Mesothelioma Information and Facts, Symptoms and Diagnosis

Mesothelioma Information, Facts About Mesothelioma, Symptoms and Diagnosis.

Mesothelioma Information and Facts, Symptoms and Diagnosis

Mesothelioma Information and Facts, Symptoms and Diagnosis - 
What is Mesothelioma? Mesothelioma cancer of the lining of the lung or the lining of the abdomen is very different from a lung cancer. A typical lung cancer grows as a single identifiable nodule or mass which is anywhere from the size of a grape to the size of a baseball or larger when discovered. Because most lung cancer grows as a solitary defined mass, sometimes it can be cut out and followed up with chemotherapy or radiation which results in removing and killing off all of the lung cancer cells so that the cancer does not return.

So far, medical science has only very, very rarely been able to accomplish the same thing for persons with mesothelioma. The reasons for this is that mesothelioma grows on the lining of the lung (or the lining of the abdomen) as a diffuse multi-site tumor with tumor nodules being spread on a wide area of the pleura. Even when an individual is able to undergo surgery for removal of the entire pleura, lung on the side where the mesothelioma is located, and parts of the diaphragm, this almost never results in total removal of all of the cancer cells. Mesothelioma Information, symptoms and causes:

Facts About Mesothelioma

Mesothelioma cancer does not act the same way in all people. In addition, a person's general state of health can have a lot to do with how they fare with the mesothelioma.

There are different cell types of mesothelioma. Of the three cell types of mesothelioma, epithelial mesothelioma seems to grow the slowest. Sarcomatous or spindle-cell mesotheliomas seem to grow the fastest and biphasic mesotheliomas, which have characteristics of both epithelial and sarcomatous mesotheliomas seem to grow at a rate in between those two. Life expectancy from the date of diagnosis with mesothelioma to death varies from as short as several months to five years or in some cases longer. Age at time of diagnosis and overall general health make a big difference in how long a person lives.

A few cases are reported of persons alive five and more years after diagnosis. More of these cases are occurring as time goes on and more is known about how to try and fight the cancer.

Symptoms and Diagnosis

Mesothelioma cancer is usually diagnosed after a person develops breathing difficulty, shortness of breath, chest discomfort, chest pain, and fatigue. When a person goes to the doctor for the first time with these symptoms, the doctor will usually take a chest x-ray and listen to the chest. Many times the chest x-ray will show a large area of white which indicates an accumulation of fluid. It is very common for mesothelioma to cause fluid to accumulate in the pleural space (a pleural effusion).

The pleural space is the area between the outside lining of the lung and the inside lining of the chest wall. In a normal person, the pleura -- which lines the chest -- rubs up against the pleura which lines the chest wall. Each of these pleura are about as thick as a piece of saran wrap. There is a very tiny amount of fluid which coats each of the pleura so that when they rub up against one another as a person inhales and exhales, there will be no friction or irritation.

When a mesothelioma develops, the pleura often becomes much thickened and studded with tumor nodules. Part of the body's response to the presence of the tumor is to weep fluid into the pleural space. As the fluid collects in the pleural space, it compresses the lung, making it harder and harder for a person to breathe and causing more and more shortness of breath. If the mesothelioma has produced fluid, it is usually possible for the doctor to drain the fluid out of the pleural space, (thoracentesis) giving immediate relief of the symptoms of the mesothelioma. When the fluid is drained, the lung is able to return to close to normal size and it becomes immediately easier for the person to breathe.

A diagnosis of mesothelioma can sometimes be made just by looking at the cells which are contained in the pleural fluid. Sometimes the specimen of pleural fluid will contain some of the cancer cells which have sloughed off of the mesothelioma tumor on the lining of the lung. If some of these cells are found in the pleural fluid, then the pathologist can make a firm diagnosis of mesothelioma just by looking at the pleural fluid specimen. Many times, however, the pleural fluid does not contain cells of the mesothelioma cancer. This does not mean that the cancer is not there. Rather, it simply means that a better specimen needs to be obtained in order to determine whether or not a person has mesothelioma.

If the specimen of pleural fluid does not provide any information as to the presence of mesothelioma, doctors will often move on to suggest that there be a pleural biopsy. Doctors can attempt to obtain a specimen of the pleura by doing a needle biopsy. The needle biopsy involves the insertion of a needle through the outside of the chest, between the ribs, through the chest wall and into the pleura in order to snag a small piece of tissue.

If the needle is put into an area where the mesothelioma tumor is growing and is able to retrieve some of those cells in the small piece of tissue which is extracted, then the pathologist will be able to make a diagnosis of mesothelioma. Sometimes, a person with mesothelioma will have repeated needle biopsy and still there will be no diagnosis of mesothelioma by the pathologist.

