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1.
Zhonghua Zhong Liu Za Zhi ; 43(4): 383-394, 2021 Apr 23.
Artigo em Chinês | MEDLINE | ID: mdl-33902201

RESUMO

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.


Assuntos
Neoplasias Pulmonares , Mesotelioma , Neoplasias Pleurais , China , Humanos , Imunoterapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Mesotelioma/diagnóstico , Mesotelioma/epidemiologia , Mesotelioma/terapia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/epidemiologia , Neoplasias Pleurais/terapia
3.
J Breath Res ; 14(4): 046011, 2020 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-32731209

RESUMO

Malignant mesothelioma (MM) is an incurable cancer. MM is often misdiagnosed, with a poor 5-year survival and limited treatment options. The discovery of endogenous volatile organic compounds (VOCs) is required in order to accelerate the development of a breath test as an alternative to conventional MM diagnosis. For the first time, this study used solid-phase microextraction and gas chromatography-mass spectrometry to identify VOCs released directly from the biphasic MM cell line MSTO-211H and the epithelioid MM cell line NCI-H28 as well as the non-malignant mesothelial cell line MET-5A. Multivariate statistical analysis showed separation between MSTO-211H, NCI-H28 and MET-5A results. 2-ethyl-1-hexanol was significantly increased in both MSTO-211H and NCI-H28 cells compared to MET-5A controls. In addition, ethyl propionate and cyclohexanol were significantly increased in MSTO-211H cells and dodecane was significantly increased in NCI-H28 cells. This is the first study reporting headspace analysis of these MM cell lines and the first to consider the effects of mesothelioma sub-type on VOC profile. Current results further highlight the potential for a diagnostic mesothelioma breath test as well as providing proof of concept for the differentiation between biphasic and epithelioid mesothelioma based on VOC profiles.


Assuntos
Cromatografia Gasosa-Espectrometria de Massas , Mesotelioma/diagnóstico , Mesotelioma/patologia , Testes Respiratórios , Contagem de Células , Linhagem Celular Tumoral , Sobrevivência Celular , Humanos , Análise dos Mínimos Quadrados , Análise de Componente Principal , Compostos Orgânicos Voláteis/análise
4.
Artigo em Chinês | MEDLINE | ID: mdl-32536066

RESUMO

Objective: To explore the relationship between the new Tumor-Node-Metastasis (TNM) staging system and the serum CA125 level with the prognosis of malignant peritoneal mesothelioma (MPeM) . Methods: The clinical data of 74 patients with MPeM diagnosed by pathology and immunohistochemistry were collected from January 2005 to June 2016 in Cangzhou Central Hospital. According to the results of CT-peritoneal carcinoma index (PCI) , the tumor load was divided into T1 (PCI 1-10) , T2 (PCI 11-20) , T3 (PCI 21-30) and T4 (PCI 31-39) , combined with lymph node metastasis and extraperitoneal metastasis, a new TNM staging system was established. And serum CA125 level was measured in the same time. The median survival time of patients with MPeM, the effect of the new TNM staging system, and serum CA125 levels on their prognosis were retrospectively analyzed. Results: Among the 74 patients with MPeM, 25 (33.8%) cases were males and 49 (66.2%) cases were females. There were 8 cases with systemic chemotherapy, 8 cases with heated intraperitoneal chemotherapy, and 1 case with combination chemotherapy. 10 cases were T1, 22 cases were T2, 27 cases were T3, 15 cases were T4, 12 cases had lymph node metastasis and 10 cases had distant metastasis. The median survival time of T1, T2, T3 and T4 were 12, 10, 6 and 3 months respectively. There were 38 (77.6%) cases with high serum CA125 in all 49 cases who have been tested for CA125. The median survival time of positive group and negative group were 6 months and 11 months respectively. 68 (91.9%) patients had died by the end of collecting data. The median survival time was 8 months. Univariate analysis showed that there were significant differences in survival time between patients with different CT-PCI stages, serum CA125 levels, and with or without lymph node and extraperitoneal metastasis (P<0.05) . Multivariate analysis showed that CT-PCI was independent risk factors for the prognosis of MPeM (HR=2.203, 95%CI: 1.475-3.289) . Conclusion: The new TNM staging system and serum CA125 are important for the prognosis of patients with MPeM. Early detection, early diagnosis and comprehensive treatment can improve the survival time of patients with MPeM.


