Clinical analysis of combined immunotherapy in patients with malignant pleural mesothelioma / 中华肿瘤杂志

Objective: To observe the present situation, efficacy and safety of immunotherapy in patients with malignant pleural mesothelioma (MPM). Methods: The data of 39 patients with MPM in two centers from 2016 to 2021 were collected and the efficacy and safety were evaluated. According to the application of immune checkpoint inhibitors (ICIs), these patients, whose median clinical follow-up amounting to 18.97 months, were divided into immunotherapy group (19 cases) and control group (20 cases). Kaplan-Meier method and Log-rank test were used for the survival analysis. Results: The objective response rate (ORR) and the disease control rate (DCR) in the immunotherapy group is 21.05% and 79.0% respectively, compared with 10.0% and 55.0% in the control group; and the difference was not statistically significant (P>0.05). The median overall survival (OS) in the immunotherapy group was significantly longer than that in the control group (14.53 months vs 7.07 months, P=0.015), but there was no significant difference in the median progression free survival (PFS) between two groups (4.80 months vs 2.03 months, P=0.062). Single factor survival analysis showed that the nature of pleural effusion, pathological subtype and the efficacy of immunotherapy were related to both PFS and OS of the patients with MPM (P<0.05). The incidence of adverse reactions in immunotherapy group was 89.5% (17 out of 19 cases), and the most common adverse event was hematological toxicity (9 cases), followed by nausea and vomiting (7 cases), fatigue (6 cases) and skin damage (6 cases). Five patients had immune checkpoint inhibitors (ICIs) related adverse reactions with grade 1-2. Conclusions: Patients with MPM have begun to receive immunotherapy in more than 2-line mainly combined chemotherapy in the real world, and the median treatment line is 2-line. Either combined with chemotherapy or anti-angiogenesis therapy, ICI inhibitors have significant efficacy, controllable adverse events and good clinical value.

Development and validation of prognostic nomogram for malignant pleural mesothelioma / 中华肿瘤杂志

Objective: To development the prognostic nomogram for malignant pleural mesothelioma (MPM). Methods: Two hundred and ten patients pathologically confirmed as MPM were enrolled in this retrospective study from 2007 to 2020 in the People's Hospital of Chuxiong Yi Autonomous Prefecture, the First and Third Affiliated Hospital of Kunming Medical University, and divided into training (n=112) and test (n=98) sets according to the admission time. The observation factors included demography, symptoms, history, clinical score and stage, blood cell and biochemistry, tumor markers, pathology and treatment. The Cox proportional risk model was used to analyze the prognostic factors of 112 patients in the training set. According to the results of multivariate Cox regression analysis, the prognostic prediction nomogram was established. C-Index and calibration curve were used to evaluate the model's discrimination and consistency in raining and test sets, respectively. Patients were stratified according to the median risk score of nomogram in the training set. Log rank test was performed to compare the survival differences between the high and low risk groups in the two sets. Results: The median overall survival (OS) of 210 MPM patients was 384 days (IQR=472 days), and the 6-month, 1-year, 2-year, and 3-year survival rates were 75.7%, 52.6%, 19.7%, and 13.0%, respectively. Cox multivariate regression analysis showed that residence (HR=2.127, 95% CI: 1.154-3.920), serum albumin (HR=1.583, 95% CI: 1.017-2.464), clinical stage (stage Ⅳ: HR=3.073, 95% CI: 1.366-6.910) and the chemotherapy (HR=0.476, 95% CI: 0.292-0.777) were independent prognostic factors for MPM patients. The C-index of the nomogram established based on the results of Cox multivariate regression analysis in the training and test sets were 0.662 and 0.613, respectively. Calibration curves for both the training and test sets showed moderate consistency between the predicted and actual survival probabilities of MPM patients at 6 months, 1 year, and 2 years. The low-risk group had better outcomes than the high-risk group in both training (P=0.001) and test (P=0.003) sets. Conclusion: The survival prediction nomogram established based on routine clinical indicators of MPM patients provides a reliable tool for prognostic prediction and risk stratification.

