title: Diagnosis and treatment of malignant pleural mesothelioma.
abstract: There are three major challenges in the diagnosis of malignant pleural mesothelioma: mesothelioma must be distinguished from benign mesothelial hyperplasia; malignant mesothelioma (and its subtypes) must be distinguished from metastatic carcinoma; and invasion of structures adjacent to the pleura must be demonstrated. The basis for clarifying the first two aspects is determination of a panel of monoclonal antibodies with appropriate immunohistochemical evaluation performed by highly qualified experts. Clarification of the third aspect requires sufficiently abundant, deep biopsy material, for which thoracoscopy is the technique of choice. Video-assisted needle biopsy with real-time imaging can be of great assistance when there is diffuse nodal thickening and scant or absent effusion. Given the difficulties of reaching an early diagnosis, cure is not generally achieved with radical surgery (pleuropneumonectomy), so liberation of the tumor mass with pleurectomy/decortication combined with chemo- or radiation therapy (multimodal treatment) has been gaining followers in recent years. In cases in which surgery is not feasible, chemotherapy (a combination of pemetrexed and platinum-derived compounds, in most cases) with pleurodesis or a tunneled pleural drainage catheter, if control of pleural effusion is required, can be considered. Radiation therapy is reserved for treatment of pain associated with infiltration of the chest wall or any other neighboring structure. In any case, comprehensive support treatment for pain control in specialist units is essential: this acquires particular significance in this type of malignancy.
authors: Instituto de Biomedicina de Sevilla (IBiS), Unidad Médico-Quirúrgica de Enfermedades Respiratorias (UMQER), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, España CIBER de Enfermedades Respiratorias (CIBERES), I.S. Carlos III, Madrid, España. Electronic address: frodriguezpan@gmail.com.
authors: Francisco
authors: F
authors: Rodríguez Panadero
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001707:Biopsy, Needle / Q000379:methods; D002277:Carcinoma / Q000175:diagnosis / Q000556:secondary; D003131:Combined Modality Therapy; D003199:Computer Systems; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D004848:Epithelium / Q000473:pathology; D005544:Forecasting; D006801:Humans; D006965:Hyperplasia; D007167:Immunotherapy; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D008654:Mesothelioma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D010994:Pleura / Q000601:surgery; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000473:pathology / Q000628:therapy; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D018700:Pleurodesis; D011013:Pneumonectomy / Q000379:methods; D018714:Radiotherapy, Adjuvant; D013906:Thoracoscopy
keywords: Biomarcadores; Biomarkers; Derrame pleural maligno; Malignant pleural effusion; Malignant pleural mesothelioma; Mesotelioma pleural maligno; Thoracoscopy; Toracoscopia