Multimodality therapy for diffuse malignant pleural mesothelioma

Despite the rising incidence of diffuse malignant pleural mesothelioma (MPM), there is still no standard treatment for this disease, and the prognosis for patients remains poor. Recently, long-term survival has been reported when multimodality therapy is used, combining extrapleural pneumonectomy with perioperative chemotherapy and/or radiotherapy in highly selected patients. We report a case of a patient who presented with MPM, accompanied by a large malignant pleural effusion and pneumothorax, who was successfully treated with combination therapy. After being diagnosed with epithelial type MPM using thoracoscopic surgery, the patient underwent extrapleural pneumonectomy. Examination of the surgical specimen revealed invasion of the chest wall muscle and fat, as well as several positive mediastinal lymph nodes. The patient received 2 courses of postoperative chemotherapy using cisplatin and gemcitabine. He is currently alive and has been disease-free for 2 years.     

A case of localized pleural mesothelioma

A case of localized pleural mesothelioma is reported. A 49-year-old man was operated for coin lesion detected on routine chest X-ray. A tumor arose from the visceral pleura of right lower lobe and was pedunculated. Size of the tumor was 4 x 3 x 3 cm. Cut surface of the tumor was solid and yellowish white. Pathological diagnosis was fibrous type of the pleural mesothelioma. The patient is well and has no sign of recurrence for three years. There are 123 cases of localized pleural mesothelioma including our case in Japan. Five in 78 cases which was diagnosed to be benign histologically at operation, had recurrence later. It is important to follow up strictly for long term.     

A case of localized pleural mesothelioma

A 68-year-old male with localized pleural mesothelioma was described. The tumor was removed surgically in association with left upper pulmonary lobe and regional lymph nodes, since low grade malignancy had been suggested by preoperative needle biopsy. The operative and macroscopic findings revealed that the tumor was well encapsulated and arise from visceral pleura of S3 segment of left upper lobe, projecting into pleural cavity as a pedunculated mass. The tumor measured 9 X 6 X 4 cm in diameter. Based on electron microscopic and immunohistochemical findings of the tumor, the origin of tumor cells was discussed.     

Liposarcomatous differentiation in diffuse pleural mesothelioma.

A case history is presented of a woman who died eight hours after hospital admission with severe breathlessness. At necropsy the right lung was encased in a thickened pleura with a large tumour. Histological examination of the tumour showed pleural mesothelioma with liposarcomatous differentiation. The lungs showed changes of asbestosis and the asbestos fibre count was significantly raised. Liposarcomatous differentiation in pleural mesothelioma has not been reported previously.     

Hypoglycemic pleural mesothelioma. A case report

Organic hypoglycemia occurs in pancreatic and mesenchymal tumors. Thirty percent of extrapancreatic tumors are intrathoracic. A patient with hypoglycemic pleural mesothelioma was treated by surgical excision without recurrence five years after surgery. The mechanisms of hypoglycemia are not clearly established. The recurrence of hypoglycemia is a good sign of tumor recurrence.     

A case of diffuse pleural mesothelioma in which contralateral exploratory thoracoscopy assisted the selection of therapy.

Diffuse pleural mesothelioma is a rare condition with a poor prognosis. Recent reports have indicated that extensive surgery combined with chemotherapy and radiotherapy prolongs the survival of selected patients with early disease. Thoracoscopy allows complete visualization of the pleural cavity and provides high-quality biopsy samples. We present a case of successful diagnosis of bilateral pleural mesothelioma by thoracoscopy. It is important to observe the contralateral pleural cavity by thoracoscopy to confirm the presence or absence of a tumor before considering extrapleural pneumonectomy for mesothelioma.     

Extrapleural pneumonectomy for diffuse malignant pleural mesothelioma: techniques and complications

Innovative therapeutic agents and strategies are being investigated to improve survival with this lethal disease. New chemotherapy agents, including gemcitabine (Eli Lilly and Company; Indianapolis, Indiana) and pemtrexed (Eli Lilly and Company) show promise against mesothelioma. Kaiser has reported using novel therapies, such as cytokines and suicide gene therapy, to target mesothelioma. Pass et al , Moskal et al , Schouwink et al , and Friedberg et al have applied photodynamic therapy to the hemithorax after surgical resection. Because recurrence of mesothelioma after surgical resections tends be locoregional rather than distant , strategies to improve local control may be beneficial. Several groups, including our Brigham and Women's Hospital Thoracic Surgery Division and Dana Farber Thoracic Oncology Program, are investigating intraoperative intracavitary lavage of hyperthermic chemotherapy immediately after EP (discussed elsewhere in this issue). Although mesothelioma remains a difficult disease to treat, the techniques of surgical resection for mesothelioma have improved dramatically. Currently, EPP can be performed with acceptable morbidity and mortality at experienced centers.     