Multicenter study of diffuse pleural mesothelioma. histopathological and immunohistochemical features / Estudio multicéntrico de características histopatológicas e inmunohistoquímicas del mesotelioma pleural difuso

Abstract The pathological diagnosis of diffuse pleural mesothelioma (DPM) contributes to treatment selection and clinical trials interpretation. To know its characteristics and evaluate the viability of comprehensive pathological diagnosis of DPM in Argentina we did a retrospective descriptive study of DPM cases reported from 2009 to 2018. We analyzed 398 cases corresponding to 238 (60%) men and 160 (40%) women, median age 66 years, from surgical biopsies (78%), small biopsies (16.5%) and surgical resections (5.5%). The 77% were epithelioid (E-DPM), 12% biphasic, 10% sarcomatoid, and 4 cases transitional variant. In E-DPM the main pattern was tubular in 36% and solid in 33%. There was a second pattern in 179 cases. Considering the main pattern and the second together, 48% presented tubular subtype and 48% solid subtype. Stroma, necrosis, and nuclear score showed significant differences between E-DPM and non-epithelioid mesotheliomas. Overall tumor grade was predominantly low in E-DPM, except for 42% of the solid main pattern. We recognized the transitional variant extensively in 4 cases and focally in 8. The immunohistochemical antibody panel used included pan-cytokeratin, calretinin, WT-1, cytokeratin 5, CEA and TTF-1. The expression of cytokeratin 5, calretinin and WT-1 was lower in the sarcomatoid type (43%, 87 and 37%) than in the epithelioid type (92%, 98% and 93%). This study highlights the tumor heterogeneity of DPM that shows the diagnostic difficulty, and the feasibility of evaluating histological aggressiveness in E-DPM, B-DPM and S-DPM in our country.

Resumen El diagnóstico patológico del mesotelioma pleural difuso (MPD) contribuye a la selección del tratamiento y a la interpretación de los ensayos clínicos. Para conocer sus características y evaluar la viabilidad del diagnóstico patológico de MPD en Argentina se realizó un estudio descriptivo retros pectivo de los casos de MPD informados de 2009 a 2018. Se analizaron 398 casos correspondientes a 238 (60%) hombres y 160 (40%) mujeres, mediana de edad de 66 años, a partir de biopsias quirúrgicas (78%), biopsias pequeñas (16.5%) y resecciones quirúrgicas (5.5%). El 77% fue epitelioide (E-MPD), 12% bifásicos, 10% sarcomatoides y 4 casos variante transicional. En E-MPD se encontró como patrón principal el tubular en 36% y el sólido en 33%. Hubo un segundo patrón en 179 casos. Considerando el principal y el segundo patrón en conjunto, el 48% presentó subtipo tubular y el 48% subtipo sólido. El estroma, la necrosis y el score nuclear mostraron diferencias significativas entre E-MPD y mesoteliomas no epitelioides. El grado general del tumor fue predominantemente bajo en E-MPD, a excepción del 42% del patrón principal sólido. Reconocimos la variante transicional en forma extensa en 4 casos y focalmente en 8. La expresión de citoqueratina 5, calretinina y WT-1 fue menor en el tipo sarcomatoide (43%, 87 y 37%) que en el tipo epitelioide (92%, 98% y 93%). Este estudio destaca la heterogeneidad tumoral de MPD que evidencia la dificu ltad en el diagnóstico y la viabilidad de evaluar la agresividad histológica en E-MPD, B-MPD y S-MPD en nuestro país.

Advances in Immunotherapy for Malignant Pleural Mesothelioma / 中国肺癌杂志

Patients with malignant pleural mesothelioma (MPM) usually present with poor prognosis and short survival period, and there has been a lack of effective treatment options for a long time. Chemotherapy has limited improvement in the clinical outcome of advanced patients (the median survival is less than one year), and it is difficult to find suitable targets for targeted therapy. Recent in-depth research on immunotherapy has changed the treatment pattern of MPM. Especially, the dual immunotherapy regimen significantly improved the survival outcome of patients across subgroups and prolonged the survival time of MPM patients. Therefore, it has been approved for unresectable MPM as first-line treatment for patients. The exploration of other mono or combo immunotherapy regimens in the first and second-line settings of MPM is also underway. How to identify the best beneficial population of each regimen through predictive biomarkers is also a hot spot for researchers. This article will focus on the most up-to-date progress of MPM epidemiology, histological characteristics, pathogenesis, treatment patterns and the advances of immunotherapy in the disease.
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Analysis of the Efficacy of Pemetrexed Maintenance Therapy in Patients with Malignant Pleural Mesothelioma / 中国肺癌杂志