This can occur if the needle biopsy does not happen to take a specimen from the area where the cancer is growing. Another way for the surgeon to get a specimen of the pleura is to actually open the chest, separate the ribs and cut out a portion of the pleura for examination by the pathologist. If a person with shortness of breath, chest discomfort and pleural fluid has a mesothelioma, this type of operation almost always obtains a large enough specimen of pleural tissue for the pathologist to determine whether the person has a mesothelioma.

The diagnosis of mesothelioma is not always straight forward. Only about 2,000-3,000 cases of mesothelioma occur every year. (By comparison, 2 million or more Americans die every year.) Most mesotheliomas occur in persons who live in urban areas where there is the greatest opportunity for exposure to asbestos. Thus, community hospital pathologists rarely have an opportunity to see a person with mesothelioma as part of their practice.

Because of this, community hospital pathologists will often send tissue specimens suspected of being mesothelioma to other pathologists with an expertise in the diagnosis of mesothelioma for a second opinion. Most teaching hospitals in large metropolitan areas have pathologists on staff who are more than competent to diagnose mesothelioma. In addition, there are two other organizations to which community hospital pathologists can go for second opinions when it comes to the diagnosis of mesothelioma. Mesothelioma facts, information, pictures:

1.  Mesothelioma

Mesothelioma Information and Facts, Symptoms and Diagnosis

The dense white encircling tumor mass is arising from the visceral pleura and is a mesothelioma. These are big bulky tumors that can fill the chest cavity.The risk factor for mesothelioma is asbestos exposure. However, mesothelioma is rare even in persons with asbestos exposure. Asbestosis more commonly predisposes to bronchogenic carcinomas, increasing the risk by a factor of five. Smoking increases the risk for lung cancer by a factor of ten. Thus, smokers with a history of asbestos exposure have a risk 50 fold greater likelihood of for developing lung cancer.

2.  Mesotheliomas Have Either Spindle Cells

Mesothelioma Information and Facts, Symptoms and Diagnosis

Mesotheliomas have either spindle cells or plump rounded cells forming gland-like configurations, as seen here at high power microscopically. They are very difficult to diagnose cytologically.

3.  Asbestosis

Mesothelioma Information and Facts, Symptoms and Diagnosis

This is the causative agent for asbestosis, a long, thin asbestos fiber. Some houses, business locations, and ships still contain building products with asbestos, particularly insulation materials, so care must be taken when doing remodelling or reconstruction.

4.  Asbestosis - Ferruginous body

Mesothelioma Information and Facts, Symptoms and Diagnosis

The asbestos fiber becomes coated with iron and calcium, which is why it is often referred to as a "ferruginous body" as seen here with an iron stain. Ingestion of these fibers by macrophages sets off a fibrogenic response via release of growth factors that promote collagen deposition by fibroblasts.

5.  Fibrous Pleural Plaque

Mesothelioma Information and Facts, Symptoms and Diagnosis

Another gross lesion typical for pneumoconioses, and asbestosis in particular, is a fibrous pleural plaque. Seen here on the pleural side of the diaphragmatic leaves are several tan-white pleural plaques.

6.  Micrograph of a Pleural Plaque

Mesothelioma Information and Facts, Symptoms and Diagnosis

Microscopically, the fibrous pleural plaque is composed of dense layers of collagen.

7.  Silicotic Nodule

Mesothelioma Information and Facts, Symptoms and Diagnosis

A silicotic nodule within lung parenchyma is seen here. It is composed mainly of bundles of interlacing pink collagen. There is a minimal inflammatory reaction. The greater the degree of exposure to silica and increasing length of exposure determine the amount of silicotic nodule formation and the degree of restrictive lung disease. Silicosis increases the risk for lung carcinoma only about 2-fold.

8.  Coal Worker's Pneumoconiosis

Mesothelioma Information and Facts, Symptoms and Diagnosis

Anthracotic pigment ordinarily is not fibrogenic, but in massive amounts (as in "black lung disease" in coal miners) a fibrogenic response can be elicited to produce the "coal worker's pneumoconiosis" seen here.

9.  Silicosis and Coal Workers' Pneumoconiosis

Mesothelioma Information and Facts, Symptoms and Diagnosis

By polarized light microscopy can be seen the etiology for most pneumoconiosis (even those in coal miners)--silica crystals. Here are seen bright white crystals of varying sizes. The silica induces a fibrogenic response by macrophages to produce the nodular foci of collagen deposition.

10. Silica Crystals in Silicosis of Lung, Polarized

Mesothelioma Information and Facts, Symptoms and Diagnosis

Bright white collections of polarizable crystals are seen here, but are diffuse and centered around vascular spaces. This is the lung of a patient with a long history of intravenous drug use. Only about 1% of such persons get a significant degree of pulmonary fibrosis. The crystals represent talc that is used to to dilute the injected drug.

11. Fat Embolism Syndrome

Mesothelioma Information and Facts, Symptoms and Diagnosis

The rounded holes that appear in the vascular spaces here in the lung are fat emboli. Fat embolization syndrome occurs most often following trauma with fracture of long bones that releases fat globules into the circulation which are trapped in pulmonary capillaries. Cumulatively, they have the same effect as a large saddle pulmonary embolus.

