A membrane covering the lung, the visceral pleura, and the membrane covering the ribs' inner surface is called the parietal pleura. There is a gap between these two membranes, which separates them. Malignant mesothelioma is a cancer of these membranes.
Cancer in these membranes can reach a thickness of 1-2 cm, and fluid/water accumulates in this gap. The patient complains of pain and shortness of breath. In addition, complaints such as cough, weight loss, loss of appetite, and fatigue are also common.
Malignant mesothelioma is very common in our country. Because in our country, exposure to white soil containing asbestos is high. In some regions of Turkey, people use asbestos to whitewash houses in villages. In addition, with the development of the industry, asbestos exposure is also common as an occupational disease. Asbestos exposure can cause cancer even after 20-50 years.
Here, inhaled asbestos fibers enter the cells and reach the lung membrane. It affects the DNA and differentiation of normal cells.
Diagnosis of Malignant Mesothelioma
- Chest x-ray
- Thorax CT
- Definitive diagnosis is biopsy.
- Closed pleural biopsy
- Thoracoscopic/ VATS biopsy
- A pleural biopsy is performed by entering through a single incision.
- MRI or USG
- shows diaphragm and intra-abdominal involvement
- It helps in the differentiation of benign and malignant diseases.
- shows us where invasion is highest, guides the biopsy area's determination, increases diagnostic accuracy.
- contributes to mesothelioma staging.
Types of Malignant Mesothelioma
- Epithelioid type
- We generally operate the epithelioid type.
- Sarcomatoid type
- Biphasic (mixed) type
Note: Malignant Mesothelioma can be confused with lung adenocarcinoma. Because pleural metastases are frequently encountered in adenocarcinomas and may mimic mesothelioma, therefore immunohistochemical examination is essential.
Figure 2. A) Malignant mesothelioma nodules on the lung with thoracoscopic/VATS,
B) Malignant mesothelioma and its nodules on the diaphragm in a patient who was operated on and had his diaphragm removed.
Malignant Mesothelioma Treatment
In malignant mesothelioma, we prefer open surgery (thoracotomy). Some of the steps of the surgery are as follows:
- If a mediastinal lymph node tumor is suspected, mediastinoscopy is performed before thoracotomy.
- Radical pleurectomy/decortication (P/D)
- İs currently the most preferred method.
- Both membranes of the lung are removed,
- The pericardium/heart membrane is removed,
- A synthetic patch replaces the removed pericardium.
- The diaphragm is removed,
- A synthetic patch replaces the removed diaphragm.
- Extrapleural pneumonectomy (EPP)
- Nowadays, it is less preferred.
- The pulmonary membranes, lung, pericardium, and diaphragm are all removed together. Mortality is higher than with other techniques.
- Pleurectomy/decortication (P/D)
- It applies to patients diagnosed very early without pericardial and diaphragmatic involvement. Few patients are diagnosed at this stage.
- The membranes are sometimes removed to relieve chest pain and reduce fluid accumulation.
- Sometimes the general condition is not very good; the surgery risk is high, so we remove just the membranes.
NOTE: In our internationally published article, you can find the results of the patients that have undergone surgery for malignant mesothelioma. If you click on the link below, you can find all the details of the article.
Malign Mezotelyomada ameliyat yaptığımız hastaların sobuçları Tabloda görülmektedir.