BACKGROUND Primary malignant pericardial mesothelioma(PMPM)is an extremely rare malignant tumor,and it is difficult to diagnose definitively before death.We present a case in which PMPM was diagnosed at autopsy.We con...BACKGROUND Primary malignant pericardial mesothelioma(PMPM)is an extremely rare malignant tumor,and it is difficult to diagnose definitively before death.We present a case in which PMPM was diagnosed at autopsy.We consider this case to be highly suggestive and report it here.CASE SUMMARY A 78-year-old male presented with transient loss of consciousness and falls.The transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease,fever with dehydration,and paroxysmal atrial fibrillation.Ultrasound cardiography(UCG)and computed tomography showed cardiac enlargement and high-density pericardial effusion.We considered pericardial disease to be the main pathogenesis of this case.Cardiac magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the pericardium.Pericardial biopsy was considered to establish a definitive diagnosis,but the patient and his family refused further treatment and examinations,and the patient was followed conservatively.We noticed a thickening of the pericardium and massive changes in the pericardium on UCG over time.We performed an autopsy 60 h after the patient died of pneumonia.Giemsa staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor,and immunostaining showed positive and negative factors for the diagnosis of PMPM.Based on these findings,the final diagnosis of PMPM was made.CONCLUSION PMPM has a poor prognosis,and early diagnosis and treatment are important.The temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.展开更多
Pleural mesothelioma is a very aggressive malignancy that arises from the pleural mesothelial cell lining and is linked strongly to prior asbestos exposure.The ban on asbestos has helped to lower the incidence,but in ...Pleural mesothelioma is a very aggressive malignancy that arises from the pleural mesothelial cell lining and is linked strongly to prior asbestos exposure.The ban on asbestos has helped to lower the incidence,but in developing countries like India,it is expected to rise.It has an extended latency period usually progressing over decades and presents with nonspecific symptoms.It has a median survival ranging between 10-22 months.The diagnosis of malignant pleural mesothelioma is challenging and is done using computed tomography(CT),magnetic resonance imaging,or positron emission tomography-CT,with the last two predicting the resectability of the tumor better than CT alone.A pleural biopsy along with an array of immunohistochemical markers,such as p16,BRCA1 associated protein 1,and claudin-4,are required for a definitive diagnosis.Several genetic alterations have prognostic significance as well.The current histological subtype identification is indispensable for decision making because of the new therapeutic avenues being explored.The combination of nivolumab and ipilimumab-based immunotherapy outperformed platinum and pemetrexed-based chemotherapy in terms of survival benefit and improved quality of life especially for non-epithelioid subtypes.However,the latter continues to be a robust treatment option for patients with the epithelioid subtype.Surgery is recommended for resectable cases with radiotherapy being indicated in neoadjuvant,adjuvant,and palliative settings along with systemic treatment.This review article provides an overview of epidemiology,etiology,clinical manifestations,diagnostic approaches(including immunohistochemical and genetic markers),staging,and multidisciplinary approaches to current treatment for malignant pleural mesothelioma using surgery,chemotherapy,immunotherapy,and radiotherapy.It also sheds light on some recent studies(EMPHACIS,CALGB30901,Checkmate-743,etc.)that have led to significant developments in recent years with clinically meaningful results.展开更多
Malignant pleural mesothelioma is a rare primary tumor rising from the pleura and is associated with exposure to asbestos fibers. Mesothelioma is a locally aggressive disease that usually presents at an advanced stage...Malignant pleural mesothelioma is a rare primary tumor rising from the pleura and is associated with exposure to asbestos fibers. Mesothelioma is a locally aggressive disease that usually presents at an advanced stage and has a median overall survival of 1 year. Treatment options rarely result in cure of disease and range from trimodality treatment, including chemotherapy, radiation, and surgery, to supportive care. In patients with limited local disease and good functional status, trimodality treatment with extra-pleural pneumonectomy, chemotherapy, and radiation is frequently employed. Best supportive care should be instituted for patients with metastatic disease and poor functional status. Palliative therapy focuses on control of pleural effusions with drainage techniques and pain with radiation therapy. Novel therapies are showing promise, including photodynamic therapy, immunotherapy, and molecular targeted therapy.展开更多