BACKGROUND@#Malignant pleural mesothelioma (MPM) is a highly aggressive disease arising from pleural mesothelial cells. Advanced pleural mesothelioma has a poor prognosis, with a median survival of no more than 15 months. First line standard chemotherapy regimen recommended is Pemetrexed based chemotherapy regimen, with or without bevacizumab. There is no consensus on whether patients who have received first-line standard chemotherapy can benefit from pemetrexed maintenance chemotherapy. The study aimed to investigate the efficacy and safety of pemetrexed maintenance therapy (PMT) after treatment with a pemetrexed and platinum regimen for patients with MPM.@*METHODS@#A total of 40 MPM patients were collected from Cancer Hospital Chinese Academy of Medical Sciences from January 2013 to January 2018, eligible patients were unresectable MPM, without disease progression following 4 to 6 cycles of pemetrexed and platinum, including pemetrexed maintenance therapy group (22 cases) and observation group (18 cases). The last follow-up was conducted in January 2020. The primary endpoint were progression free survival (PFS), and the secondary end points were overall survival (OS), the efficacy, adverse reactions of PMT.@*RESULTS@#The median PFS in the PMT arm was longer than that in the observation arm (8.5 mon vs 3 mon, P=0.008), but there was no significant difference in median OS (26.4 mon vs 15.7 mon, P=0.177). Objective response rate (ORR) of two group were 22.7% and 0%, respectively. The grade 3-4 toxicity in PMT group included grade 4 neutropenia in 1 patient (4.5%), grade 3 neutropenia in 1 patient (4.5%), grade 4 anemia in 1 patient (4.5%) and grade 3 nausea and anorexia in 1 patient (4.5%).@*CONCLUSIONS@#Pemetrexed maintenance therapy following initial pemetrexed and platinum chemotherapy improve PFS in patients with MPM, and is well tolerated.

Dilemma in Diagnosing Malignant Pleural Mesothelioma with Atypical Clinical Presentation and Imaging Findings : Recurrent Chylothorax, Mediastinal Lymphadenopathies and Pulmonary Embolism

@#Malignant pleural mesothelioma (MPM) is a rare malignant tumor affecting the mesothelium. It commonly manifests as pleural thickening on contrast enhanced CT (CECT) thorax. We reported a case of a young lady who presented with respiratory symptoms and was initially treated as pneumonia. However, she had recurrent episodes of chylothorax with progressive internal jugular vein (IJV), brachiocephalic vein and superior vena cava (SVC) thrombosis leading to pulmonary embolism, associated with extensive mediastinal and supracalvicular lymphadenopathies. There are no evidence of pleural thickening in the initial investigations. Our case highlighted that MPM must remain in the differential diagnosis for these presentations, albeit rare.

Research Progress of Immune Checkpoint Inhibitors in Malignant Pleural Mesothelioma / 中国肺癌杂志

Malignant pleural mesothelioma (MPM) is a malignant tumor with strong invasiveness, low survival rate and lack of effective treatment options. As the only first-line treatment plan for the advanced MPM, combination of pemetrexed and cisplatin chemotherapy have been existing since the last 20 years. Immunotherapy has long been considered as a potential treatment plan for MPM, mainly including immune checkpoint inhibitors (ICIs), immunotoxin therapy, anti-cancer vaccine and adoptive T-cell therapy. This review focuses on summarizing the current research status of immune checkpoint inhibitors in MPM, discusses the effect of tumor heterogeneity on ICIs treatment, and describes that the biomarker-oriented immunotherapy is a new vision for the realization of individualized treatment of MPM.
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Screening and identifying genes associated with malignant pleural mesothelioma based on public database / 中国职业医学