A case of malignant localized visceral pleural mesothelioma]

We experienced malignant localized mesothelioma of which origin was visceral pleura. According to, 1) the preoperative chest X-ray and chest CT which showed extra-pleural sign, 2) the rapid tumor growth, and 3) the result from needle biopsy, we diagnosed malignant localized mesothelioma of which origin was parietal pleura. Surgical treatment was performed, and diagnosed that its origin was visceral pleura. The tumor invaded the lung. It is dangerous to diagnose by means of needle biopsy because of malignant cell implantation. We recommend that firstly the surgical treatment should be carried out for malignant mesothelioma, which needs extended resection for preventing its recurrence.     

Rare case of benign pleural fibrous mesothelioma: A surgical experience

Conclusion Case study demonstrates importance of keeping pleural pathology in mind while dealing with all peripheral space occupying lesions of the thorax. ACT guided biopsy can serve as the best diagnostic tool and surgical excision should be employed as the definitive procedure in all cases at the earliest.     

Clinical aspects and therapy of benign pleural mesothelioma. A case report

It is reported on a large benign monophasic fibrous mesothelioma. Despite its enormous size it was clinically silent and caused considerable problems in diagnosis and localisation. Computed tomography and arteriography suggested that the tumour, which was attached to the diaphragm and vascularized by strong vessels of the left gastric artery arose from the retroperitoneum. Therefore, falsely, the patient underwent initial laparotomy. At thoracotomy, the pedunculated tumour war easily removed. Histiogenesis and prognosis are evaluated in detail.     

Malignant pleural mesothelioma

Malignant pleural mesothelioma carries a poor prognosis, for which no standard therapy has been established. We report 15 cases of malignant pleural mesothelioma experienced since 2000 focusing on their clinical features. They included 14 male and 1 female aged 38 to 81 (62.8 on average) years. All patients were diagnosed by pleural biopsy under thoracoscopic guidance. Histology of the pleural biopsy specimen showed epithelial mesothelioma in 8 patients, biphasic mesothelioma in 3, sarcomatous mesothelioma in 2 and desmoplastic malignant mesothelioma (DMM) in 2. Twelve patients received chemotherapy. Of these, 3 were followed by surgery. In addition to 2 of these 3 patients, 2 underwent extrapleural pneumonectomy (EPP) without adjuvant treatment. Remaining 1 received palliative treatment only. As a result, 6 patients are surviving, 7 died of primary diseases and 2 died of other diseases. The longest survival time with chemotherapy is 41 months in a surviving patient with epithelial mesothelioma and that with EPP is 25 months in a surviving patient with DMM. The 2-year survival rate of the 14 patients was 44.4% and the median survival time in patients with epithelial mesothelioma was 30.6 months.     

Extrapleural pneumonectomy for malignant pleural mesothelioma

We analyzed 14 patients with malignant pleural mesothelioma (MPM) who underwent extrapleural pneumonectomy (EPP). 14 men had a mean age of 58.5 years. Preoperarive histological diagnosis was as follows: epithelial 12, biphasic 1, sarcomatous 1. Postoperative diagnosis was: 8, 5, 1, respectively. According to staging of International Mesothelioma Interest Group (IMIG), 3 patients had stage 11 disease, 8 did stage Ill and 3 did stage IV, postoperatively. The operative mortality rate was 7% (1 death), and morbidity rate was 50% (7 cases). The median survival time and 2- and 5-year survival rate were 20.2 months, 33. 8.3%, respectively. EPP for strictly selected patients has been successful in improving survival of patients with negative-node, epithelial type and negative residual tumors.     

Extrapleural pneumonectomy for malignant pleural mesothelioma

Standard treatment for malignant pleural mesothelioma (MPM) has not been proved yet. However, it has been recognized that extrapleural pneumonectomy (EPP) is a treatment of choice for epithelial MPM when combined with adjuvant therapies though EPP may frequently cause fetal complications. We report 5 cases of MPM with EPP, including 1 with good prognosis. Sixteen patients with MPM were admitted to our hospital between 1988 and 2003. Five patients underwent EPP, among which 4 were male and 1 female with ages from 46 to 61 years old. Histologically, 3 of them were epithelial and 2 were biphasic. Those with biphasic experienced acute respiratory failure and empyema, and died 81 days and 8 months after the surgery respectively. Among those with epithelial MPM, 2 are alive with no recurrence at 129 and 29 months after the surgery, and the other, followed by postoperative radiotherapy, died at 12 months. More cases with EPP or randomized controlled trials regarding EPP are necessary to evaluate efficacy of EPP for MPM.