Objective: To summarize the experience in the diagnosis of mesothelioma. Methods: Analyzing the clinical data of 19 patients with pleural mesothelioma, including age, history of exposure to asbestos, clinical manifest...Objective: To summarize the experience in the diagnosis of mesothelioma. Methods: Analyzing the clinical data of 19 patients with pleural mesothelioma, including age, history of exposure to asbestos, clinical manifestations, imaging and laboratory examinations and metastases. Results: None of the 19 patients had a history of exposure to asbestos. Eight cases (42.1%) had no obvious thoracodynia, 9 cases (47.4%) had pleural effusion limited to the right chest, and in 2 cases (10.5%) the brachialis plexus was involved, and in 1 case (5.3%) malignant mesothelial cells were detected in the pleural effusion. Pleural thickening or nodules were found in 13 cases on CT and in 9 cases by B ultrasonographic examination. Conclusion: Exposure to asbestos is not the only cause of pleural mesothelioma. Chest pain is not always associated with pleural mesothelioma. CT and B ultrasonography are a help in the diagnosis of pleural mesothelioma.展开更多
Benign multicystic peritoneal mesothelioma(BMPM)is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women.A 56-year-old Caucasian male was admitted to our surgical department with a chie...Benign multicystic peritoneal mesothelioma(BMPM)is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women.A 56-year-old Caucasian male was admitted to our surgical department with a chief complaint of a painful mass in his right lower abdomen for almost 2 years.The physical examination revealed a palpable painful mass.Computed tomography demonstrated an irregular,cystic tumor in his right lower abdomen.There was no obvious capsule or internal septations.No enhancement after intravenous administration of contrast was noted.An exploratory laparotomy was performed,and a multicystic tumor and adherent to the caecum was noted.The walls of the cysts were thin and smooth,filled with clear fluid,and very friable.An en bloc resection of the tumor,including appendix and caecum,was performed.Histological examination revealed multiple cysts lined with flattened simple epithelial cells,and the capsule walls of the cysts were composed of fibrous tissue.Immunohistochemical analysis documented positive expression of mesothelial cells and calretinin.The final diagnosis was BMPM.The patient was well at 6-mo follow-up.BMPM is exceedingly rare lesion.A complete resection of the tumor is required.The diagnosis of BMPM is based on pathological analysis.展开更多
The aim of this study is to compare and discuss the efficacy of FDG PET/CT （fludeoxyglucose positron emission tomography/computated tomography） in the diagnosis, staging, prognosis, pre-therapeutic planning, therape...The aim of this study is to compare and discuss the efficacy of FDG PET/CT （fludeoxyglucose positron emission tomography/computated tomography） in the diagnosis, staging, prognosis, pre-therapeutic planning, therapeutic assessment and detecting recurrence of mesothelioma. Following method has been used： （1） Search setting on PubMed （by priority）： meta-analysis, randomized controlled trial, other study types; （2） The key words： ＂FDG PET/CT＂, ＂mesothelioma＂, ＂diagnosis＂, ＂staging＂, ＂prognosis＂, ＂therapeutic＂, ＂assessment＂ and ＂recurrences＂; （3） Review the literature that discusses the imaging modalities in the management of mesothelioma; （4） Create an evidence table; （5） Compare and discuss the different modalities and their sensitivity and specificity in managing mesothelioma; （6） Construct the passage reviewing the articles chosen. There is evidence that suggests that FDG PET/CT is superior to most other modalities in the diagnosis, staging, prognosis, pre-therapeutic planning, therapeutic assessment and detecting recurrence of mesothelioma. There are some close contenders like PET scan by itself as a modality to detect mesothelioma. However, due to the lack of anatomical presentation, there were many occurrences of misdiagnosis. FDG PET/CT, which superimposes functional imaging over the anatomical mapping, yields a more accurate presentation ofmesothelioma. The nature of this hybrid imaging enables diagnosis and management to be carried-out in a minimally invasive manner. PET/CT to a great extent has tranformed the way we diagnose neoplastic occurences heretofore. By amalgamating anatomic localization to functional imaging, this hybrid modality yields valuable information that was remotely attainable before. Although there are a few flaws to PET/CT that have been discussed in some studies, there is an apparent potential to this modality that is waiting to be uncovered. Evidently, PET/CT is highly effective in differentiating benign and malignant pleural lesion. Likewise, it is substantially useful in the management of mesothelioma particularly in the diagnosis, staging, prognosis, treatment, monitoring and detecting recurrences. With PET/CT having such adequacy in managing mesothelioma, it is imperative to acknowledge and further investigate this modality as a central tool in the management of the latter for the exclusive benefit of the patient.展开更多