Assuntos
Mesotelioma , Neoplasias Peritoneais , Antígeno Ca-125/análise , Feminino , Humanos , Masculino , Proteínas de Membrana/análise , Mesotelioma/diagnóstico , Estadiamento de Neoplasias , Neoplasias Peritoneais/diagnóstico , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
5.
Artigo em Inglês | MEDLINE | ID: mdl-32560553

RESUMO

BACKGROUND: Patients of malignant mesothelioma (MM) and their caregivers face significant physical and psychological challenges. The purpose of the present study is to examine the emotional impact after the diagnosis of MM in a group of patients and familial caregivers in a National Priority Contaminated Site (NPCS). METHODS: A sample of 108 patients and 94 caregivers received a sociodemographic/clinical questionnaire, the Beck Depression Inventory II, the Davidson Trauma Scale, the Coping Orientation to the Problems Experienced-New Italian Version, and the Defense style questionnaire. The risk of depressive and post-traumatic stress disorder (PTSD) symptoms in relation to the strategies of coping and defense mechanisms was estimated in patients and caregivers separately by logistic regression models. RESULTS: For patients, a high risk of depression was associated with high usage of Defense Style Questionnaire (DSQ) Isolation (OR: 53.33; 95% CI: 3.22-882.30; p = 0.01) and DSQ Somatization (OR: 16.97; 95% CI: 1.04-275.90; p = 0.05). Other significant risks emerged for some coping strategies and some defenses regarding both depression and trauma in patients and caregivers. CONCLUSIONS: This research suggests that for both patients and caregivers unconscious adaptive processes have a central role in dealing with overwhelming feelings related to the disease.


Assuntos
Cuidadores/psicologia , Mesotelioma/epidemiologia , Mesotelioma/psicologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/psicologia , Angústia Psicológica , Adaptação Psicológica , Adulto , Idoso , Asbestos/efeitos adversos , Asbestose/diagnóstico , Asbestose/epidemiologia , Asbestose/etiologia , Asbestose/psicologia , Carcinógenos , Cuidadores/estatística & dados numéricos , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia , Masculino , Mesotelioma/diagnóstico , Mesotelioma/etiologia , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/etiologia , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
6.
Pathologe ; 41(4): 406-410, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32472158

RESUMO

Proliferative changes seen in reactive mesothelial hyperplasia of a hydrocele sac may mimic malignant mesothelioma. There is no immunohistochemical staining that reliably separates benign from malignant mesothelial proliferations. However, the combined analysis of BAP1 by immunohistochemistry and CDKN2A by FISH has been reported to yield both a high specificity and sensitivity in this differential diagnosis. In addition, the evaluation of risk factors such as asbestos exposure or prior traumata may be helpful for the correct diagnosis. Exclusion of stromal invasion, which is diagnostic for malign mesothelioma, is of utmost importance. Therefore, extended histological workup is essential.


Assuntos
Neoplasias Pulmonares , Mesotelioma , Neoplasias Testiculares , Proliferação de Células , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/diagnóstico , Masculino , Mesotelioma/diagnóstico , Neoplasias Testiculares/patologia , Testículo , Proteínas Supressoras de Tumor/análise , Ubiquitina Tiolesterase/análise
7.
Cancer Invest ; 38(6): 356-364, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32468861

RESUMO

Pleural effusion adenosine deaminase (ADA) levels are elevated in various diseases. We investigated whether pleural effusion ADA levels differ among patients with malignant pleural mesothelioma (MPM), lung cancer (LC), and benign diseases, including tuberculous pleurisy. We examined 329 patients from February 2002 to July 2013. There were 131 MPM cases with ADA levels of 32.29 IU/L; 117 LC cases with ADA levels of 21.12 IU/L; 54 benign disease cases with ADA levels of 20.98 IU/L. A significant difference existed in pleural effusion ADA levels between MPM and benign disease patients. Pleural effusion ADA levels were significantly higher in MPM patients.


