Mesothelioma

Aggressive malignant tumour of the mesothelium, 90% arise from the pleura

Aetiology

  • Asbestos (40-80% of patients)
    • 20-40 years post exposure
    • Most strongly associated with chrysotile asbestos fibres

Clinical presentation

  • Often presents with pleural effusion - progressive dyspnoea, stony dull percussion
  • Chest pain
  • Weight loss

Investigations

CXR

  • Pleural effusion
  • ‘Pleural mass with lobulated margin’
  • May show pleural thickening - indicates asbestos exposure

CT

  • Pleural mass
  • Staging

Histological investigations

  • Thorascopy - biopsy of tumour
  • Aspiration of pleural fluid - lymphocytes and low glucose indicates malignancy

Management

  • Only palliative options (chemo/radiotherapy) as excision is usually not possible
  • Poor prognosis - life expectance 12 months post diagnosis
  • Managing a malignant pleural effusion - TALC (sclerosing agent), long term pleural catheter