Objective:To investigate the significance of computed tomography findings in diffuse malignant peritoneal mesothelioma(DMPeM),tuberculous peritonitis(TBP),and peritoneal carcinomatosis(PC)to differentiate the three di...Objective:To investigate the significance of computed tomography findings in diffuse malignant peritoneal mesothelioma(DMPeM),tuberculous peritonitis(TBP),and peritoneal carcinomatosis(PC)to differentiate the three diseases.Methods:The clinical manifestation and computed tomography scans of 147 patients with diffuse malignant peritoneal mesothelioma(n=60),tuberculous peritonitis(n=32),and peritoneal carcinomatosis(n=55)were retrospectively reviewed,while taking into account of ascites,pleural plaques,viscera infiltration;abnormalities in the peritoneum;involvement of the mesentery and omentum;as well as the presence and location of enlarged lymph nodes.Results:There was no significant difference among all three groups in terms of clinical manifestation,peritoneum,omentum,and mesentery involvement,ascites,as well as the presence and location of enlarged lymph nodes.The study found that 95%of DMPeM patients had been exposed to asbestos in the past.The patients showed significant differences in the following aspects:(1)irregular peritoneum thickening,caked omentum thickening,pleural plaques,visceral infiltration,and asbestos exposure were more common in peritoneal mesothelioma patients;(2)nodular peritoneum thickening and visceral metastasis were more common in patients with peritoneal carcinomatosis;(3)smooth peritoneal thickening,pleural effusion,and extraperitoneal tuberculosis were more common in patients with tuberculous peritonitis.Conclusion:A combination of computed tomography findings could improve our ability in differentiating the three diseases.展开更多
Benign multicystic peritoneal mesothelioma(BMPM)is a rare tumor originating from peritoneal mesothelial cells.Here,we present a case of an 18-year-old male with right lower abdominal pain.Physical examination revealed...Benign multicystic peritoneal mesothelioma(BMPM)is a rare tumor originating from peritoneal mesothelial cells.Here,we present a case of an 18-year-old male with right lower abdominal pain.Physical examination revealed a palpable mass with unclear boundaries.Laboratory tests showed elevated levels of monocytes and high-sensitivity C-reactive protein.CT scan revealed a cystic mass in the ileocecal region with multiple septations.Laparoscopic surgery confirmed a cystic solid mass resembling beads on the colon’s right side.Immunohistochemistry confirmed BMPM diagnosis.BMPM,especially in the ileocecal region,is uncommon and presents diagnostic challenges.Differential diagnosis includes lymphangioma,peritoneal metastasis,and malignant mesothelioma.CT findings,such as thin cyst walls and septations,aid in diagnosis.Recognition of BMPM’s imaging features improves diagnostic accuracy.Surgical resection remains the primary treatment.This case underscores the importance of considering BMPM in young male patients with abdominal pain and emphasizes the value of imaging modalities in accurate diagnosis and management.展开更多
文摘BACKGROUND Primary malignant pericardial mesothelioma(PMPM)is an extremely rare malignant tumor,and it is difficult to diagnose definitively before death.We present a case in which PMPM was diagnosed at autopsy.We consider this case to be highly suggestive and report it here.CASE SUMMARY A 78-year-old male presented with transient loss of consciousness and falls.The transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease,fever with dehydration,and paroxysmal atrial fibrillation.Ultrasound cardiography(UCG)and computed tomography showed cardiac enlargement and high-density pericardial effusion.We considered pericardial disease to be the main pathogenesis of this case.Cardiac magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the pericardium.Pericardial biopsy was considered to establish a definitive diagnosis,but the patient and his family refused further treatment and examinations,and the patient was followed conservatively.We noticed a thickening of the pericardium and massive changes in the pericardium on UCG over time.We performed an autopsy 60 h after the patient died of pneumonia.Giemsa staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor,and immunostaining showed positive and negative factors for the diagnosis of PMPM.Based on these findings,the final diagnosis of PMPM was made.CONCLUSION PMPM has a poor prognosis,and early diagnosis and treatment are important.The temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.