Assuntos
Adenosina Desaminase/genética , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias/diagnóstico , Neoplasias Pleurais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/diagnóstico por imagem , Mesotelioma/genética , Mesotelioma/patologia , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/patogenicidade , Neoplasias/diagnóstico por imagem , Neoplasias/genética , Neoplasias/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/genética , Derrame Pleural Maligno/patologia , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/genética , Neoplasias Pleurais/patologia , Toracoscopia , Tuberculose Pleural/diagnóstico , Tuberculose Pleural/genética , Tuberculose Pleural/microbiologia , Tuberculose Pleural/patologia
9.
J Toxicol Environ Health A ; 83(3): 126-134, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32114955

RESUMO

Malignant pleural mesothelioma (MPM) is a type of cancer characterized by a short survival time and poor prognosis. Malignant pleural mesothelioma is most frequently associated with exposure to asbestos and other elongated mineral fibers. The aim of this study was to examine molecular differences between asbestos-exposed and non-exposed MPM patients and assess prognostic significances of molecular factors. Clinical and genetic data were downloaded from Cancer Genome Atlas. To identify the molecular differences, Significant Analysis of Microarray method was used. Prognostic significances of differentially expressed genes were confirmed by using Kaplan-Meier curve with the Log-Rank test. Although mRNAs did not exhibit any significant differences between the two patient groups, nine miRNAs were found to be down-regulated in the asbestos-exposed group. The top five pathways most relevant to the selected miRNAs were extracted through pathway enrichment analysis. Survival analysis revealed that high expression of only hsa-miR-98 was significantly associated with poor prognosis in patients with asbestos-exposed MPM. Evidence suggests that management of the aggressiveness and progression of asbestos-induced MPM may require high levels of hsa-miR-98 due to its tumor-suppressive role. This study might be helpful in enhancing our understanding of the biological mechanisms underlying asbestos-induced MPM and for acquiring greater insights into targeted therapy.Abbreviations: FDR: false discovery rate; MM: malignant mesothelioma; MPM: malignant pleural mesothelioma; mRNA: messenger RNA; miRNA: microRNA; SAM: significance analysis of microarrays; TCGA: the cancer genome atlas.


Assuntos
Asbestos/toxicidade , Carcinógenos/toxicidade , Mesotelioma/diagnóstico , MicroRNAs/metabolismo , Idoso , Biomarcadores Tumorais , Regulação para Baixo , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Masculino , Mesotelioma/induzido quimicamente , MicroRNAs/genética , Pessoa de Meia-Idade
10.
Rev. cuba. cir ; 59(1): e831, ene.-mar. 2020.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126407

RESUMO

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)


Assuntos
Humanos , Asbestos/efeitos adversos , Literatura de Revisão como Assunto , Mesotelioma/diagnóstico , Mesotelioma/terapia , Bases de Dados Bibliográficas , Fibras Minerais
11.
Artigo em Inglês | MEDLINE | ID: mdl-32050546

RESUMO

Malignant pleural mesothelioma (MPM) is mainly related to previous asbestos exposure. There is still dearth of information on non-invasive biomarkers to detect MPM at early stages. Human studies on exhaled breath biomarkers of cancer and asbestos-related diseases show encouraging results. The aim of this systematic review was to provide an overview on the current knowledge about exhaled breath analysis in MPM diagnosis. A systematic review was conducted on MEDLINE (PubMed), EMBASE and Web of Science databases to identify relevant studies. Quality assessment was done by the Newcastle-Ottawa Scale. Six studies were identified, all of which showed fair quality and explored volatile organic compounds (VOC) based breath profile using Gas Chromatography Coupled to Mass Spectrometry (GC-MS), Ion Mobility Spectrometry Coupled to Multi-capillary Columns (IMS-MCC) or pattern-recognition technologies. Sample sizes varied between 39 and 330. Some compounds (i.e, cyclohexane, P3, P5, P50, P71, diethyl ether, limonene, nonanal, VOC IK 1287) that can be indicative of MPM development in asbestos exposed population were identified with high diagnostic accuracy rates. E-nose studies reported breathprints being able to distinguish MPM from asbestos exposed individuals with high sensitivity and a negative predictive value. Small sample sizes and methodological diversities among studies limit the translation of results into clinical practice. More prospective studies with standardized methodologies should be conducted on larger populations.


Assuntos
Asbestos , Biomarcadores Tumorais , Testes Respiratórios , Mesotelioma , Compostos Orgânicos Voláteis , Biomarcadores Tumorais/análise , Expiração , Humanos , Mesotelioma/diagnóstico , Estudos Prospectivos
12.
Am J Surg Pathol ; 44(3): 347-356, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32045387

