Analysis of invasive diagnostic techniques for pathological confirmation of pleural mesothelioma.

BACKGROUND AND OBJECTIVES: Mesothelioma is an infrequent neoplasm with a poor prognosis that is related to exposure to asbestos and whose peak incidence in Europe is estimated from 2020. Its diagnosis is complex; imaging techniques and the performance of invasive pleural techniques being essential for pathological confirmation. The different diagnostic yields of these invasive techniques are collected in the medical literature. The present work consisted of reviewing how the definitive diagnosis of mesothelioma cases in our centre was reached to check if there was concordance with the data in the bibliography. MATERIALS AND METHODS: Retrospective review of patients with a diagnosis of pleural mesothelioma in the period 2019-2021, analysing demographic data and exposure to asbestos, the semiology of the radiological findings and the invasive techniques performed to reach the diagnosis. RESULTS: Twenty-six mesothelioma cases were reviewed. 22 men and 4 women. Median age 74 years. 9 patients had a history of asbestos exposure. Moderate-severe pleural effusion was the most frequent radiological finding (23/26). The sensitivity of the invasive techniques was as follows: Cytology 13%, biopsy without image guidance 11%, image-guided biopsy 93%, surgical biopsy 67%. CONCLUSIONS: In our review, pleural biopsy performed with image guidance was the test that had the highest diagnostic yield, so it should be considered as the initial invasive test for the study of mesothelioma.

Tumor fibroso pleural ¿son realmente benignos? ¿Cuándo deben operarse? / Pleural fibrous tumor, are they really benign? When should they have operation?

El tumor fibroso pleural es un tumor habitualmente asintomático, benigno y de lento crecimiento, que en un pequeño porcentaje de los casos tiene un comportamiento más agresivo. Para definir los criterios de malignidad es necesario un análisis inmunohistoquímico. El tratamiento de elección es la resección quirúrgica completa con márgenes de seguridad ya sea por toracotomía o por videotoracoscopia en función del tamaño. Se encuentra en estudio la utilización de terapia adyuvante radioterápica o quimioterápica que en el momento actual no cuenta con resultados significativos. Presentamos dos casos que fueron tratados de forma quirúrgica, con extirpación completa siendo el primero definido como maligno según los criterios histológicos y el segundo benigno, pero de alto riesgo. Solo uno de ellos recibió terapia adyuvante. (AU)

Solitary fibrous pleural tumor is a usually asymptomatic, benign and slow-growing tumor, which in a small percentage of cases has a more aggressive behavior. To define the malignancy criteria, an immunohistochemical analysis is necessary. The gold standard treatment is a complete surgical resection with safety margins either by thoracotomy or by videothoracoscopy depending on the size. The use of radiotherapy or chemotherapy as an adjuvant therapy is under study, which at the present time does not have significant results. We present two cases that were treated surgically, with complete removal, one being classified as malignant according to histological criteria and the other benign but high risk. Only one of them received adjuvant therapy. (AU)

Reconocimiento del mesotelioma de pleura como enfermedad profesional en la Comunidad Valenciana de 2012 a 2018 / Recognition of pleural mesothelioma as an occupational disease in the Valencian Community from 2012 to 2018

Fundamentos: El mesotelioma de pleura es un cáncer atribuido casi en exclusiva a la exposición laboral al amianto y que tienela consideración legal de enfermedad profesional, aunque pocos casos consiguen ese reconocimiento oficial. Describir y analizar esteproblema y los obstáculos para su reconocimiento fue el objetivo de este trabajo. Métodos: Se realizó un estudio epidemiológico descriptivo y retrospectivo de las cifras y algunas características de todos los pa-cientes de mesotelioma de pleura recogidos en los principales registros oficiales, sanitarios y laborales, de la Comunidad Valenciana,desde 2012 a 2018, utilizando frecuencias, fracciones y tasas de incidencia. Resultados: Hubo grandes diferencias en el número de casos recogidos en los distintos registros. En los siete años estudiados,los mesoteliomas de pleura diagnosticados en el sistema sanitario público valenciano fueron 590. De ellos, aplicando la fracciónatribuible al trabajo con amianto, al menos 437 fueron atribuibles al trabajo. Los facultativos comunicaron 31 casos como sospechasde enfermedad profesional, el 7,09% del total, y, finalmente, 13 casos se reconocieron oficialmente como enfermedad profesional. Elcoste económico estimado de su atención sanitaria para el sistema público valenciano fue de 2.270.520 euros. Conclusiones: Una mínima parte de los mesoteliomas obtienen el reconocimiento de enfermedad profesional. Este hechoconlleva importantes repercusiones asistenciales y económicas para las personas afectadas y para el sistema sanitario público.(AU)

