unknown why MPM occurs in relatively few people within the large population exposed to asbestos. Only 2% to 10% of people develop a severe and prolonged exposure to asbestos MPM. Conversely, up to 80% of patients had a history of MPM exposure.4 asbestos

To produce due to lack of exposure to asbestos in some patients with MPM as well as violations of the tumor in all exposed individuals, researchers for other etiologies or cofactors for MPM have been looking for. Genetic predisposition for MPM can play an important role, so that even a seemingly trivial or minimal exposure to asbestos can lead to cancer formation. An interesting and controversial putative cofactor in conjunction with the development MPM is exposure to tumorigenic vacuolating simian virus 40 (SV40), one of more than 40 viruses that have infected Macacus monkey kidney cells were used to prepare the batches of vaccine against polio live. SV40 virus gene sequences are displayed using a variety of malignancies, including some brain tumors, sarcomas of bone, non-Hodgkin lymphoma, and in more than 50% of epithelial MPM.5, 6 of the estimated 62% of 92 million citizens who received potentially SV40-contaminated Salk vaccine against polio was used for eight years (1955-1963), who may have received at least one fifth live, infectious containing an SV40 vaccine. Despite numerous studies and very com-Pelling’s possible role and malignant trans-formation ability of SV40 virus in vitro and in animal studies of MPM are not five epidemiological studies of age-specific incidence trends in the U.S. States of MPM in accordance with an aetiological implications of exposure to SV40-contaminated polio virus.7 While testing for SV40 was performed rigorously, not all cohorts born after 1963 SV40-free. A major manufacturer of Europe uses a SV40 off so as not completely inactivate SV40 in oral polio vaccine private and SV40-contaminated vaccines were produced from the 1960s until about 1978 and were used all Throughout the world.8 This remains a most controversial aspect of the etiology and pathogenesis MPM.


Of the two basic types of asbestos fibers over the Amphi-Bole are the most carcinogenic. Their greater biopersistence and the high iron content catalyze the production of reactive oxygen radicals. When inhaled, the fibers are too large to be phagocytosed by pulmonary macrophages, and over the years, they dig back into the peritoneum, pleura, pericardi-order, and the peritoneum. Asbestos can cause a variety of other diseases such as benign pleural plaques, diffuse

Clinical Presentation

The first clinical presentation of most patients with MPM is progressive dyspnea and / or stationary pain.4Dyspnea chest wall is usually the result of a large pleural effusion, and nonpleuritic chest pain is usually caused by the invasion of significant chest wall. It can also be a dry cough, weight loss, fever, fatigue, or night sweats. The disease is most frequently found allies unilateral (95%) in the right breast (60%), and it occurs mainly in men, mostly taken in the sixth to eight Decades. Eighty percent of patients

have an accurate history of exposure to asbestos, often with a 20 – to the latency period of 50 years between asbestos exposure and the development of malignancy. The symptoms of MPM can be insidious and nonspecific, so that the time of first presentation of the diagnosis is often 3 to 6 months. Joint count prior professional exhibitions Pipelayers, plumbers, pipefitters, construction workers and heavy shipbuilding, and workers on ships, especially in the boiler room.


Physical examination and chest radiography large pleural effusion from 80% to 95% of patients with MPM.5 Conversely, 10% to 29% some liquid or not. As the disease progresses, people tend to be less pleural fluid may be present. First, the liquid is free flowing and layers on the chest decubitus Radi-ographs, which is similar in appearance to the outpouring of heart failure may soon empyema, and other benign causes. Later, when MPM progresses, the effusion is compartmentalized. Localized pain in the breast and chest wall showed a large mass and nonresectability invasion of the chest wall.

Thoracic computed tomography (CT) with contrast is a much more sensitive test. CT shows a pleural effusion, the size of lymph nodes in the mediastinum and the hilum and the presence of pleural masses, especially since the tumor to a shell of tissue that surrounds the lungs and are subject to many times in the columns and along the mediastinal pleura and the diaphragm. Although chest wall invasion and trans-diaphragmatic spread of tumor cells may be visible or features on the chest CT, magnetic resonance imaging (MRI) of the chest with contrast, the views Coro-Nal, and sagittal suspicion, is more sensitive to the presentation of which is particularly important when potentially curative surgery is considered for the patient. Figure 1 shows some of the results are usually seen on imaging in the MPM. Can provide emission tomography (PET), additional information in the staging of MPM, as it reliably detects extrathoracic metastases and contralateral breast involvement as a supraclavicular lymph node. In some cases it may be difficult to distinguish the primary tumor from N2 mediastinal lymph node lymph because of their close physical

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