RESUMO

Nuclear grading systems for epithelioid malignant pleural mesothelioma (MPM) have been proposed but it remains uncertain if they could be applied in a biopsy-heavy setting. Using the proposed system, we conducted an independent, external validation study using 563 consecutive cases of epithelioid MPM diagnosed at our institution between 2003 and 2017, of which 87% of patients underwent biopsies only. The median number of sites sampled was 1, with a median maximum tissue dimension of 17 mm (biopsy) and 150 mm (resection). The median overall survival (OS) was 14.7 months. The frequencies of grade I, II, and III tumors were 31% (132/563), 52% (292/563), and 17% (94/563). Grade I tumors were associated with the most favorable median OS (24.7 mo) followed by grades II (12.7 mo) and III (7.2 mo). The 2-tier nuclear grade separated tumors into low grade (19.3 mo) and high grade (8.9 mo). In multivariate analysis, 3-tier nuclear grade, 2-tier nuclear grade, and mitosis-necrosis score predicted OS independent of age, procedural type, solid-predominant growth pattern, necrosis, and atypical mitosis (all P<0.001 except 2-tier nuclear grade, P=0.001). In the scenario of a single- site biopsy with tissue dimension ≤10 mm, none but age (P=0.002) were independently predictive. Our data also suggested sampling 3 sites or a maximum tissue dimension of at least 20 mm from a single site is optimal for nuclear grade assessment. In conclusion our study confirmed the utility of nuclear grade in epithelioid MPM using a biopsy-heavy cohort provided the tissue sample met minimum dimensional criteria.


Assuntos
Neoplasias Pulmonares/patologia , Mesotelioma/patologia , Pleura/patologia , Neoplasias Pleurais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Masculino , Mesotelioma/diagnóstico , Mesotelioma/mortalidade , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/mortalidade , Estudos Retrospectivos , Análise de Sobrevida
14.
Surg Pathol Clin ; 13(1): 73-89, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32005436

RESUMO

Mesothelioma is a rare neoplasm that arises from mesothelial cells lining body cavities including the pleura, pericardium, peritoneum, and tunica vaginalis. Most malignant mesotheliomas occur in the chest and are frequently associated with a history of asbestos exposure. The diagnosis of malignant mesothelioma is challenging and fraught with pitfalls, particularly in small biopsies. This article highlights what the pathologist needs to know regarding the clinical and radiographic presentation of mesothelioma, histologic features including subtypes and variants, and recent advances in immunohistochemical markers and molecular testing.


Assuntos
Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Biópsia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Imagem por Ressonância Magnética , Mesotelioma/diagnóstico por imagem , Mesotelioma/patologia , Radiografia , Tomografia Computadorizada por Raios X
15.
BMJ Case Rep ; 13(2)2020 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-32041759

RESUMO

A 75-year-old man presented to the emergency department with 1-day history of right lower limb pain and 3-month history of vague abdominal pain. In the emergency department a thrombus was discovered in the right popliteal artery. CT scan of the abdomen and pelvis revealed high-density material in the pelvis, multiple hypodensities on the liver, ascites with omental nodularity, and high-density material along the stomach wall. He underwent thrombectomy and was started on anticoagulation therapy. The core needle biopsy revealed primary omental mesothelioma. There was no history of any known asbestos exposure. He also had to undergo therapeutic paracentesis twice due to abdominal distension. Mesothelioma treatment of carboplatin and pemetrexed was started, and the patient is currently receiving this chemotherapy treatment regimen.


Assuntos
Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias Peritoneais/diagnóstico , Abdome/diagnóstico por imagem , Idoso , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Asbestos , Ascite/diagnóstico por imagem , Biópsia com Agulha de Grande Calibre , Carboplatina/uso terapêutico , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Mesotelioma/tratamento farmacológico , Pelve/diagnóstico por imagem , Pemetrexede/uso terapêutico , Neoplasias Peritoneais/tratamento farmacológico , Artéria Poplítea/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Trombose/cirurgia
16.
Pathol Res Pract ; 216(3): 152817, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32008868

RESUMO

Calretinin, a mesothelioma marker, is sometimes expressed in lung cancer, which may complicate the differential diagnosis of mesothelioma. Here, the clinicopathological and immunohistochemical characteristics of calretinin-positive lung cancer were examined to reduce confusion with malignant mesothelioma. Calretinin expression in 307 consecutive cases of lung cancer was evaluated immunohistochemically. Survival was analyzed using the Kaplan-Meier method and log-rank test. Calretinin expression was identified in 67 (22%) tumors, including those with partial and weak expression [15% (37/250) of adenocarcinomas, 54% (25/46) of squamous cell carcinomas, 75% (3/4) of adenosquamous carcinomas, and 29% (2/7) of sarcomatoid carcinomas]. In calretinin-positive adenocarcinoma (n = 37), expression percentages of Wilms tumor-1, podoplanin, thyroid transcription factor-1, and claudin-4 were 6, 3, 52, 82%, respectively, whereas in calretinin-positive squamous cell carcinoma (n = 25) the percentages were 8, 12, 12, 68%, respectively, indicating that other mesothelial markers were only rarely expressed and that claudin-4 expression was common. Although not an independent marker, calretinin expression was associated with a poor prognosis for stage I tumors of adenocarcinoma (p < 0.001) and of all histological subtypes (p < 0.001). In conclusion, calretinin-positive lung tumors share characteristics with those of smokers and advanced stages and can be differentiated from mesothelioma with the use of other mesothelial and epithelial markers.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico , Calbindina 2/biossíntese , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Adenocarcinoma de Pulmão/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Calbindina 2/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Fumar/efeitos adversos
17.
Interact Cardiovasc Thorac Surg ; 30(4): 593-596, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32003806