Background: Pleural mesothelioma is a neoplasm almost exclusively attributed to occupational exposure to asbestos and islegally considered an occupational disease. Nevertheless, only a few cases achieve that official recognition. The objective of this workwas to describe and analyse this issue, and to identify the major obstacles to its recognition. Methods: A descriptive and retrospective epidemiological study of data was carried out, including figures and some characteristics,of all patients with pleural mesothelioma registered in the official health and labor registries of the Valencian Community from 2012 to2018, using frequencies, proportions, and incidence rates.Results: There were large differences between the two sets of data collected in the different registries, especially regarding thenumber of cases. During the seven years of data examined, 590 pleural mesotheliomas were diagnosed in the Valencian public healthsystem. Of these, the number of cases that were related to occupational exposure was at least 437. Despite the legal duty of doctorsto report such cases, only 31 were reported as suspected occupational disease (7.09%), of which only 13 were ultimately officiallyrecognized as such. It was estimated that the annual economic overcost to the public system of unrecognised patients with thisoccupational disease by was 2,2270,520 euros. Conclusions: Only a small proportion of occupational mesotheliomas are officially recognized as such. This has importanthealth care and economic repercussions for the individuals involved as well as for the public health system.(AU)

Diagnóstico y evolución de los pacientes con derrames pleurales idiopáticos / Diagnosis and outcome of patients with idiopathic pleural effusions

Introducción No se ha determinado la evolución de los pacientes con derrames pleurales idiopáticos con un seguimiento a largo plazo. Métodos Entre octubre de 2013 y junio de 2021 se hizo un seguimiento prospectivo de todos los pacientes con derrame idiopático mediante exploración clínica y estudios de imagen al cabo de 1, 3 y seis meses y cada seis meses durante un mínimo de un año. Resultados Veintinueve pacientes fueron diagnosticados de derrame idiopático y objeto de seguimiento. Durante el seguimiento se detectó un mesotelioma en dos pacientes al cabo de siete y 18 meses; en uno de ellos se observó líquido pleural teñido de sangre y el otro refirió una pérdida de peso de 10%. En ninguno de los pacientes con derrame que cubriera menos de dos tercios del hemitórax y sin síntomas constitucionales ni aparición de líquido teñido de sangre se diagnosticó un mesotelioma. La mayoría de los derrames desaparecieron o mostraron una clara mejoría en los primeros seis meses. Conclusiones Los pacientes sin pérdida de peso y con derrames no hemáticos pequeños pueden beneficiarse de un tratamiento conservador y un seguimiento clínico-radiológico (AU)

Introduction Long-term follow-up course for patients with idiopathic pleural effusions has not been established. Methods From October 2013 to June 2021 all patients with idiopathic effusion were prospectively followed up with clinical examination and imaging at 1,3,6 and every 6 months for a minimum of 1 year. Results Twenty-nine patients were diagnosed with idiopathic effusion and followed up. Mesothelioma was detected during the follow-up in two patients at 7 and 18 months, one of whom had blood-tinged pleural fluid and the other reported a 10% weight loss. Mesothelioma was not diagnosed in any of the patients with effusion covering less than two thirds of the hemithorax, and without constitutional symptoms or a blood-tinged fluid appearance. Most of the effusions resolved or showed a clear improvement in the first six months. Conclusions Patients without weight loss and with small, non-hematic effusions, may benefit from conservative treatment and clinical-radiological follow-up (AU)

Diagnosis and outcome of patients with idiopathic pleural effusions.

INTRODUCTION: Long-term follow-up course for patients with idiopathic pleural effusions has not been established. METHODS: From October 2013 to June 2021 all patients with idiopathic effusion were prospectively followed up with clinical examination and imaging at 1, 3, 6 and every 6 months for a minimum of 1 year. RESULTS: Twenty-nine patients were diagnosed with idiopathic effusion and followed up. Mesothelioma was detected during the follow-up in two patients at 7 and 18 months, one of whom had blood-tinged pleural fluid and the other reported a 10% weight loss. Mesothelioma was not diagnosed in any of the patients with effusion covering less than two thirds of the hemithorax, and without constitutional symptoms or a blood-tinged fluid appearance. Most of the effusions resolved or showed a clear improvement in the first six months. CONCLUSION: Patients without weight loss and with small, non-hematic effusions, may benefit from conservative treatment and clinical-radiological follow-up.