OBJECTIVE: To explore the related signaling pathways, biomarkers and prognostic genes of malignant pleural mesothelioma(MPM) based on the gene chip and second-generation sequencing datasets in public database by bioinformatics-related method. METHODS: MPM microarray expression datasets GSE51024 and GSE2549, with 82 and 49 MPM patients, respectively, were downloaded from the Gene Expression Omnibus database. The RNA sequencing data of 86 MPM patients were downloaded from the The Cancer Genome Atlas(TCGA). The weighted gene co-expression network analysis(WGCNA) and differentially expressed genes(DEGs) screening were used to screen and identify hub genes in the GSE51024 dataset by RStudio 4.0 software. The gene set enrichment analysis(GSEA) was used to explore relevant signaling pathways. Finally, a total of 135 MPM gene expression data from GSE2549 dataset and TCGA database were used to verify the hub genes. RESULTS: The green key gene module identified by the WGCNA was highly correlated with MPM, with a correlation coefficient of 0.83(P<0.01). A total of 3 245 DEGs were screened by DEGs analysis. Among them, 1 229 genes were up-regulated and 2 016 genes were down-regulated. GSEA results showed that the genes were significantly enriched in the areas of G2/M cell cycle checkpoint, epithelial-mesenchymal transition, E2 F target gene, and mitotic spindle pathways. Three hub genes were screened, including the proliferating cell nuclear antigen-associated factor(PCLAF), nucleolar and spindle-associated protein 1(NUSAP1) and topoisomerase Ⅱ-α(TOP2 A). Compared with para-cancerous tissues, normal pleural tissues or lung tissues, the relative expression of PCLAF, NUSAP1 and TOP2 A were increased in the MPM tissues(all P<0.05). Downregulation of these three genes was correlated with good prognosis, and upregulation of these three genes was correlated with poor prognosis in the patients. CONCLUSION: G2/M checkpoint, epithelial-mesenchymal transition, E2 F target gene and mitotic spindle pathway are the key signaling pathways in the occurrence and development of MPM. PCLAF, TOP2 A and NUSAP1 genes could be the biomarkers for the prognosis of MPM.

Chinese guideline for clinical diagnosis and treatment of malignant pleural mesothelioma (2021 Edition) / 中华肿瘤杂志

Malignant pleural mesothelioma (MPM) is a pleura-derived malignant tumor, with a gradually increasing incidence in recent years based on domestic and foreign epidemiologic data. Most patients with MPM are diagnosed at an advanced stage due to its insidiousness and aggressiveness. The therapeutic strategies of MPM mainly include surgery, chemotherapy and radiotherapy. Recently, the immunotherapy has altered the treatment pattern and further improved the survival of these patients. In order to timely present the domestic and foreign progress in the diagnosis and treatment of MPM, and to further improve the level of standardized diagnosis and treatment in MPM in China, this guideline was formulated on the basis of existing clinical research evidence combined with experts' opinions. The guideline covers the epidemiology, diagnosis, pathology, treatment and follow-up of MPM.

A Retrospective Study to Explore Prognostic Factors of Short Survival in Patients with Malignant Pleural Mesothelioma upon the Time of Admission to Palliative Care Unit

Objective: This study investigated prognostic factors of short survival in patients with malignant pleural mesothelioma (MPM) upon the time of their admission to the Palliative Care Unit (PCU). Method: We conducted a retrospective review of the medical records of 12 patients with MPM, who died at the PCU of our hospital from January 2016 to April 2018. According to the classification of survival period by previous predictor model, these patients were classified into three Groups, Group A: less than 13 days, Group B: between 14 and 55 days, and Group C: more than 56 days. Results: The number of patients was 5 in Group A, 5 in Group B, and 2 in Group C, respectively. Hemoptysis was seen in 40% of patients of Group A only and oxygen inhalation was necessary for all the patients of Group A. Dysphagia and bilateral pleural involvement were seen in 80% of Group A and in 60% of Group B. Pneumonia was seen in 60% of Group A and in 20% of Group B. The above four factors were not seen in Group C. Conclusion: This preliminary study suggests that hemoptysis, dysphagia, bilateral pleural involvement, pneumonia, and oxygen inhalation are possibly prognostic factors of short survival of patients with MPM upon their admission to PCU.