RESUMO

Although 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan has been generally validated in the staging of malignant pleural mesothelioma (MPM), its diagnostic and prognostic performances are not clearly established. Aiming to identify possible factors causing 18F-fluorodeoxyglucose PET/CT false-negative results and influencing prognosis in MPM patients, we analysed clinical, radiometabolic and pathological features in 141 MPM patients who underwent diagnostic 18F-fluorodeoxyglucose PET/CT scan (January 2009-July 2018) at 2 high-volume institutions. The Fisher's exact test and the Cox model were used in statistical analysis. Overall detection rate was 88.3% with 16 patients (11.6%) presenting with a standardized uptake value (SUV) max <2.5 (PET-negative). PET-negative cases were more frequently detected in older patients (P = 0.027) and early-stage tumours (33.3% false-negative in stage I and 40.0% false-negative in T1-tumours, with P = 0.014 both). Mean SUVmax value was higher in sarcomatoid (11.8 ± 4.6) and biphasic MPM (9.3 ± 7.0), rather than in epithelioid MPM (6.9 ± 3.8, P < 0.001). Concerning overall survival, SUVmax (both as continuous and as categorical variable) was found to be a prognostic factor, in addition to stage (P = 0.032) and histology (P = 0.014) as confirmed by multivariable analysis (hazard ratio 2.65, confidence interval 1.23-5.70; P < 0.001). In the light of such results, we highlight that a low fluorodeoxyglucose uptake might be observed in more than 10% MPMs, especially in early-stage tumours affecting elderly patients. Furthermore, high SUVmax values significantly correlated with a worse prognosis.


Assuntos
Fluordesoxiglucose F18/farmacologia , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Estadiamento de Neoplasias/métodos , Neoplasias Pleurais/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Prognóstico , Compostos Radiofarmacêuticos/farmacologia , Reprodutibilidade dos Testes
18.
BMC Cancer ; 20(1): 162, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32106829

RESUMO

BACKGROUND: Malignant mesothelioma of the tunica vaginalis is a rare tumour which comprises less than 1% of all mesotheliomas. CASE PRESENTATION: 69-years old patient with painful hard mass and hydrocele in the right scrotum to whom a right hydrocelectomy was performed. Any history of scrotal trauma or exposure to asbestos was not present. Excisional biopsy revealed a multinodular tumour with focal areas of necrosis and infiltrative growth. According to morphological and immunohistochemical findings, diagnosis of malignant biphasic mesothelioma of the tunica vaginalis testis was made. Two months after hydrocelectomy, right inguinal orchidectomy was performed. Post-surgical whole body CT scan revealed paraaortic and pararenal lymphadenopathy, likely to be metastatic. Adjuvant treatment with 6 cycles of cisplatin and pemetrexed was applied. After 3 cycles of chemotherapy, CT scan showed progression and the treatment was changed to gemcitabine 1 month after. CONCLUSIONS: Although malignant mesothelioma of the tunica vaginalis is a rare malignancy, it poses a diagnostic challenge which can mimic common inguinal or scrotal diseases such as hydrocele. Despite aggressive surgical procedures or adjuvant therapies, the prognosis remains poor.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Hidrocele Testicular/cirurgia , Neoplasias Testiculares/diagnóstico , Idoso , Biópsia , Cisplatino/uso terapêutico , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Progressão da Doença , Evolução Fatal , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Linfadenopatia , Masculino , Mesotelioma/complicações , Mesotelioma/terapia , Orquiectomia , Pemetrexede/uso terapêutico , Prognóstico , Hidrocele Testicular/etiologia , Neoplasias Testiculares/complicações , Neoplasias Testiculares/terapia
19.
Ann Thorac Surg ; 109(5): 1537-1543, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31962118