Herniación gástrica por rotura de prótesis diafragmática en el postoperatorio de pleuroneumonectomía por mesotelioma: una complicación a tener en cuenta / Gastric herniation due to rupture of diaphragmatic prosthesis in the postoperative period of pleuropneumonectomy due to mesothelioma: A complication to consider

La neumonectomía extrapleural, habitualmente asociada a reconstrucción pericárdica y diafragmática con material protésico, es una de las técnicas quirúrgicas empleadas en el tratamiento del mesotelioma pleural maligno. La herniación de vísceras abdominales hacia el tórax a través del material protésico a nivel diafragmático es una complicación rara, pero potencialmente grave de estos procedimientos, que debe de ser diagnosticada rápidamente para su reparación urgente.Presentamos el caso de un paciente que presentó una herniación gástrica en el postoperatorio precoz de una neumonectomía izquierda por un mesotelioma pleural. Los hallazgos clínicos fueron leves, pero apoyados en las pruebas de imagen, confirmaron la hipótesis diagnóstica y facilitaron la solución del cuadro. Se revisan los posibles factores contribuyentes y se incide en la necesidad de un diagnóstico y tratamiento precoz para evitar la isquemia de las vísceras abdominales herniadas en la cavidad torácica, por el riesgo de necrosis y contaminación por material fecaloideo.(AU)

Extrapleural pneumonectomy, usually associated with pericardial and diaphragmatic reconstruction with prosthetic material, is one of the surgical techniques used in the treatment of malignant pleural mesothelioma. Herniation of the abdominal viscera towards the thorax through the prosthetic material at the diaphragmatic level is a rare but potentially serious complication of these procedures, which must be diagnosed quickly for urgent repair.We present the case of a patient who presented with gastric herniation in the early postoperative period of a left pneumonectomy due to pleural mesothelioma. The clinical findings were mild, but supported by imaging tests, they confirmed the diagnostic hypothesis and facilitated the solution of the condition. Possible contributing factors are reviewed and the need for early diagnosis and treatment is emphasized to avoid ischemia of herniated abdominal viscera in the thoracic cavity, due to the risk of necrosis and contamination by fecaloid material.(AU)

Gastric herniation due to rupture of diaphragmatic prosthesis in the postoperative period of pleuropneumonectomy due to mesothelioma: A complication to consider.

Extrapleural pneumonectomy, usually associated with pericardial and diaphragmatic reconstruction with prosthetic material, is one of the surgical techniques used in the treatment of malignant pleural mesothelioma. Herniation of the abdominal viscera towards the thorax through the prosthetic material at the diaphragmatic level is a rare but potentially serious complication of these procedures, which must be diagnosed quickly for urgent repair. We present the case of a patient who presented with gastric herniation in the early postoperative period of a left pneumonectomy due to pleural mesothelioma. The clinical findings were mild, but supported by imaging tests, they confirmed the diagnostic hypothesis and facilitated the solution of the condition. Possible contributing factors are reviewed and the need for early diagnosis and treatment is emphasized to avoid ischemia of herniated abdominal viscera in the thoracic cavity, due to the risk of necrosis and contamination by fecaloid material.

La eficacia de [18F]FDG PET/TC en el seguimiento de la progresión de la enfermedad en el mesotelioma pleural maligno / The efficacy of [18F]FDG PET/CT in monitoring disease progression in malignant pleural mesothelioma

Objetivo En caso de sospecha de progresión del mesotelioma pleural maligno (MPM), la imagen juega un papel importante. Nuestro objetivo es evaluar la eficacia de la PET/TC con [18F]FDG en el seguimiento de la progresión de la enfermedad, comparándola con la TC, y estimar la mediana de supervivencia global (OS, del inglés Overall Survival) según el estado de progresión en función de la TC y la PET/TC con [18F]FDG. Materiales y métodos Se trata de un estudio observacional, retrospectivo y unicéntrico con pacientes con MPM a los que se les realizó tanto la PET/TC con [18F]FDG como la TC para controlar la progresión de la enfermedad desde marzo de 2009 hasta febrero de 2020. Se registraron las características clínicas, los hallazgos radiológicos y el estado de progresión según la TC (progresión radiológica negativa [PRN], progresión radiológica positiva [PRP]) y la PET/TC con [18F]FDG (progresión metabólica negativa [PMN], progresión metabólica positiva [PMP]). Se evaluaron las discrepancias y la concordancia entre ambos métodos. La OS se estimó mediante el método de Kaplan-Meier. Resultados Se incluyeron un total de 56 pacientes. Había 31 (55,3%) PRN y 25 (44,7%) PRP, mientras que había 26 (46,5%) PMN y 30 (53,5%) PMP. También todos los pacientes con PRP resultaron ser PMP, sin embargo, entre los PRN, 5 pacientes (8,9% de todos los pacientes) fueron evaluados como PMP. La concordancia entre los 2 métodos en el seguimiento de la progresión de la enfermedad fue muy buena (K=0,423; p<0,01). La OS fue de 26±2,6 meses en todos los pacientes. Las curvas de Kaplan-Meier entre PRN y PRP, y entre PMN y PMP no mostraron diferencias estadísticamente significativas (p=0,56 y 0,25, respectivamente). Conclusiones Ambos métodos son igualmente aceptables en el seguimiento de la progresión de la enfermedad en el MPM, aunque la PET/TC con [18F]FDG detectó más progresión que la TC (AU)

