Skip to main content

Early detection of malignant pleural mesothelioma

Abstract

Malignant pleural mesothelioma (MPM) is a rare tumour. Exposure to asbestos is a well-established aetiological factor for MPM. Patients typically present with shortness of breath due to pleural effusion or chest pain in a more advanced stage. The diagnosis is usually suggested by imaging studies (unilateral pleural thickening; pleural effusion). An occupational history must be obtained. Cytological examination of the effusion can be diagnostic, but often shows equivocal results. Therefore, histology, including immunohistochemistry, is the gold standard. Thoracoscopy, a video-assisted surgical procedure or open pleural biopsy in a fused pleural space may be necessary to provide sufficient material for accurate histological diagnosis. There are three main histological types (epithelial, sarcomatous and mixed) with ~60% being epithelial.

Data suggest the possible contribution of serum mesothelin-related proteins and osteopontin along with others as useful markers to support the diagnosis of mesothelioma; however, the precise role of these markers is yet to be defined.

References

  1. 1

    Hoang CD, O’cunha J, Kratzke MG, et al. Gene expression in profiling, identifies matriptase over expression in malignant mesothelioma. Chest 2004; 125:1843–1852.

    CAS  PubMed  Google Scholar 

  2. 2

    Peto J, Qecarli A, La Vecchia C, et al. The European mesothelioma epidemic. Br J Cancer 1999; 79:666–672.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. 3

    Dunleavey R. Malignant mesothelioma risk factors and current management. Nurs Times 2004; 100:40–43.

    PubMed  Google Scholar 

  4. 4

    Sugarbaker DJ, Jaklitsch MI, Bueno R. Prevention, early detection, and management of complication after 328 consecutive extrapleural pneumonectomy. J Thorac Cardiovasc Surg 2004; 128:138–146.

    PubMed  Google Scholar 

  5. 5

    Addis B, Roche H. Problems in mesothelioma diagnosis. Histopathology 2009; 54:55–68.

    PubMed  Google Scholar 

  6. 6

    Pass HI, Carbone M. Current status of screening for malignant pleural mesothelioma. Semin Thorac Cardiovas Surg 2009; 21:97–104.

    Google Scholar 

  7. 7

    Delgerma V, Takahashi K, Park EK. Global mesothelioma death reported to the World Health Organization between 1994 and 2008. Bull World Health Organ 2011; 89:716–724C.

    Google Scholar 

  8. 8

    Driscoll T, Nelson DI, Steenland K, et al. The global burden of disease due to occupational carcinogens. Am J Ind Med 2005; 48:419–431.

    PubMed  Google Scholar 

  9. 9

    Park EK, Takahashi K, Hoshuyama T, et al. Global magnitude of reported and unreported mesothelioma. Environ Health Perspect 2011; 119:514–518.

    PubMed  PubMed Central  Google Scholar 

  10. 10

    Isel A, Yui T, Goggins W, et al. The. current or future mesothelioma epidemics in Hong Kong the tragic legacy of uncontrolled use of asbestos in the past? Environ Health perspect 2006; 118:382–386.

    Google Scholar 

  11. 11

    Britton M. The epidemiology of mesothelioma. Semin Oncol 2002; 29:18–25.

    PubMed  Google Scholar 

  12. 12

    White C. Annua. deaths from mesothelioma in Britain to peach 2000 by 2010. Br Med J 2003; 325:1417.

    Google Scholar 

  13. 13

    Joshi TK, Gupta RK. Asbestos in developing countries: magnitude of risk and its practical implications. Int J Occup Med Environ health 2004; 17:179–185.

    PubMed  Google Scholar 

  14. 14

    Takahashi K, Kang SK. Toward elimination of asbestos-related disease; a theoretical framework for international cooperation. Saf Health Work 2010; 1:103–106.

    PubMed  PubMed Central  Google Scholar 

  15. 15

    Ismail HM, Nouth MA, Abulkheir IL. Pleural mesothelioma: diagnostic problems and evaluation of prognostic factors. J Egypt Natl Canc Inst 2006; 18:303–3120.

    PubMed  Google Scholar 

  16. 16

    Gaafar RM, Alyeldin NH. Epidemic of mesothelioma in Egypt. Lung Cancer 2005; 49:17–20.

    Google Scholar 

  17. 17

    Kazan Allen L. 2006; Asbestos: the environmental hazard. Proceedings of the International Conference Asbestos Risk Reduction and Measurement of Asbestos Fibre concentration; 28–29 September; Cracow/Krakow, Poland: Faculty of Materials Science and Ceramics, AGH University of Science and Technology. Available at: http://www.Ceramika.agh.edu.pl/azbesto612.pdf. [Last accessed on Aug 11 2008].