Mesotelioma pleural maligno. Actualización sobre diagnóstico y tratamiento / Malignant pleural mesothelioma. Update on diagnosis and treatment

RESUMEN Introducción: El mesotelioma pleural maligno es un tumor maligno primario de la pleura, comúnmente asociado con la exposición al asbesto. Se considera una patología rara y muy agresiva. Objetivo: Realizar una revisión sobre los criterios de diagnóstico y tratamiento actualizados en torno al mesotelioma pleural maligno. Métodos: Se realizó una revisión bibliográfica en fuentes de información disponibles en la Biblioteca Virtual de Salud, de la red telemática Infomed, entre ellas, las bases de datos SciELO, Pubmed/Medline, Cumed, Lilacs, así como el Google Académico. Se seleccionaron un total de 39 referencias. Conclusiones: Existen pocas referencias en la literatura nacional relacionadas con el diagnóstico, tratamiento y seguimiento de los pacientes con mesotelioma pleural maligno. El diagnóstico combina el uso del método clínico, los estudio imagenológicos e histoquímicos. No existe un tratamiento estándar, siendo recomendable un enfoque individualizado que combine según cada caso, cirugía, quimio y radioterapia. Los desafíos futuros incluyen el desarrollo de nuevas alternativas terapéuticas(AU)

ABSTRACT Introduction: Malignant Pleural Mesothelioma is a primary malignant tumor of the pleura, commonly associated with exposure to asbestos. It is considered a rare and very aggressive pathology. Objective: Conduct a review of updated diagnostic and treatment criteria for malignant pleural mesothelioma. Material and Methods: A bibliographic review was made through the search of information in sources available from the Cuban National Health Care Network and Portal (INFOMED), among them, databases such as SciELO, Pubmed / Medline, Cumed, Lilacs, as well as Google Scholar. Finally, a total of 39 references were selected for our study. Conclusions: There are few references in the national literature related to the diagnosis, treatment and follow-up of patients with malignant pleural mesothelioma. The diagnosis combines the use of the clinical method, the imaging and histochemical studies. There is no standard treatment, being recommended an individualized approach that combines according to each case, surgery, chemo and radiotherapy. Future challenges include the development of new therapeutic alternatives(AU)

Analysis of 5 cases of occupational asbestos-induced pleural mesothelioma / 中国职业医学

OBJECTIVE: To retrospectively analyze the clinical characteristics of 5 cases of occupational asbestos-induced pleural mesothelioma. METHODS: The clinical features and occupational diagnostic data of 5 patients with pleural mesothelioma caused by occupational asbestos exposure were collected. The occupational history, the occupational hazard exposure history, the length of latency, the clinical features, chest computed tomography(CT) and immunohistochemical staining examination of these 5 patients were analyzed. RESULTS: The median of occupational asbestos exposure length was 8 years and the median of latent period was 30 years in these 5 patients. One patient had been diagnosed as occupational asbestos lung. Typical chest CT findings of asbestos-induced pleural mesothelioma were one-sided pleural effusion, pleural nodules and enlarged mediastinal lymph nodes. The clinical symptoms were mainly chest pain, cheat tightness, and fatigue. Erythrocyte sedimentation rate increased in 3 cases. According to immunohistochemical findings, 4 patients showed that melanocortin, calretinin, cytokeratin 5/6, and cytokeratin 7 were positive, and 3 patients showed that wilms′ tumor nuclear protein were positive. Examination of lung function in 4 patients showed restrictive ventilation dysfunction. CONCLUSION: Most patients with pleura mesothelioma showed insignificant symptoms at early stage. The occupational health surveillance and chest CT examination of occupational asbestos-exposed workers should be strengthened, and early diagnosis should be made as soon as possible to win surgical opportunities.