Objective In the event of suspicion of malignant pleural mesothelioma (MPM) progression, imaging plays an important role. We aimed to evaluate the efficacy of [18F]FDG PET/CT in monitoring disease progression by comparing it with CT, and estimate median overall survival (OS) according to progression status with CT and [18F]FDG PET/CT. Materials and Methods This was an observational, retrospective, single-institution study with MPM patients who had both [18F]FDG PET/CT and CT for monitoring disease progression from March 2009 to February 2020. Clinical features, radiological findings, and progression status according to CT [radiologic progression negative (RPN), radiologic progression positive (RPP)] and [18F]FDG PET/CT [metabolic progression negative (MPN), metabolic progression positive (MPP)] were recorded. The discrepancies and concordance between two methods were evaluated. The OS was estimated using the Kaplan–Meier method. Results A total of 56 patients were included. There were thirty-one (55.3%) RPN and 25 (44.7%) RPP, while there were 26 (46.5%) MPN and 30 (53.5%) MPP. All RPP patients were also found to be MPP, however, among RPN, 5 patients (8.9% of all patients) were evaluated as MPP. The concordance between two methods in monitoring disease progression was very good (K=.423; P<.01). The OS was 26 ± 2.6 months in all patients. Kaplan-Meier curves between RPN and RPP, and between MPN and MPP did not show statistically significant differences (P=.56 and P=.25, respectively). Conclusions Both methods are equally acceptable in monitoring disease progression in MPM, even though [18F]FDG PET/CT detected more progression than CT did (AU)

[Well differentiated papillary mesothelioma: description of three case reports and review of the literature]. / Mesotelioma papilar bien diferenciado: descripción de tres casos y revisión bibliográfica.

Well Differentiated Papillary Mesothelioma (MPBD) is a very rare neoplasm that mainly affects women of reproductive age. The most common location is the peritoneum and it is an incidental finding, with a generally favorable prognosis. We present three cases diagnosed incidentally, in the course of a surgical intervention of various causes, which presented as peritoneal exophytic lesions not detected in the pre-surgical imaging study. It is important to keep this entity in mind, to differentiate it from other neoplasms with an unfavorable prognosis and evolution, such as Malignant Mesothelioma or primary and metastatic carcinomas. Recent studies give the MPBD a specific immunohistochemical and molecular profile that allow a greater diagnostic precision of the entity.

Mesotelioma papilar bien diferenciado: descripción de tres casos y revisión bibliográfica / Well differentiated papillary mesothelioma: description of three case reports and review of the literature

El mesotelioma papilar bien diferenciado (MPBD) es una neoplasia muy infrecuente que afecta fundamentalmente a mujeres en edad reproductiva. La localización más habitual es el peritoneo y se trata de un hallazgo incidental, con un pronóstico generalmente favorable. Presentamos tres casos diagnosticados de manera incidental, en el trascurso de una intervención quirúrgica de causas diversas, que se presentaron como lesiones exofíticas peritoneales no detectadas en el estudio de imagen prequirúrgico. Es importante tener presente esta entidad para diferenciarla de otras neoplasias de pronóstico y evolución desfavorable, como el mesotelioma maligno o carcinomas primarios y metastásicos. Estudios recientes le confieren al MPBD un perfil inmunohistoquímico y molecular específico que permiten una mayor precisión diagnóstica de la entidad.(AU)

Well Differentiated Papillary Mesothelioma (MPBD) is a very rare neoplasm that mainly affects women of reproductive age. The most common location is the peritoneum and it is an incidental finding, with a generally favorable prognosis. We present three cases diagnosed incidentally, in the course of a surgical intervention of various causes, which presented as peritoneal exophytic lesions not detected in the pre-surgical imaging study. It is important to keep this entity in mind, to differentiate it from other neoplasms with an unfavorable prognosis and evolution, such as Malignant Mesothelioma or primary and metastatic carcinomas. Recent studies give the MPBD a specific immunohistochemical and molecular profile that allow a greater diagnostic precision of the entity.(AU)

The efficacy of 18F-FDG PET/CT in monitoring disease progression in malignant pleural mesothelioma.

OBJECTIVE: In the event of suspicion of malignant pleural mesothelioma (MPM) progression, imaging plays an important role. We aimed to evaluate the efficacy of 18F-FDG PET/CT in monitoring disease progression by comparing it with CT, and estimate median overall survival (OS) according to progression status with CT and 18F-FDG PET/CT. MATERIALS AND METHODS: This was an observational, retrospective, single-institution study with MPM patients who had both 18F-FDG PET/CT and CT for monitoring disease progression from March 2009 to February 2020. Clinical features, radiological findings, and progression status according to CT [radiologic progression negative (RPN), radiologic progression positive (RPP)] and 18F-FDG PET/CT [metabolic progression negative (MPN), metabolic progression positive (MPP)] were recorded. The discrepancies and concordance between two methods were evaluated. The OS was estimated using the Kaplan-Meier method. RESULTS: A total of 56 patients were included. There were thirty-one (55.3%) RPN and 25 (44.7%) RPP, while there were 26 (46.5%) MPN and 30 (53.5%) MPP. All RPP patients were also found to be MPP, however, among RPN, 5 patients (8.9% of all patients) were evaluated as MPP. The concordance between two methods in monitoring disease progression was very good (K = 0.423; p < 0.01). The OS was 26 ±â€¯2.6 months in all patients. Kaplan-Meier curves between RPN and RPP, and between MPN and MPP did not show statistically significant differences (p = 0.56 and p = 0.25, respectively). CONCLUSIONS: Both methods are equally acceptable in monitoring disease progression in MPM, even though 18F-FDG PET/CT detected more progression than CT did.