  18. 18

    Madkour MT, Madkour MS, Awadallah HI, et al. Environmental exposure to asbestos and the exposure-response relationship with mesothelioma. East Mediterr Health J 2009; 15:25–38.

    CAS  PubMed  Google Scholar 

  19. 19

    Lee YC, Detherk NH, Henderson DW, et al. Malignant mesothelioma. Chapter 3. Hendrick D, Burge S, Bekeh B, Churg A, editors. In occupational disorders of the lung. 4th ed. Philadelphia: WB Saunders; 2001:135–150.

    Google Scholar 

  20. 20

    Spirtas R, Heineman EF, Bernstein L, et al. Malignant mesothelioma attribuable risk of asbestose exposure. J Occup Environ Med 1994; 51:804–811.

    CAS  Google Scholar 

  21. 21

    Young P, Rogers A. An occupational industry matrix analysis of mesothelioma cases in Australia, 1980–1985. Appl Occup Environ Hyg 2001; 16:40–44.

    Google Scholar 

  22. 22

    Scott B, Mukherjee S, Lake R, Robinson BWS. Malignant mesothelioma. In: Hanson H, ed. Textbook of lung cancer, London: Martin Dunitz; 2000:273–293.

    Google Scholar 

  23. 23

    Musani AI, Sterman DH. Tumors of the mediastinum, pleura, chest wall and diaphragm. In: Crapo JD, Karlinsky JP, Glassroth J, King TE, editors. Baum’s textbook of pulmonary diseases. Philadelphia: Lippincott Williams and Wilkins; 2004. 900–911.

    Google Scholar 

  24. 24

    Adams RF, Gray W, Davies RJ, et al. Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma. Chest 2001; 120:1798–1802.

    CAS  PubMed  Google Scholar 

  25. 25

    Chahinian AP, Pass H. Malignant mesothelioma. Chapter 89. In: Holland JF, Frei E III, editors. Cancer. 5th ed. London: B.C Decker; 2000:1293–1312.

  26. 26

    Cugell DW, Kamp DW. Asbestos and the pleura: a review. Chest 2004; 125:1103–1117.

    PubMed  Google Scholar 

  27. 27

    Adachi S. CT diagnosis of solitary pulmonary nodule. Nippon Acta Radiologica 1999; 59:231–238.

    CAS  Google Scholar 

  28. 28

    Brink JA, Heiken JP, Semen Kovich J, et al. Abnormalities of the diaphragm and the adjacent structures, findings on multi-plane spiral CT. Am J Roentgenol 1994; 163:307–310.

    CAS  Google Scholar 

  29. 29

    Knvuttila A, Halme M, Kivisauri L. The clinical importance of magnetic resonance imaging versus computed tomography in malignant pleural mesothelioma. Lung Cancer 1998; 22:215–225.

    Google Scholar 

  30. 30

    Rusch VW. Diffuse malignant mesothelioma. Chapter 65. In: Shields W, LoCicero III J, Ponn, R, editors. General thoracic surgery. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2000:764–782.

    Google Scholar 

  31. 31

    Zhang YH. Molecular imaging of mesothelioma with (99)Tc-ECG and (68)Ga-ECG. J Biomed Biotechnol 2012;2012:232863. doi: 10.1155/2012/232863. Epub 2012 May 8.

  32. 32

    Zahid I, Sharif S, Routtedge T, et al. Malignant. pleural mesothelioma? Cardiovasc Thorac Surg 2011; 12:254–259.

    Google Scholar 

  33. 33

    Yoshida S, Fukumoto M, Motohara T. Gallium Scan in diffuse malignant mesothelioma with CT and pathological findings. Ann Nucl Med 1999; 13:49.

    CAS  PubMed  Google Scholar 

  34. 34

    Watanab SL, Pass HI, Carbone M, et al. Benign and malignant mesothelioma. Chapter 40. In: Devita VT, Helliman S, Rosenberg, SA, editors. Cancer: principles and practice of oncology. 6th ed. Philadelphia: Lippincott-Raven; 2001:1960–1982.

    Google Scholar 

  35. 35

    Massimo P, James R. Malignant mesothelioma update, current management and newer therapeutic strategies. Chest 2004; 126:1318–1329.

    Google Scholar 

  36. 36

    Antomy, VB. Pathophysiology and diagnosis of pleural diseases. In: Crapo JD, Karlinsky, JB, Glascroth J, King, TE, editors. Baum’s textbook of pulmonary diseases. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2004. 1361–1367.