Mesotelioma pleural con manifestaciones paraneoplásicas de osteoartropatía hipertrófica / Pleural mesothelioma with paraneoplastic manifestations of hypertrophic osteoarthropathy

RESUMEN Se presenta un paciente exfumador de 65 años que, un año antes de comenzar las manifestaciones respiratorias, comenzó con dolores óseos erráticos, tratados con medicamentos comunes hasta que es atendido por disnea, tos y dolor torácico en el Hospital Básico San Antonio, ciudad de Riobamba, provincia de Chimborazo, Ecuador. El paciente presenta un gran derrame pleural, del cual obtienen 1500 ml de líquido serohemático, cuyo estudio citológico es positivo de malignidad. Se somete a cirugía, se confirma histológicamente mesotelioma maligno en etapa IV y se trata posteriormente con quimioterapia, pero el paciente empeora progresivamente hasta fallecer. Los autores resaltan que las manifestaciones paraneoplásicas del cáncer del pulmón son más frecuentes cuando la localización es parenquimatosa y no pleural, y llaman la atención sobre el hecho de que en este paciente comenzaron 1 año antes de que aparecieran los síntomas respiratorios.

ABSTRACT We present a 65-year-old ex-smoker patient, in which respiratory manifestations with erratic bone pain treated with common medications, began a year before he was atended for dyspnea, cough and chest pain at "San Antonio" Basic Hospital, Riobamba city, Chimborazo province, Ecuador. The patient presented a large pleural effusion of 1500 ml of serohematic fluid. Cytological study was positive for malignancy to rule out mesothelioma. Surgery was performed, histologically malignant mesothelioma was confirmed in stage IV and treated with chemotherapy. But the patient worsens progressively until death. Authors emphasized that lung cancer paraneoplastic manifestations were more frequent in not pleural and parenchymal location. They also called attention to patients´ symptoms, which began one year before the respiratory condition appeared.

Fatal hemothorax caused by pleural mesothelioma in a lion / Hemotórax fatal causado por mesotelioma pleural em um leão

Mesothelioma is considered a malignant neoplasm caused by the proliferation of mesothelial cells mostly from the pleura, peritoneum and pericardium. Here we described a case of fatal hemothorax caused by pleural mesothelioma in a lion by means of necropsy, histopathology and immunohistochemistry. Gross inspection of the thoracic cavity showed hemothorax with about 4 liters of blood. Microscopically, numerous, randomly distributed, soft, red-pink, irregular masses with up to 1cm in diameter were observed in both visceral and parietal pleurae. Microscopically, a papillary structure pattern was observed in the thoracic masses, composed mainly by one layer of cubic mesothelial cells, which presented eosinophilic cytoplasm, central nucleus and evident nucleolus, supported by a low cellular fibrovascularstroma. Neoplastic cells were positive for both cytokeratin and vimentin by immunohistochemistry. This seems to be the first report of fatal hemothorax caused by pleural mesothelioma in a lion.(AU)

O mesotelioma é considerado um neoplasma maligna causada pela proliferação de células mesoteliais, principalmente da pleura, peritôneo e pericárdio. O presente caso descreve os achados macroscópicos, microscópicos e imuno-histoquímicos do hemotórax fatal causado por um mesotelioma pleural em um leão. Macroscopicamente, na cavidade torácica, foi observado cerca de 4 litros de sangue. Além disso, foram observadas numerosas massas macias, vermelho-rosa, irregulares, com até 1cm de diâmetro e distribuídas aleatoriamente pelas pleuras parietal e visceral. Microscopicamente, as massas torácicas apresentavam estruturas papilares, compostas por uma camada de células mesoteliais, que apresentavam citoplasma eosinofílico, núcleo central e nucléolo evidente, suportada por um estroma fibrovascular pouco celular. A imuno-histoquímica foi positiva para ambas citoqueratina e vimentina nas células neoplásicas. Este trabalho descreve o que parece ser o primeiro relato de um hemotórax fatal causado por um mesotelioma pleural em um leão.(AU)

​Prevalence of Malignant Pleural Mesothelioma in Pleural Effusion Patients in Thanjavur Medical College Hospital: A Pilot Study

Background: The incidence of malignant pleural mesothelioma (MPM) has increased for some decades and was expected topeak between 2010 and 2020. The prevalence of MPM in India is unclear. No such study is available regarding MPM in India.Materials and Methods: After obtaining proper informed consent, patients presenting with pleural effusion were subject topleural biopsy, and the samples were then sent to histopathological confirmation of malignancy.Results: Histopathological evidence confirmed two cases of MPM of the 12 cases. Five of them were diagnosed with tuberculosispleuritis, while two cases had inflammatory pathology and two cases were confirmed to have been metastatic tumors.Conclusions: The present findings show that the prevalence of MPM is rather high at about 16%. A more comprehensivestudy is warranted based on our findings.