Mesotelioma maligno en Colombia: carga de enfermedad, panorama general e índice sociodemográfico subnacional, 2015-2020 / Malignant mesothelioma in Colombia: burden of disease, overview, and subnational sociodemographic index, 2015-2020 / Mesotelioma maligno na Colômbia: carga de morbidade, visão geral e índice sociodemográfico subnacional, entre 2015 e 2020

RESUMEN Objetivo. Establecer la carga de enfermedad por mesotelioma maligno (MM) en Colombia entre 2015 y 2020 y su asociación con el índice sociodemográfico (SDI) subnacional y las localizaciones de asbesto. Métodos. Estudio ecológico mixto en la población colombiana con diagnóstico de MM según la CIE-10 durante 2015 a 2020. La carga global de enfermedad (GBD, por su sigla en inglés) se estimó por medio de la metodología propuesta de Murray y López a partir de la prevalencia y mortalidad obtenida de fuentes oficiales. Se estimó el SDI (por su sigla en inglés) subnacional (nivel departamental) como medida de desarrollo socioeconómico y se establecieron regresiones lineales con la GBD, el SDI y las localizaciones documentadas de asbesto. Resultados. La GBD estimada por MM en Colombia durante 2015-2020 fue de 51,71 años de vida ajustados por discapacidad (AVAD) por cada 1 000 000 de habitantes (15 375,79 AVAD totales), con predominio en personas mayores de 50 años (91,1%) y de sexo masculino (66,4%). A nivel departamental, Bogotá y Valle del Cauca presentaron la mayor cantidad de AVAD ajustados; mientras que Bogotá tuvo el SDI más alto, y Guainía y Cesar el más bajo. Se evidenció una asociación entre los AVAD y el SDI, donde este último explicó 22,8% de los casos de AVAD. Conclusión. El MM es causa de una gran cantidad de AVAD, con predominio en los departamentos con mayor desarrollo socioeconómico, y con presencia de empresas que solían utilizar asbesto; no obstante, el posible subdiagnóstico de MM limita el análisis de la información.

ABSTRACT Objective. Establish the disease burden of malignant mesothelioma (MM) in Colombia between 2015 and 2020, and its association with the subnational sociodemographic development index (SDI) and with asbestos sites. Methods. Mixed ecological study of the Colombian population diagnosed with MM (according to ICD-10) from 2015 to 2020. The global burden of disease (GBD) was estimated using the methodology proposed by Murray and Lopez, based on prevalence and mortality data obtained from official sources. The subnational (departmental level) SDI was estimated as a measure of socioeconomic development. Linear regressions were established with the GBD, SDI, and documented asbestos sites. Results. The estimated GBD of MM in Colombia during 2015-2020 was 51.71 disability-adjusted life years (DALYs) per 1 000 000 inhabitants (15 375.79 total DALYs), with predominance in people over 50 years of age (91.1%) and males (66.4%). Bogotá and Valle del Cauca were the departments with the highest number of adjusted DALYs. Bogotá had the highest SDI and Guainía and Cesar had the lowest. There was evidence of an association between DALYs and SDI, explaining 22.8% of DALYs. Conclusion. Malignant mesothelioma is the cause of a large number of DALYs, predominantly in the departments with greater socioeconomic development and with companies that used to use asbestos. However, possible underdiagnosis of MM limits analysis of the information.

RESUMO Objetivo. Estabelecer o ônus da doença por mesotelioma maligno (MM) na Colômbia entre 2015 e 2020 e sua associação ao índice sociodemográfico subnacional (ISS) e locais de amianto. Métodos. Estudo ecológico misto na população colombiana diagnosticada com MM, de acordo com a CID-10 durante 2015 a 2020. A carga global da doença (CGD) foi estimada usando a metodologia proposta por Murray e López com base na prevalência e na mortalidade obtidas de fontes oficiais. O SDI subnacional (nível departamental) foi estimado como uma medida de desenvolvimento socioeconômico e foram estabelecidas regressões lineares com CGD, SDI e localizações documentadas de amianto. Resultados. A estimativa de CGD por MM na Colômbia entre 2015-2020 foi de 51,71 anos de vida ajustados por incapacidade (AVAI) por 1 000 000 de habitantes (15 375,79 AVAI totais), com predominância em pessoas com mais de 50 anos (91,1%) e do sexo masculino (66,4%). Com relação aos departamentos, Bogotá e Valle del Cauca tiveram o maior número de AVAI ajustados, enquanto Bogotá teve o maior SDI, e Guainía e Cesar, o menor. Houve uma associação entre os AVAI e o SDI, sendo que o SDI foi responsável por 22,8% dos AVAI. Conclusões. O MM é a causa de um grande número de AVAI, predominantemente em departamentos com maior desenvolvimento socioeconômico e com a presença de empresas que usavam amianto; no entanto, o possível subdiagnóstico do MM limita a análise das informações.