    Google Scholar 

  37. 37

    Thomas A, Tasker AD, Flower C, et al. Intervention in the pleura. Eur J Rad 2000; 34:119–132.

    Google Scholar 

  38. 38

    Adams RF, Gleeson FV. Percutaneous image-guided cutting needle biopsy of the pleura in the presence of a suspected malignant effusion. Radiology 2001; 219:510–514.

    CAS  PubMed  Google Scholar 

  39. 39

    Loddenkemper R, Frank W. Invasive pulmonary diagnostic procedures: pleural diagnostic procedures. In: Crapo JD, Glassroth J, Karlinsky JB, King TE, editors. Baum’s text book of pulmonary diseases. Philadelphia: Lippincott Williams and Wilkins; 2004. 103–111.

    Google Scholar 

  40. 40

    Kurtz RC, Ginsberg RJ. Cancer diagnosis: endoscopy. Thoracoscopy. In: Devita VT, Hellman S, Rosenberg SA, editors. Cancer principles and practice of oncology. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2001. 734–735.

  41. 41

    Maran CA, Suster S. Diagnostic histopathology of tumours. In Tumors of the lung and pleura. Chapter 5. 2nd ed. Churchill Livingstone; 2000:199–208.

  42. 42

    Ordonez NG. Immunohistochemical diagnosis of epithelial mesothelioma an update. Arch pathol lab Med 2005; 129:1407–1414.

    PubMed  Google Scholar 

  43. 43

    Kufe DW, Pollock RE, Gancer TS, et al. Malignant mesothelioma. In: Hollan JF, Frei E. Cancer medicine. Canada, Hamilton: Decker Inc.; 2003.

  44. 44

    Husain AN, Colby TV, Ordonez NG, et al. Guidelines for pathologic diagnosis of malignant mesothelioma: a consensus statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med 2009; 133:1317–1331.

    PubMed  Google Scholar 

  45. 45

    Antman KH, Pass HI, Schiff PB, et al. Management of mesothelioma. In: Devita VT, Hellman S, Rosenberg SA, editors. Cancer principles and practice of oncology. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2001;1943–1969.

  46. 46

    Eryukseel E, Killian KL, Brutsche MH. Functional genomics and gene chips from research to clinical medicine. Turk Thorac J 2003; 4:27–31.

    Google Scholar 

  47. 47

    Amati M, Tomasetti M, Scartozzi M. Profiling tumor-associated markers for early detection of malignant mesothelioma: an epidemiological study. Cancer epidemiol Biomarkers Prev 2008; 17:163–170.

    CAS  PubMed  Google Scholar 

  48. 48

    Scherpereel A, Grigori UB, Conti M, et al. Soluble mesothelin-related peptide in the diagnosis of MPM. Am J Respir Crit Care Med 2003; 173:1155–1160.

    Google Scholar 

  49. 49

    Hassan R, Remaley AT, Sampson MI, et al. Detection and quantitation of serum mesothelin, a tumor marker for patients with mesothelioma and ovarian cancer. Clin Cancer Res; 2006; 12:447–453.

    CAS  PubMed  Google Scholar 

  50. 50

    Kanzu S, Hagiwara Y, Sonoue K, et al. Sensitive and specific new enzyme linked immunoassay (ELISA) for N-ERC/Mesothelin increasing its potential as a useful serum tumor marker for mesothelioma. Clin Cancer Res 2008; 14:1431–1437.

    Google Scholar 

  51. 51

    Robinsan BW, Creams J, Lake R, et al. Soluble mesothelin-related protein — a blood test for mesothelioma. Lung Cancer 2005; 49:S109–S111.

    Google Scholar 

  52. 52

    Pass HI, Wali A, Tang N, et al. Soluble mesothelin-related peptide level elevation in mesothelioma serum and pleural effusion. Ann Thorac Surg 2008; 85:265–272.

    PubMed  Google Scholar 

  53. 53

    Holleroet K, Nackaert SK, Thimpo TJ, et al. Diagnostic performance of soluble mesothelin and MPM mesothelioma. Am J Respir Crit Care Med 2010; 18:620–625.

    Google Scholar 

  54. 54

    Pass HI, Lott D, Lonardo F, et al. Asbestos exposure, pleural mesothelioma, and serum osteoportin levels. N Engl J med 2005; 353:1564–1573.

    CAS  PubMed  Google Scholar 

  55. 55

    Park EK, Thomas PS, Johnson AR, et al. Osteoportin levels in asbestos-exposed population. Clin Cancer Res 2009; 15:1362–1366.