Progress of malignant pleural mesothelioma / 肿瘤研究与临床

Malignant pleural mesothelioma (MPM) is a rare primary tumor originating from pleural mesothelial cells.The disease is insidious and the etiology is not yet clear,but exposure to asbestos is the main pathogenic factors.The early symptoms of MPM are not obvious,and owning to the lack of specific symptoms,it's hard to be diagnosed,so it depends on histopathological immunohistochemistry to confirm the diagnosis.Only a few patients can undergo radical surgery.The current treatment is mainly chemotherapy,and cisplatin combined with pemetrexed is the most commonly used chemotherapy.The prognosis of MPM patient is very poor,and the survival period is short.The median survival time of MPM patients after supportive therapy alone is 4-12 months.This article will summarize the status and research progress of diagnosis and treatment of MPM.

Mesotelioma Pleural. Reporte de caso. Hospital de Clínicas. Asunción, Paraguay / Pleural Mesothelioma. Case report. Hospital of Clinics. Asunción, Paraguay

Paciente varón de 49 años, No conocido portador de patología de base, ingresó por sensación febril con escalofríos, cefalea, mialgias. Tres días antes del ingreso, tos con expectoración blanquecina, dolor en punta de costado del lado izquierdo y dificultad respiratoria. Examen Físico: PA: 107/61 FC: 96 X' FR: 24 X' Tax: 36°C. Aparato Respiratorio: Murmullo vesicular conservado del lado derecho. Abolido en campo medio y base del lado izquierdo. Sistema Hemolinfopoyético: Adenomegalias múltilples en región inguinal bilateral, móviles, pequeñas, no dolorosas. Evolución: Se instaló tubo de drenaje pleural, por importante derrame pleural. Se realizó toracoscopía, se constató masa extrabronquial y se tomó biopsia. La anatomía patológica + Inmunohistoquímica informa, tumor de alto grado más compatible con Mesotelioma. El paciente falleció al mes del diagnóstico. El mesotelioma pleural se considera una patología laboral-ambiental, causada por la inhalación de fibras de asbesto o amianto, tiene un mal pronóstico y es una enfermedad prevenible. Existen serias discusiones sobre prohibición del uso del asbesto. En algunos países está prohibida su importación/exportación, no así en Paraguay.

Male, 49 years old, without any disease, entered by feeling feverish, with chills, headache, myalgia. Three days before hospital admission, he presents with cough and whitish sputum and pain in left side tip and respiratory distress. At physical examination: BP: 107/61; HR: 96 X' ; RR: 24 X'; T: 36°C. Respiratory: Breath sounds on the right side preserved, abolished in base and midfield on left side. Haemolynphopoietic system: lynphadenopathy inguinal region, mobile, small, painless. Evolution: He settled chest tube, because of an important pleural effusion. Thoracoscopy was performed, an extrabronchial mass was found and a biopsy was taken. Pathology + Inmunohistochemistry says, high grade tumor that seems a pleural mesothelioma. The patient died a month after his diagnosis. Pleural Mesothelioma considered as a pathology labor - enviromental, caused by the inhalation of asbestos fibers. There are serious discussions about banning the use of asbestos. In some countries import / export is prohibited, but not in Paraguay.

Mesotelioma pleural maligno en ocho pacientes y revisión del tema / Malignant pleural mesothelioma in eight patients and review of topic