Qualidade dos registros de ocupação das doenças associadas ao asbesto no sistema de informação sobre mortalidade, Brasil / Quality of occupation records of asbestos-related diseases in the mortality information system, Brazil

Resumo Introdução: Registros de ocupações de trabalhadores em sistemas de informação significam muito mais que um dado sociodemográfico. Na Medicina do Trabalho e na Epidemiologia em Saúde do Trabalhador, são especialmente relevantes por indicarem possíveis fatores de risco ocupacionais. Objetivo: Estimar indicadores de qualidade do registro da ocupação das doenças associadas ao asbesto no Sistema de Informação sobre Mortalidade (SIM), Brasil. Método: Estudo transversal conduzido com registros de óbito de maiores de 16 anos de idade, registrados no SIM, entre 2000-2016, com diagnósticos de doenças tipicamente associadas ao asbesto (DAA): mesotelioma, asbestose e placas pleurais. O registro da "ocupação" foi analisado para a completude e consistência. Resultados: Foram identificados 3.764 registros de óbito, para os quais observou-se 60,3% (n=2.268) de incompletude/inconsistência do registro da ocupação. Dados inválidos da ocupação representaram 40,1% (n=1.508), concentrando-se em registros de aposentados e donas de casa, não reconhecidos como ocupações. A má qualidade do registro de ocupação entre os óbitos por DAA foi superior a 50,0% em todas as regiões do país. Conclusões: A qualidade do registro da ocupação no SIM foi ruim tanto para as DAA quanto outros diagnósticos, especialmente no que se refere a completude e consistência dos dados, em relação à Classificação Brasileira de Ocupações.

Abstract Background: Records from occupations of workers in information systems mean much more than just sociodemographic data. In Occupational Medicine and Occupational Health Epidemiology, they are especially relevant as they indicate possible occupational risk factors. Objective: To estimate quality indicators of the record of occupation of asbestos-related diseases in the Mortality Information System (SIM), Brazil. Method: Cross-sectional study, conducted with death records of people over 16 years of age, registered in SIM, from 2000 to 2016, with diagnoses of asbestos-related diseases (ARD): mesothelioma, asbestosis, and pleural plaques. The "occupation" field was analyzed for completeness and consistency. Results: From a total of 3,764 death records, for which 60.3% (n=2,268) of missed/inconsistent occupation records were observed. Invalid occupation data accounted for 40.1% (n=1,508), mainly filled with "retired" or "housewives", not recognized as formal job titles. The poor occupancy record quality among ARD records was over 50.0% in all regions of the country. Conclusions: The quality of the occupation records in SIM was poor for both ARD and other diagnoses, especially regarding the completeness and consistency of the data, in relation to the Brazilian Classification of Occupations.

Estudio proteomico diferencial entre liquidos pleurales secundarios a cáncer de pulmón versus mesotelioma / Differential proteomic study between pleural fluid secondary to lung cancer versus mesothelioma

Objetivo: Encontrar perfiles proteicos en líquido pleural que diferencien derrames pleurales secundarios a cáncer de pulmón (CP) versus mesotelioma pleural maligno (MPM).Metodología: Recogimos líquidos pleurales de 60 pacientes de tres grupos diferentes: MPM (N = 20), CP (N = 20) y derrames pleurales benignos (N = 20). Realizamos un análisis con proteómica diferencial con ITRAQ 4 plex (Applied Biosystem). Realizamos la identificación y cuantificación relativa de las proteínas con el programa Proteome Discoverer 1.4 (Termofisher Scientific). Construimos diagramas de Venn con las proteínas sobre/infra-expresadas en cada grupo. Realizamos una validación interna/externa mediante ELISA (Myobiosorce) añadiendo 25 muestras de CP y 14 de MPM.Resultados: Encontramos sobreexpresión de Pi3K en los derrames pleurales neoplásicos (16,86 +/- 25,83 ng/ml en CP; 20,66 +/- 17,26 ng/ml en MPM vs 5,92 +/- 0,99 ng/ml en controles). Hubo sobreexpresión de SPRM en MPM (30.702 +/- 30.310,53 ng/ml en el grupo MPM vs 10.404 +/- 10.157,72 ng/ml en el grupo CP vs 8.498 + /- 3.437,18 ng/ml en controles). Existió sobreexpresión de RhoB en CP (4,46 +/- 1,65 mg/ml en CP vs 1,65 +/- 2,65 mg/ml en MPM vs 0,92 +/- 1,6 mg/ml en controles). También encontramos sobreexpresión de PDGFR-alfa en derrames pleurales benignos (74,12 +/- 22,57 ng/ml en controles vs 43,05 +/- 23,96 ng/ml en CP vs 36,12 +/- 21,51 ng/ml en MPM).Conclusión: Existe un perfil diferencial proteico entre los derrames secundarios a CP (sobreexpresión de RhoB) y a MPM (sobrexpresión de SPRM). La sobrexpresión de Pi3K indica asociación a derrames pleurales malignos y la de PDGFR-alfa a derrames benignos. (AU)

