UpToDate - Pleural Mesothelioma Flashcards
Typical presentation of MPM?
60 years and older, typically presenting decades after an exposure to asbestos with gradually worsening, nonspecific pulmonary symptoms and CT showing pleural thickening or an effusion.
What are the three histological subtypes of malignant mesothelioma?
epithelioid, sarcomatoid, and biphasic
How is MPM diagnosed?
morphologic and immunohistochemical features of a cytologic or surgical specimen (ie biopsy)
Discuss the different diagnostic modalities for MPM?
Thora cytology and closed biopsy makes it difficult to differentiate from adenocarcinoma.
VATS has the highest yield.
Do bronchoscopy at time of VATS as endobronchial lesions make MPM unlikely. It also allows for EBUS.
Is there a risk of seeding the biopsy site if undergoing invasive biopsy for pleural mesothelioma?
Yes. 10% chance of chest wall recurrence.
Prophylactic RT is controversial.
Because no single immunohistochemical marker exhibits high sensitivity or specificity, the International Mesothelioma Interest Group recommends using what?
A panel of at least two immunoreactive and two nonimmunoreactive markers to establish the diagnosis of mesothelioma.
Similarly, according to several European expert groups, standard staining procedures are insufficient in approximately 10 percent of cases, justifying the use of specific markers, including BAP1 and cyclin-dependent kinase inhibitor 2A (CDKN2A [p16]), for the separation of atypical mesothelial proliferation from MPM.
What is included in the staging and pre-tx eval of MPM?
Need to ID pts who may benefit from surgical resection as well.
CT w/ contrast and 1mm axial images.
PET-CT to assess mediastinal nodes. Serially done to eval response.
MRI w/ contrast may help eval local extent (brachiocephalic vessels, chest wall, central mediastinal structures, diaphragm).
If imaging suggests resectability, extended surgical staging should be considered - mediastinoscopy vs EBUS, laparoscopy w/ peritoneal lavage to eval subdiaphragmatic involvement.
Prechemo - CBC, LFTs, ALP, LDH (prognostic).
What was survival after diagnosis of MPM?
9-17 mo
What complications cause does in MPM?
Tumor extension below the diaphragm may result in death from small bowel obstruction. Patients may also die from arrhythmias, heart failure, or stroke caused by tumor invasion of the heart or pericardium.