    CAS  PubMed  Google Scholar 

  56. 56

    Shiomi K, Miyanesto H, Segwa T, et al. Novel ELISA system for detection of N-ERC/mesothelin in the sera of mesothelioma patients. Cancer Scienc 2006; 97:928–932.

    CAS  Google Scholar 

  57. 57

    Cullen MR. Serum osteopontin levels –is it time to screen asbestos-exposed workers for pleural mesothelioma? N Engl J med 2005; 353:1617–1628.

    CAS  PubMed  Google Scholar 

  58. 58

    Ray M, Kindler HL. Malignant pleural mesothelioma. An update on biomarkers and treatment. Chest 2009; 136:888–896.

    PubMed  Google Scholar 

  59. 59

    Jain RK. Molecular regulation of vessel maturation. Nat Med 2003; 9:685–693.

  60. 60

    Tabata C, Tabata R, Kalokawa Y, et al. Thalidomide prevents bleomycin induced pulmonary fibrosis in mice. J Immunol 2007; 179:708–714.

    CAS  PubMed  Google Scholar 

  61. 61

    Zhang Y, Marmorstein LY. Focus on molecules: fibulin-3 (EFE MP1). Exp Eye Res 2010; 90:374–375.

    CAS  PubMed  Google Scholar 

  62. 62

    Rao P, Srikamth N. Biomarkers for malignant mesothelioma review article. Indian J Occup Environ Med 2006; 10:107–110.

    Google Scholar 

  63. 63

    Emri S, Ustunday Y, Buda KT, et al. Assessment of the valve of fibronectin as a tumor marker in malignant pleural mesothelioma. Monaldi Arch Chest Dis 1997; 52:335–338.

    CAS  PubMed  Google Scholar 

  64. 64

    Paganuzzi M, Onetto M, Marroni P, et al. Diagnostic value of CYFRA 21-1 tumour marker and CEA in pleural effusions due to mesothelioma. Chest 2001; 119:1138–1142.

    CAS  PubMed  Google Scholar 

  65. 65

    Bonfrer JM, Schouwink JH, Korse CM, et al. CYFRA21-1 and TPA as markers in malignant mesothelioma. Anticancer Res 1997; 17:2971–2973.

    CAS  PubMed  Google Scholar 

  66. 66

    Filiberti R, Marroni P, Neri M, et al. Serum PDGF-AB in pleural mesothelioma. Tumour Biol 2005; 26:221–226.

    CAS  PubMed  Google Scholar 

  67. 67

    Hedman M, Arnberg H, Wernlund J, et al. Tissue polypeptide antigen (TPA), hyaluronan and CA125 as serum markers in malignant mesothelioma. Anticancer Res 2003; 23:531–536.

    CAS  PubMed  Google Scholar 

  68. 68

    Thylen A, Wallin J, Martenssan G. Hyaluronan in serum as an indicator of progressive disease in hyaluronan-producing malignant mesothelioma. Cancer 1999; 86:2000–2005.

    CAS  PubMed  Google Scholar 

  69. 69

    Dahl IM, Solheim OP, Erikstein B, et al. A longitudinal study of the hyaluronan level in the serum of patients with malignant mesothelioma under treatment. Hyaluronan as an indicator of progressive disease. Cancer 1989; 64:68–73.

    CAS  PubMed  Google Scholar 

  70. 70

    Onda M, Nagata S, Ho M, et al. Megakaryocyte potentiation factor elevated from mesothelin precursor is a useful tumor marker in the serum of patients with mesothelioma. Clin Cancer Res 2006; 12:4225–4231.

    CAS  PubMed  Google Scholar 

  71. 71

    Pass HL; Levin SM Harbut MR, et al. Fibulin-3 as a blood and effusion biomarker for pleural mesothelioma. N Engl J Med 2012; 367:1417–1427.

    CAS  PubMed  PubMed Central  Google Scholar 

  72. 72

    Marukawa M, Hiyama J, Shiota Y, et al. The usefulness of CYFRA21-1 in diagnosis and monitoring malignant pleural mesothelioma. Acta Med Okayama 1998; 52:119–123.

    CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Hussein F. Mahmoud PhD, FCCP.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mahmoud, H.F. Early detection of malignant pleural mesothelioma. Egypt J Bronchol 8, 1–9 (2014). https://doi.org/10.4103/1687-8426.137342

Download citation

Keyword

  • Malignant pleural mesothelioma
  • asbestos
  • pleural effusion
  • Thoracoscopy
  • mesothelin
  • osteopontin
\