Objetivo: Find protein profiles in pleural fluid that differentiate pleural effusions secondary to lung cancer (LC) versus malignant pleural mesothelioma (MPM).Metodología: We collected pleural fluids from 60 patients from three different groups: MPM (N = 20), CP (N = 20), and benign pleural effusions (N = 20). We performed differential proteomics analysis with ITRAQ 4 plex (Applied Biosystem). We performed the identification and relative quantification of the proteins with the Proteome Discoverer 1.4 program (Termofisher Scientific). We built Venn diagrams with the over/under-expressed proteins in each group. We performed an internal/external validation using ELISA (Myobiosorce) adding 25 CP and 14 MPM samples.Resultados: We found Pi3K overexpression in neoplastic pleural effusions (16.86 +/- 25.83 ng/ml in PC; 20.66 +/- 17.26 ng/ml in MPM vs 5.92 +/- 0.99 ng/ml in controls). There was overexpression of SPRM in MPM (30,702 +/- 30,310.53 ng/ml in the MPM group vs 10,404 +/- 10,157.72 ng/ml in the CP group vs 8,498 +/- 3,437.18 ng/ml in controls). There was overexpression of RhoB in CP (4.46 +/- 1.65 mg/ml in CP vs 1.65 +/- 2.65 mg/ml in MPM vs 0.92 +/- 1.6 mg/ml in controls). We also found overexpression of PDGFR-alpha in benign pleural effusions (74.12 +/- 22.57 ng/ml in controls vs 43.05 +/- 23.96 ng/ml in PC vs 36.12 +/- 21.51 ng/ml in MPM ).Conclusión: There is a differential protein profile between effusions secondary to CP (RhoB overexpression) and MPM (SPRM overexpression). Pi3K overexpression indicates association with malignant pleural effusions and PDGFR-alpha overexpression with benign effusions. (AU)

Metastasis of malignant pleural mesothelioma to the scalp following chemotherapy: A case report and review of the literature.

Malignant pleural mesothelioma is a neoplasm involving mesothelial cells of the pleura. Both local and distant metastases may develop, although the latter are less common and it is extremely rare for cutaneous metastases to appear as a solitary lesion on the scalp. We present the case of a 54-year-old woman with a 2-year history of unresectable left pleural mesothelioma treated with chemotherapy, who had developed a painful lump on the scalp one month prior to consultation. Skin metastases of mesothelioma must be differentiated from primary neoplasms, and immunohistochemistry is fundamental to determine the origin of such lesions, which can be correctly identified through the use of a panel of markers.

[Pleural deciduoid mesothelioma: A report of 3 cases and a review of the literature]. / Mesotelioma deciduoide pleural: presentación de 3 casos y revisión de la literatura.

Deciduoid mesothelioma is an uncommon histological variant of epithelial mesothelioma which is extremely clinically aggressive. We report 3 cases of pleural caducoid mesothelioma in women of 75, 74 and 23 years of age. All patients presented with dyspnoea, vomiting and pelvic pain. Their imaging studies showed nodular pleuropericardic thickening, a parietal pleuropericardic solid mass and a large thoracic mass, respectively. Only one of them could be treated with chemotherapy, surgery and radiotherapy. Post diagnostic survival was 24 days, 1 month and 17 months respectively (mean 6.2 months). We describe the clinicopathological and immunohistochemical findings together with a review of the relevant literature.