文摘Pleural mesothelioma is a very aggressive malignancy that arises from the pleural mesothelial cell lining and is linked strongly to prior asbestos exposure.The ban on asbestos has helped to lower the incidence,but in developing countries like India,it is expected to rise.It has an extended latency period usually progressing over decades and presents with nonspecific symptoms.It has a median survival ranging between 10-22 months.The diagnosis of malignant pleural mesothelioma is challenging and is done using computed tomography(CT),magnetic resonance imaging,or positron emission tomography-CT,with the last two predicting the resectability of the tumor better than CT alone.A pleural biopsy along with an array of immunohistochemical markers,such as p16,BRCA1 associated protein 1,and claudin-4,are required for a definitive diagnosis.Several genetic alterations have prognostic significance as well.The current histological subtype identification is indispensable for decision making because of the new therapeutic avenues being explored.The combination of nivolumab and ipilimumab-based immunotherapy outperformed platinum and pemetrexed-based chemotherapy in terms of survival benefit and improved quality of life especially for non-epithelioid subtypes.However,the latter continues to be a robust treatment option for patients with the epithelioid subtype.Surgery is recommended for resectable cases with radiotherapy being indicated in neoadjuvant,adjuvant,and palliative settings along with systemic treatment.This review article provides an overview of epidemiology,etiology,clinical manifestations,diagnostic approaches(including immunohistochemical and genetic markers),staging,and multidisciplinary approaches to current treatment for malignant pleural mesothelioma using surgery,chemotherapy,immunotherapy,and radiotherapy.It also sheds light on some recent studies(EMPHACIS,CALGB30901,Checkmate-743,etc.)that have led to significant developments in recent years with clinically meaningful results.
文摘Malignant pleural mesothelioma is a rare primary tumor rising from the pleura and is associated with exposure to asbestos fibers. Mesothelioma is a locally aggressive disease that usually presents at an advanced stage and has a median overall survival of 1 year. Treatment options rarely result in cure of disease and range from trimodality treatment, including chemotherapy, radiation, and surgery, to supportive care. In patients with limited local disease and good functional status, trimodality treatment with extra-pleural pneumonectomy, chemotherapy, and radiation is frequently employed. Best supportive care should be instituted for patients with metastatic disease and poor functional status. Palliative therapy focuses on control of pleural effusions with drainage techniques and pain with radiation therapy. Novel therapies are showing promise, including photodynamic therapy, immunotherapy, and molecular targeted therapy.
文摘Objective: To summarize the experience in the diagnosis of mesothelioma. Methods: Analyzing the clinical data of 19 patients with pleural mesothelioma, including age, history of exposure to asbestos, clinical manifestations, imaging and laboratory examinations and metastases. Results: None of the 19 patients had a history of exposure to asbestos. Eight cases (42.1%) had no obvious thoracodynia, 9 cases (47.4%) had pleural effusion limited to the right chest, and in 2 cases (10.5%) the brachialis plexus was involved, and in 1 case (5.3%) malignant mesothelial cells were detected in the pleural effusion. Pleural thickening or nodules were found in 13 cases on CT and in 9 cases by B ultrasonographic examination. Conclusion: Exposure to asbestos is not the only cause of pleural mesothelioma. Chest pain is not always associated with pleural mesothelioma. CT and B ultrasonography are a help in the diagnosis of pleural mesothelioma.
文摘Benign multicystic peritoneal mesothelioma(BMPM)is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women.A 56-year-old Caucasian male was admitted to our surgical department with a chief complaint of a painful mass in his right lower abdomen for almost 2 years.The physical examination revealed a palpable painful mass.Computed tomography demonstrated an irregular,cystic tumor in his right lower abdomen.There was no obvious capsule or internal septations.No enhancement after intravenous administration of contrast was noted.An exploratory laparotomy was performed,and a multicystic tumor and adherent to the caecum was noted.The walls of the cysts were thin and smooth,filled with clear fluid,and very friable.An en bloc resection of the tumor,including appendix and caecum,was performed.Histological examination revealed multiple cysts lined with flattened simple epithelial cells,and the capsule walls of the cysts were composed of fibrous tissue.Immunohistochemical analysis documented positive expression of mesothelial cells and calretinin.The final diagnosis was BMPM.The patient was well at 6-mo follow-up.BMPM is exceedingly rare lesion.A complete resection of the tumor is required.The diagnosis of BMPM is based on pathological analysis.
