CASE N°28 – Mesothelioma Cytology & Histology
Cough, chest pain and worsening dyspnea.
Tac-scan: diffuse pleural thickening, no pulmonary nodules.
Cytological speciemen: Pleural Effusion
Mesothelial cells with nuclear atypia, mixed with activated mesothelial cells, lymphocytes, granulocytes and erythrocytes.
Positive for malignancy. Cytological findings consistent with mesothelioma.
Histological speciemen: Pleural Biopsy
Pleural mesothelial atypical papillary proliferation, with focal aspects of invasion, consistent with epithelioid mesothelioma.
Immunostaining performed: calretinin, D2-40, TTF1, BerEP4.
Mesothelioma is being strongly related to industrial use of asbestos, currently banned for 21 years (1992) and being eliminated in some countries. Since the disease high latency period (the incubation period is about 30 years old), it is expected a constant level of accidents of the disease (eg in Italy until 2020) and a subsequent decrease.
Mesothelioma occurs macroscopically as a thickening of the pleura, usually diffuse, more rarely nodular. Its growth can lead to obliteration of the pleural space and thus blocking lung in the case requires action demolitive. It comes in three histological forms: epithelioid, sarcomatoid and biphasic
The prognosis is poor.
Characterized by aggressiveness and resistance to common therapies, allows a median survival of 7.7 months (standard deviation 1-72) from the time of diagnosis. The most affected age is between 40 and 60 years with male affection in 60% of cases, mainly because the majority of its population working exposure to the carcinogen
There aren’t clear guidelines for the treatment of mesothelioma. Commonly in stage 1 and in limited cases of stages 2 and 3 is provided pleurectomy with decortication of the same or pleuropneumectomia (the pleura are removed and the part of the lung involved). At the end of intervention may be associated with the hyperthermic intracavitary chemotherapy, which consists in the continuous washing of the operating field with chemotherapeutic drugs at high temperatures, with the purpose to “sterilize” the area and reduce the risk of recurrence of the desease.