Mesotelioma pleural / Pleural mesothelioma

El diagnóstico de mesotelioma pleural difuso requiere en la mayoría de los casos una biopsia pleural, realizada bajo control de imagen (ecografía o tomografía computarizada) o mediante toracoscopia. La pérdida de expresión de BAP1 o de MTAP (inmunohistoquímica) y la deleción homocigota de CDKN2A (hibridación fluorescente in situ) constituyen los marcadores moleculares básicos para el diagnóstico de mesotelioma. El tipo histológico y el estado funcional del paciente son los factores pronósticos más importantes. El control del derrame pleural se puede realizar a través de la inserción de catéteres pleurales tunelizados, bien como medida aislada (p. ej. pacientes no susceptibles de terapia multimodal que se han diagnosticado por citología del líquido pleural o biopsia guiada por imagen) o combinada con la administración de talco aerosolizado durante una toracoscopia diagnóstica. La inmunoterapia constituye una de las primeras líneas de tratamiento en pacientes inoperables, particularmente en las variedades histológicas bifásicas o sarcomatosas. (AU)

The diagnosis of diffuse pleural mesothelioma requires in most cases a pleural biopsy, performed either under imaging guidance (ultrasound or computed tomography) or thoracoscopy. Loss of BAP1 or MTAP expression (immunohistochemistry) and homozygous deletion of CDKN2A (fluorescence in situ hybridization) are the basic molecular markers for the diagnosis of mesothelioma. The histologic type and patient's performance status are the most important prognostic factors. Pleural effusion can be managed by the insertion of tunneled pleural catheters, either as a stand-alone measure (e.g., patients not amenable to multimodality therapy who have been diagnosed by pleural fluid cytology or image-guided biopsy) or combined with the administration of aerosolized talc during a diagnostic thoracoscopy. Immunotherapy is one of the front-line approaches in inoperable patients, particularly in biphasic or sarcomatous histologic varieties. (AU)

Cuidados Paliativos en una paciente con Mesotelioma Peritoneal. Revisión de la literatura

Introducción: Los mesoteliomas peritoneales se origina de las células que recubren la serosa de las cavidades del cuerpo, el 15% se originan del peritoneo. Su incidencia de es 0.2 a 3 casos por millones de personal al año. Son tumores raros y su supervivencia global se limita hasta 12 meses. El objetivo de esta presentación de caso es describir una presentación atípica de esta entidad y realizar una revisión de la literatura. Materiales y métodos: Se realizó una descripción de un caso en la consulta externa de oncología diagnosticada con Mesotelioma papilar bien diferenciado de primario de peritoneo diagnosticada en el 2012 quien en el 2022 mantiene 10 años de supervivencia global y se realizó una revisión de la literatura en base al caso clínico. Resultados:  Se define los tipos de mesotelioma peritoneal, sus características clínicas, el manejo del Mesotelioma Peritoneal según el Consenso de Chicago, los principios en cuidados de soporte como la ascitis peritoneal, el dolor, náuseas y vómitos, distrés psicosocial, así como la discusión del caso. Conclusión: El mesotelioma peritoneal es una enfermedad rara que puede ser rápidamente progresiva con una carga de enfermedad importante y pronóstico limitado. La instauración temprana de cuidados paliativos en pacientes con neoplasia incurable como el mesotelioma peritoneal permite el abordaje una mejor calidad de vida del paciente, así como de cumplir objetivos acordes a la situación clínica de cada paciente. (provisto por Infomedic International)

Introduction: Peritoneal mesotheliomas originate from the cells lining the serosa of the body cavities, 15% originate from the peritoneum. Their incidence is 0.2 to 3 cases per million personnel per year. They are rare tumors and their overall survival is limited to 12 months. The aim of this case report is to describe an atypical presentation of this entity and to review the literature. Materials and methods: A description of a case was made in the oncology outpatient clinic diagnosed with well-differentiated papillary mesothelioma of primary peritoneum diagnosed in 2012 who in 2022 maintains 10 years of overall survival and a review of the literature was performed based on the clinical case. Results: We define the types of peritoneal mesothelioma, its clinical features, the management of peritoneal mesothelioma according to the Chicago Consensus, the principles in supportive care such as peritoneal ascites, pain, nausea and vomiting, psychosocial distress, as well as the discussion of the case. Conclusion: Peritoneal mesothelioma is a rare disease that can be rapidly progressive with a significant disease burden and limited prognosis. The early establishment of palliative care in patients with incurable neoplasm such as peritoneal mesothelioma allows the approach to a better quality of life of the patient, as well as to meet objectives according to the clinical situation of each patient. (provided by Infomedic International)

Pleural mesothelioma. / Mesotelioma pleural.

The diagnosis of diffuse pleural mesothelioma requires in most cases a pleural biopsy, performed either under imaging guidance (ultrasound or computed tomography) or thoracoscopy. Loss of BAP1 or MTAP expression (immunohistochemistry) and homozygous deletion of CDKN2A (fluorescence in situ hybridization) are the basic molecular markers for the diagnosis of mesothelioma. The histologic type and patient's performance status are the most important prognostic factors. Pleural effusion can be managed by the insertion of tunneled pleural catheters, either as a stand-alone measure (e.g., patients not amenable to multimodality therapy who have been diagnosed by pleural fluid cytology or image-guided biopsy) or combined with the administration of aerosolized talc during a diagnostic thoracoscopy. Immunotherapy is one of the front-line approaches in inoperable patients, particularly in biphasic or sarcomatous histologic varieties.

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.