Se actualizan aspectos etiopatogénicos, clínicos, diagnósticos y terapéuticos en el mesotelioma pleural maligno, enfermedad temida e infrecuente en nuestro medio. Nos impresionó sobremanera, una profesional de salud tratada recientemente y en etapa temprana que apenas sobrevivió un año. El objetivo es elevar el conocimiento sobre el tema para tratar de mejorar la sobrevida. Se presentan una síntesis de ocho pacientes estudiados y tratados con este diagnóstico en los hospitales "Amalia Simoni", "Manuel Ascunce Domenech", "Madam Curie" de Camagüey y el "Martín Chang Puga" de Nuevitas desde 1998 hasta 2015, señalando el cuadro clínico, exámenes complementarios, diagnóstico, tratamiento médico quirúrgico y los resultados. Más de la mitad de los pacientes eran fumadores con pequeño derrame pleural inicial que hicieron pensar en la enfermedad, todo lo contrario cuando no existió derrame. Hubo tres enfermos donde el diagnóstico nos sorprendió por lo inesperado. La sobrevida fue baja con una media alrededor de 11 meses, solo uno vivió dos años. Los complementarios utilizados se ajustan a otros reportes y nuestras posibilidades. El tratamiento fue actualizado y acorde a otras series en el momento del diagnóstico. Se compara nuestra casuística, la cual se asemeja a publicaciones foráneas en cuanto a diagnóstico, tratamiento y sobrevida. Señalamos que, independiente de algunos recursos desde el punto de vista diagnóstico y terapéutico con que no contamos, los resultados se ajustan a la literatura actual y la sobrevida lograda fue sin dudas, adversa(AU)

Several etiopathogenetic, clinical, diagnostic and therapeutic aspects of the malignant pleural mesothelioma, fearful and infrequent disease in our context, are updated. It was really impressive the case of a female health professional that was recently treated at early stage of disease and barely survived one year. The objective of this review was to raise the level of knowledge on this disease in oder to improve survival rates. To this end, eight patients with this diagnosis, who were studied and treated in "Amalia Simoni", "Manuel Ascunce Domenech", "Madame Curie" hospitals in Camaguey and in "Martin Chang Puga" in Nuevitas from 1998 to 2015 were presented. Their clinical picture, supplementary tests, diagnosis, medical and surgical treatment and final results were described. Half of them were smokers with initial small pleural effusion that made the specialists suspect the existence of the disease. There were three patients whose diagnoses surprised the physicians because they were unexpected. Survival was low and the average survival rate was 11 months, although one managed to live two years. The indicated supplementary tests were similar to those of other reports and adjusted to our setting. Treatment was updated and consistent with other series at the time of diagnosis. The casuistry in our conditions was compared to others and it was similar in terms of diagnosis, treatment and survival rates to the one shown in foreign publication. Regardless of some unavailable diagnostic and therapeutic resources, the results of the treatment agree with those of the current literature on the topic and the survival rate was undoubtedly negative(AU)

Malignant Pleural Mesothelioma and Gastric Metastasis: A Very Rare Case Report and Literature Review.

Introduction: Malignant pleural mesothelioma (MPM) is a rare neoplasm. It has closed association with occupational asbestos exposure. Symptoms are commonly due to local invasion of pleura and mediastinal structures. MPM may have local or rarely distant organ metastasis by haematogenous spread in different organs such as liver, adrenal gland, kidney and contralateral lung. However, gastrointestinal involvement is very rare. Case Report: We report herein a 58-year-old female patient who was presented with back painand finally was diagnosed as MPM with distant metastasis to the stomach. Conclusion: Clinical, imaging and histopathologic findings play an important role in influencing the prognosis as well as treatment.

Mesotelioma pleural benigno: apresentação de um caso singular / Benign pleural mesothelioma: presentation of a singular case

Os autores relatam um caso de mesotelioma pleural benigno. São abordados aspectos histológicos, etiopatogênicos, genéticos, epidemiológicos e clínicos, bem como a casuística estudada, a terapêutica instituída e o segmento obtido. Abordam os critérios para o diagnóstico, resultante da somação de vários fatores, dando ênfase ao quadro clínico compatível, confirmação histopatológica, imuno-histopatológicos compatíveis com resposta positiva clínico-radiográfica e eficaz após a cirurgia proposta.

Cases of benign mesothelioma of the pleura are reported by authors. Histological, etiopathogenic, genetic, epidemiological and clinical aspects are approached as well the casuistry that was studied, established therapy and the acquired segment. It approaches the criteria for diagnosis resulted from many factors emphasizing compatible clinical condition, histopathological confirmation, compatible immuno-histopathology, effective and positive clinical radiography answer after the proposed surgery.