12. Amniotic Fluid Emboli

Mesothelioma Information and Facts, Symptoms and Diagnosis

This is a rare finding that may complicate a term pregnancy at delivery. Seen here in a pulmonary artery branch is an amniotic fluid embolus that has layers of fetal squames. Amniotic fluid embolization can have the same outcome as a large saddle pulmonary embolus.

13. Hypersensitivity Pneumonitis

Mesothelioma Information and Facts, Symptoms and Diagnosis

This is an example of hypersensitivity pneumonitis that can occur when there is an inhaled organic dust that produces a localized for of type III hypersensitivity (Arthus) reaction from antigen-antibody complexes. The symptoms of dyspnea, coughing, and fever abate when the affected person leaves the environment where the offending antigen is located. There are no major long-term complications.

14. Thermophilic Actinomycetes

Mesothelioma Information and Facts, Symptoms and Diagnosis

One form of hypersensitivity pneumonitis is known as farmer's lung because the farmer inhales thermophilic actinomycetes in moldy hay that set off the reaction. Bird dust (bird fancier's disease) and molds in air conditioners may produce similar problems. The bales in this field near Sterling are of good quality and less likely to produce this disease.

15. Silo Filler's Disease

Mesothelioma Information and Facts, Symptoms and Diagnosis

Farmer's lung must be distinguished from "silo filler's disease" which is an acute chemical pneumonitis due to toxic gases released from fermenting silage into the atmosphere inside the silo (an example of which is seen here on this farm between Edinburgh and Glasgow).

16. Idiopathic Pulmonary Fibrosis

Mesothelioma Information and Facts, Symptoms and Diagnosis

This is an example of pulmonary fibrosis. Some cases of restrictive lung disease have no known etiology--this is, they are known as idiopathic pulmonary fibrosis. The alveolitis that produces fibroblast proliferation and collagen deposition is progressive over time.

17. Trichrome Stain Kit

Mesothelioma Information and Facts, Symptoms and Diagnosis

A trichrome stain highlights the collagenous connective tissue of pulmonary fibrosis in blue.

18. Pulmonary Fibrosis in Sarcoidosis

Mesothelioma Information and Facts, Symptoms and Diagnosis

One cause for pulmonary intersitital fibrosis is sarcoidosis. In addition to increased interstitial markings, the chest radiograph may display prominent hilar lymphadenopathy (from non-caseating granulomatous inflammation) as shown here.

19. Diffuse Alveolar Damage

Mesothelioma Information and Facts, Symptoms and Diagnosis

Here is an example of diffuse alveolar damage in which the lung is diffusely firm and rubbery. Clinically, this is known as adult respiratory distress syndrome (ARDS).

20. Hyaline Membranes

Mesothelioma Information and Facts, Symptoms and Diagnosis

This is the microscopic appearance of diffuse alveolar damage (DAD) in the lung. DAD is simply the final common pathway for a variety of severe lung injuries. In early DAD, there are hyaline membranes lining alveoli. Later, type II pneumonocyte proliferation and then interstitial inflammation and fibrosis are seen. High oxygen tensions needed to treat the hypoxia resulting from DAD and its etiologies further potentiates this disease.

21. Honeycomb Lung

Mesothelioma Information and Facts, Symptoms and Diagnosis

Regardless of the etiology for restrictive lung diseases, many eventually lead to extensive fibrosis. The gross appearance, as seen here in a patient with organizing diffuse alveolar damage, is known as "honeycomb" lung because of the appearance of the irregular air spaces between bands of dense fibrous connective tissue.

22. Peripheral Pulmonary Artery

Mesothelioma Information and Facts, Symptoms and Diagnosis

Both restrictive and obstructive lung diseases can affect the pulmonary arterial circulation. The loss of normal lung parenchyma leads to pulmonary hypertension that leads to thickening of the small arteries along with reduplication to form a plexiform lesion, as seen here in a peripheral pulmonary artery.

23. Desquamative Interstitial Pneumonitis (DIP)

Mesothelioma Information and Facts, Symptoms and Diagnosis

This is an example of an uncommon pattern of injury called desquamative interstitial pneumonitis (DIP) that is characterized by a proliferation of alveolar macrophages (not desquamated type II cells as originally thought) filling the alveoli. Though some of these cases go on to diffuse interstitial fibrosis, many of the patients respond better to corticosteroid therapy than patients with other causes for interstitial fibrosis.

Smoking may be related to several interstitial lung diseases including the DIP shown here, as well as respiratory bronchiolitis, pulmonary Langerhans cell histiocytosis (eosinophilic granuloma of lung), and idiopathic pulmonary fibrosis. [Washko GR, Hunninghake GM, Fernandez IE, et al. Lung Volumes and Emphysema in Smokers with Interstitial Lung Abnormalities. N Engl J Med 2011; 364:897-906]. Mesotheliomainfo
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