Mesothelioma information

These are classified as primary and secondary. Primary pleural tumors are mostly mesotheliomas, of which localized benign and diffuse and malignant types are recognized. In both types, fibrous or fibrosar-comatous and epithelioid varieties are seen.
Mixtures of the two histological varieties also occur. Therefore the pathologic classification of easily removable tumor ordinarily arises from the visceral pleura. When it is excised, the symptoms and signs of arthralgia and pulmonary ostearthropathy disappear and longevity seems to be unaffected. These tumors may range in size from a few centimeters to 20 cm or more in diameter.
Diffuse or malignant mesotheliomas, on the other hand, cause chest pain and bloody pleural effusion containing malignant mesothelial cells. These tumors are characterized by findings ranging from multiple papillary projections on both visceral and parietal pleurae to encasement of the entire lung in a thick ring of tumor, with similar findings on the parietal side. Part or all of the pleural space may be obliterated. Metastases are uncommon, except late in the disease, and are often limited to the regional lymph nodes. Extrahoracic metastases do occur. However. Death within 1 or 2 years is the rule in the majority of cases.

The evidence for a causal relationship between exposure to asbestos dust and the development of malignant Mesothelioma is strong. It is based on occupational exposure, with a high incidence of both pleural Mesothelioma and bronchogenic carcinoma in asbestos workers and those exposed to asbestos.
Treatment of malignant Mesothelioma has been unsatisfactory. There have been no cures. Palliation, and a small number of 4-to 7-year survivals have been achieved by "complete" pleurectomy or pleuropneu-monectomy, but the great majority of patients have succumbed within 1 or 2 years of the diagnosis regardless of the type of treatment used. Radiation and chemotherapy or combined treatment is recommended if excision surgery is impossible or incomplete. However none of these treatment modalities has been fully studied in a systematic way"

Pleural involvement by metastatic disease is for more common than primary pleural tumor and is usually associated with implants involving the lung or with blockage of or interference with the lymphatic drainage of the visceral, parietal, diaphragmatic, or mediastinal pleura. The most common sites of primary tumor are the lung, breast , pancreas, and stomach. With direct involvement of the pleura by tumor implants, bloody fluid containing neoplastic cells can often be obtained. Various types of palliative treatment are advocated, depending upon the site of the primary tumor, the expansibility of the lung, the degree of disability from pleural effusion, and so forth. Hormonal therapy, radiation or radioisotope therapy, multiple aspirations of the chest, closed-tube thoracostomy, and the insufflations of talc or the instillation of chemotherapeutic agents (especially quinacrine and tetracycline ) have all been reported with varying degrees of palliation being achieved. Pleurectomy is the most effective, but mortality (10 per cent ) and morbidity 20 per cent ) dictate careful patient selection.

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