Pleural mesothelioma

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Classification according to ICD-10
C45.0 Pleural mesothelioma
ICD-10 online (WHO version 2019)
Pleural mesothelioma on the left in the X-ray (right side of the picture)

(Malignant) pleural mesothelioma is a malignant tumor of the pleura ( pleura ) originating from the mesothelial cells (coelomic epithelium ). The cause of the disease was first described by inhaled asbestos dust in South Africa in 1960.

causes

Asbestos can be assumed to be the cause in about half of the cases (in men> 80%, in women <40%). When exposed to asbestos, this tumor is recognized as an occupational disease (No. 4105). Detecting exposure is often difficult, however, as mesothelioma has a latency period of 20 to 40 years. Also radioactivity and viruses are associated with the pleural mesothelioma in combination. However, exposure to asbestos can be assumed in association with calcifying pleural plaques.

Symptoms

Coughing, shortness of breath, weight loss, weakness and pain in the chest are possible leading symptoms of pleural mesothelioma.

pathology

  • epithelial mesothelioma (50–60%)
  • biphasic mesothelioma (mixed type of epithelioid and sarcomadoid mesothelioma) (20-30%)
  • sarcomadoides mesothelioma (10–20%) (with a worse prognosis)

The malignant tumor grows around the entire lung following the pleura, penetrating the superficial parts of the lung tissue and the surrounding tissue ( pericardium , diaphragm ). Mesothelioma is often accompanied by a bloody (hemorrhagic) pleural effusion . A metastasis to regional lymph nodes is common.

Immunohistology

Differential diagnosis

diagnosis

Pleural mesothelioma on computed tomography left pleura (right in the picture). One recognizes the jacket-shaped thickening of the pleura, which is particularly typical on the side of the mediastinum . The pleura is also thickened in the lobe gap.

The diagnosis is usually only made at an advanced stage. To confirm the diagnosis, an X-ray, CT or MRI of the lungs and a bronchoscopy are performed to differentiate a bronchial carcinoma . With pleural puncture , tumor cells can be detected in 30–50% of cases; The 20% risk of the formation of metastases in the puncture canal due to the direct spread of tumor cells (= vaccination metastases) must be taken into account. A pleural puncture alone without evidence of tumor cells does not rule out pleural mesothelioma. Thoracoscopy with biopsy , which has to be carried out in cases of doubt, has the highest informative value .

therapy

If it occurs unilaterally, the lung half including the pleura is often removed (pleural pneumonectomy). Both chemotherapy and radiation therapy are used for this tumor. Since 2003, pemetrexed has been used successfully in chemotherapy, mostly in combination with a substance containing platinum (cis- or carboplatin); since the end of 2004, health insurance companies have paid for the costs. A study published in 2015 reports an additional benefit from the simultaneous administration of the angiogenesis inhibitor bevacizumab . An extension of the lifespan of approx. Three months can be assumed, which occurs through an improvement in the general condition in the middle of the therapy (approx. Six sessions at monthly intervals). However, a standstill or regression of the tumor cannot be assumed, afterwards progression , i.e. further growth of the tumor, involvement of the lymph nodes and metastases occur.

forecast

It is a very aggressive tumor that is usually diagnosed very late. Therefore, the median survival time is 7 to 16 months after diagnosis. Favorable prognostic factors are female gender, epitheloid histological subtype, age at diagnosis below 75 years. General factors that speak in favor of a poor prognosis are a high tumor status ( TNM ), weight loss, and deterioration in general health (e.g. determined by the Karnofsky index ). A low hemoglobin value, leukocytosis and thrombocytosis , and high LDH values are also often given as poor prognostic factors.

Individual evidence

  1. ↑ M. Ray, HL Kindler: Malignant pleural mesothelioma: an update on biomarkers and treatment. In: Chest. Volume 136, Number 3, September 2009, pp. 888-896, ISSN  1931-3543 . doi: 10.1378 / chest.08-2665 . PMID 19736192 . (Review).
  2. ↑ a b A. Scherpereel, P. Astoul, P. Baas, T. Berghmans, H. Clayson: Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma . In: European Respiratory Journal . tape 35 , no. 3 , March 1, 2010, ISSN  0903-1936 , p. 479-495 , doi : 10.1183 / 09031936.00063109 , PMID 19717482 ( ersjournals.com [accessed April 21, 2016]).
  3. ↑ GL Ceresoli: Therapeutic outcome according to histologic subtype in 121 patients with malignant pleural mesothelioma. In: Lung Cancer . 2001 Nov; 34 (2), pp. 279-287.
  4. ↑ Zalcman et al., Bevacizumab 15mg / kg plus cisplatin-pemetrexed (CP) triplet versus CP doublet in Malignant Pleural Mesothelioma (MPM): Results of the IFCT-GFPC-0701 MAPS randomized phase 3 trial. J Clin Oncol 33, 2015 (suppl; abstr 7500)

Web links

Commons : Mesothelioma  - Collection of pictures, videos and audio files