RESUMO

BACKGROUND: Most patients with malignant pleural mesothelioma experience recurrence after treatment. However no clinical studies have evaluated postrecurrence survival after pleurectomy/decortication for malignant pleural mesothelioma. This study aimed to clarify postrecurrence survival, treatment, prognostic factors, and recurrence pattern after pleurectomy/decortication. METHODS: We conducted a retrospective cohort study of 90 patients who underwent neoadjuvant chemotherapy followed by pleurectomy/decortication at our hospital between September 2012 and December 2017. Survival and recurrence were calculated using the Kaplan-Meier method with the log-rank test. Clinical factors related to postrecurrence survival were assessed using multivariate analysis with the Cox proportional hazards model. RESULTS: Of 90 patients, 57 (63.3%) developed recurrence. The 1- and 3-year recurrence-free survival rates were 69.7% and 34.0%, respectively (median recurrence-free survival time, 19.0 months). With regard to initial recurrence, 39 patients (68.4%) developed local recurrence, 6 (10.5%) developed distant recurrence, and 12 (21.1%) developed both local and distant recurrences. The 1-year postrecurrence survival rate was 59.5% (median post-recurrence survival time, 14.4 months). Forty-three patients (75.4%) underwent a postrecurrence treatment. Multivariate analysis revealed that postrecurrence treatment (hazard ratio, 0.2; 95% confidence interval, 0.07-0.55; P = .002), performance status 0 to 1 (hazard ratio, 0.24; 95% confidence interval, 0.08-0.76; P = .01), and disease-free interval more than 12 months (hazard ratio, 0.4; 95% confidence interval, 0.16-0.99; P = .04) were the independent, favorable, and significant prognostic factors of postrecurrence survival. CONCLUSIONS: Postrecurrence survival after pleurectomy/decortication is acceptable, and postrecurrence treatment, performance status, and disease-free interval are important prognostic factors of postrecurrence survival.


Assuntos
Neoplasias Pulmonares/cirurgia , Mesotelioma/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Pleura/cirurgia , Neoplasias Pleurais/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Neoplasias Pulmonares/diagnóstico , Masculino , Mesotelioma/diagnóstico , Pessoa de Meia-Idade , Neoplasias Pleurais/diagnóstico , Tomografia por Emissão de Pósitrons , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
Am J Case Rep ; 21: e920487, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31929500

RESUMO

BACKGROUND Omental calcifications of the peritoneum are typically small and asymptomatic. However, larger psammomatous bodies that cause symptoms such as abdominal pain and bloating are often associated with tumors such as primary serous papillary carcinoma, mesothelioma, or metastatic ovarian cancer. CASE REPORT We describe omental calcifications in a 68-year-old woman who had been asymptomatic for the last 10 years. The case details the histomorphologic features and immunohistochemical signature of a 4.0×3.5×1.0 cm mass consisting of mature adipose tissue that was surgically removed together with an 8.5×6.5×1.8 cm irregular intra-abdominal/mesenteric mass composed of yellow-red fatty tissue. Microscopic sections contained fat with variable clustered classic/psammomatous calcifications, some with a thin epithelioid periphery, in association with a very focal and subtle papillary surface epithelial/mesothelial proliferation. Tumor cell invasion was not observed during examination. Immunohistochemical staining showed that mesothelial cells in the mass were strongly positive for calretinin and focally positive for EMA, CK903, and vimentin. Strong nuclear positivity for PAX8 was also reported. Additional stains were added in response to this pattern, showing strong positivity for CK8, moderate positivity for BAP1, focal positivity for ER, minimal positivity for CD56, and negativity for CK5/6 and D2-40. Three possible explanations are suggested for the phenomenon observed in the pathology slides: reactive mesothelial hyperplasia, well-differentiated papillary mesothelioma, or serous papillary carcinoma of the peritoneum. CONCLUSIONS Findings suggest that these calcifications are a benign, reactive phenomenon, and that the abundance of psammoma bodies may be related to ongoing crops of papillary mesothelial hyperplasia or benign well-differentiated papillary mesothelioma.


Assuntos
Calcinose , Mesotelioma/diagnóstico , Mesotelioma/patologia , Omento/patologia , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/patologia , Idoso , Biomarcadores Tumorais , Cistadenocarcinoma Papilar/diagnóstico , Cistadenocarcinoma Seroso/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Hiperplasia/diagnóstico , Imuno-Histoquímica
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