文摘The aim of this study is to compare and discuss the efficacy of FDG PET/CT （fludeoxyglucose positron emission tomography/computated tomography） in the diagnosis, staging, prognosis, pre-therapeutic planning, therapeutic assessment and detecting recurrence of mesothelioma. Following method has been used： （1） Search setting on PubMed （by priority）： meta-analysis, randomized controlled trial, other study types; （2） The key words： ＂FDG PET/CT＂, ＂mesothelioma＂, ＂diagnosis＂, ＂staging＂, ＂prognosis＂, ＂therapeutic＂, ＂assessment＂ and ＂recurrences＂; （3） Review the literature that discusses the imaging modalities in the management of mesothelioma; （4） Create an evidence table; （5） Compare and discuss the different modalities and their sensitivity and specificity in managing mesothelioma; （6） Construct the passage reviewing the articles chosen. There is evidence that suggests that FDG PET/CT is superior to most other modalities in the diagnosis, staging, prognosis, pre-therapeutic planning, therapeutic assessment and detecting recurrence of mesothelioma. There are some close contenders like PET scan by itself as a modality to detect mesothelioma. However, due to the lack of anatomical presentation, there were many occurrences of misdiagnosis. FDG PET/CT, which superimposes functional imaging over the anatomical mapping, yields a more accurate presentation ofmesothelioma. The nature of this hybrid imaging enables diagnosis and management to be carried-out in a minimally invasive manner. PET/CT to a great extent has tranformed the way we diagnose neoplastic occurences heretofore. By amalgamating anatomic localization to functional imaging, this hybrid modality yields valuable information that was remotely attainable before. Although there are a few flaws to PET/CT that have been discussed in some studies, there is an apparent potential to this modality that is waiting to be uncovered. Evidently, PET/CT is highly effective in differentiating benign and malignant pleural lesion. Likewise, it is substantially useful in the management of mesothelioma particularly in the diagnosis, staging, prognosis, treatment, monitoring and detecting recurrences. With PET/CT having such adequacy in managing mesothelioma, it is imperative to acknowledge and further investigate this modality as a central tool in the management of the latter for the exclusive benefit of the patient.
文摘Objective:To investigate the significance of computed tomography findings in diffuse malignant peritoneal mesothelioma(DMPeM),tuberculous peritonitis(TBP),and peritoneal carcinomatosis(PC)to differentiate the three diseases.Methods:The clinical manifestation and computed tomography scans of 147 patients with diffuse malignant peritoneal mesothelioma(n=60),tuberculous peritonitis(n=32),and peritoneal carcinomatosis(n=55)were retrospectively reviewed,while taking into account of ascites,pleural plaques,viscera infiltration;abnormalities in the peritoneum;involvement of the mesentery and omentum;as well as the presence and location of enlarged lymph nodes.Results:There was no significant difference among all three groups in terms of clinical manifestation,peritoneum,omentum,and mesentery involvement,ascites,as well as the presence and location of enlarged lymph nodes.The study found that 95%of DMPeM patients had been exposed to asbestos in the past.The patients showed significant differences in the following aspects:(1)irregular peritoneum thickening,caked omentum thickening,pleural plaques,visceral infiltration,and asbestos exposure were more common in peritoneal mesothelioma patients;(2)nodular peritoneum thickening and visceral metastasis were more common in patients with peritoneal carcinomatosis;(3)smooth peritoneal thickening,pleural effusion,and extraperitoneal tuberculosis were more common in patients with tuberculous peritonitis.Conclusion:A combination of computed tomography findings could improve our ability in differentiating the three diseases.
文摘Benign multicystic peritoneal mesothelioma(BMPM)is a rare tumor originating from peritoneal mesothelial cells.Here,we present a case of an 18-year-old male with right lower abdominal pain.Physical examination revealed a palpable mass with unclear boundaries.Laboratory tests showed elevated levels of monocytes and high-sensitivity C-reactive protein.CT scan revealed a cystic mass in the ileocecal region with multiple septations.Laparoscopic surgery confirmed a cystic solid mass resembling beads on the colon’s right side.Immunohistochemistry confirmed BMPM diagnosis.BMPM,especially in the ileocecal region,is uncommon and presents diagnostic challenges.Differential diagnosis includes lymphangioma,peritoneal metastasis,and malignant mesothelioma.CT findings,such as thin cyst walls and septations,aid in diagnosis.Recognition of BMPM’s imaging features improves diagnostic accuracy.Surgical resection remains the primary treatment.This case underscores the importance of considering BMPM in young male patients with abdominal pain and emphasizes the value of imaging modalities in accurate diagnosis and management.
