diffuse malignant mesothelioma
Introduction
Introduction to diffuse malignant mesothelioma Pleural mesothelioma has a prognosis of benign fibrous mesothelioma and diffuse malignant pleural mesothelioma, which is considered to be the worst prognosis of the chest. There are no effective treatments to date. All kinds of asbestos fibers are almost related to the pathogenesis of mesothelioma, but the risk of self-sufficient fibers is not the same. The most dangerous is exposure to bluestone, the least dangerous is exposure to asbestos, the first exposure to asbestos. The incubation period of the disease is generally 20 to 40 years, and the incidence of mesothelioma is directly proportional to the time and severity of exposure to asbestos. The increase in the content of erionite in the atmosphere, people inhaled this powder of silicate zeolite can also cause mesothelioma, there are also reports of cases of pleural mesothelioma after exposure to radiation, from exposure to radiation to the time of finding pleural mesothelioma For 7 to 36 years, an average of 16 years, nitrosamines, fiberglass, hydrocyanic acid, strontium oxide, strontium and other lung diseases (such as tuberculosis and chemicals and lipid aspiration pneumonia) can lead to pleural mesothelial tumor. basic knowledge The proportion of illness: 0.0025% Susceptible people: no special people Mode of infection: non-infectious Complications: sepsis, pleural effusion, pericardial effusion, ascites
Cause
The cause of diffuse malignant mesothelioma
Cause:
All kinds of asbestos fibers are almost related to the pathogenesis of mesothelioma, but the risk of self-sufficient fibers is not the same. The most dangerous is exposure to bluestone, the least dangerous is exposure to asbestos, the first exposure to asbestos. The incubation period of the disease is generally 20 to 40 years, and the incidence of mesothelioma is directly proportional to the time and severity of exposure to asbestos.
The increase in the content of erionite in the atmosphere, people inhaled this powder of silicate zeolite can also cause mesothelioma, there are also reports of cases of pleural mesothelioma after exposure to radiation, from exposure to radiation to the time of finding pleural mesothelioma For 7 to 36 years, an average of 16 years, nitrosamines, fiberglass, hydrocyanic acid, strontium oxide, strontium and other lung diseases (such as tuberculosis and chemicals and lipid aspiration pneumonia) can lead to pleural mesothelial tumor.
Prevention
Diffuse malignant mesothelioma prevention
The prognosis of this disease is extremely poor. There is no effective treatment. The average survival time of asbestos workers from malignant pleural mesothelioma is only 11.4 months from symptom onset to death. Most patients die within 1 year. The next step should be more Scientifically integrate various treatments and develop new technologies to find more effective drugs and diagnostic methods that can be treated early.
Complication
Diffuse malignant mesothelioma complications Complications sepsis pleural effusion pericardial effusion ascites
(1) pleural adhesions
Pleural adhesion is the most common complication of this disease. It will appear soon after the patient's pleural effusion is sucked out. The pleural adhesion is caused by chemical injection into the pleural cavity. Most patients' pleural effusion is controlled, so if the pleurodesis fails or In patients with a diagnostic thoracotomy, pleural stripping should be considered.
(2) infection
Infection is the most common complication of tumor chemotherapy. It is characterized by rapid development of the disease. Once the infection occurs, it is easy to develop into sepsis. Because the infection often occurs after the leukopenia falls after chemotherapy, the chemotherapy response is not fully recovered, sometimes the primary disease. The symptoms are even more serious than general sepsis. These clinical features cause difficulties in diagnosis. At this time, it is not necessary to wait for the test results, and the treatment can be started. Broad-spectrum antibiotics should be used, and the dosage should be sufficient, but the course of treatment should not be too long. Do not apply. Sulfonamides or chloramphenicol should pay close attention to mixed infections or double infections during treatment.
(3) malignant body cavity effusion
Although malignant body cavity effusion can be the first symptom of malignant disease, the malignant effusion in most patients is a complication caused by tumor or metastases, mainly manifested as pleural effusion, ascites and pericardial effusion, malignant body cavity. Liquid may have little effect on quality of life at first, but if progress can lead to worsening of the disease and death, timely measures should be taken to promptly give palliative treatment. Diffuse peritoneal malignant mesothelioma is easy to be complicated with malignant ascites.
Symptom
Diffuse malignant mesothelioma symptoms Common symptoms Chest pain shortness chest wall collapse pleural pleural effusion bone metastasis bloody pleural effusion widening pleural thickening
(1) pathological diagnosis
The pathological diagnosis of malignant pleural mesothelioma remains controversial. Although malignant mesothelioma is classified together with soft tissue sarcoma, only 20% of histologically pure sarcoma, 33% to 50% of malignant pleural mesothelioma. Academically, it is epithelial or tubular and papillary, while the other 30% is a mixture of epithelial and sarcoma. Most pathologists believe that only patients with sarcoma or mixed tissue can be diagnosed as malignant pleural mesothelioma, with special staining and electronics. Microscopic examination data, experienced pathologists are also willing to diagnose malignant pleural mesothelioma in patients with epithelial type.
In the early stage of malignant mesothelioma, there are many white or gray particles and nodules or thin plates on the normal or opaque visceral or parietal pleura. As the tumor develops, the pleural surface becomes thicker and thicker. Nodules, tumor nodules extend to the square, continuous into a piece, encapsulation of the lungs to make the sputum smaller and smaller and the affected side of the chest wall collapse, in the advanced stage, the tumor can involve the diaphragm, intercostal muscle, mediastinal structure, pericardium and contralateral In the pleura, 50% of autopsy patients have found blood-borne metastases, but it is rarely mentioned in the clinic.
There are two types of pathological anatomy of malignant mesothelioma: 1 single fibrous pleural mesothelioma, growing from the visceral pleura, flat or fleshy, the clinical symptoms caused by the tumor are due to their expansion and development, squeezing the intrathoracic structure to move it Position, if it can be diagnosed early, can be treated surgically.
2 widely spread mesothelioma, this type of invasion of the lung lobe, infiltration of the diaphragm, intercostal muscle, can affect the pericardium and large blood vessels through the mediastinal pleura.
Microscopic findings of malignant mesothelioma have the characteristics that there are various distinct tissue components in a single tumor nodule or a tumor nodule with the same appearance in the naked eye. The histopathological classification of malignant ecdysoma is epithelial. , fiber (interstitial) type and mixed type, the epithelium of epithelial tumor cells have various structures, such as papillary, tubular, papillary, banded, and polygonal epithelial cells have many long Slim, superficially branched microvilli, desmosome, bundled elastic filaments and intercellular spaces, fibrous cells resemble spindles, equally conformate, with egg-shaped or slender nuclei, well-developed, mixed nucleoli The type has both epithelial and fibrous structures. When taking a biopsy from a tumor mass, the more specimens are taken from different parts, the more it is mixed.
(2) clinical symptoms
Malignant pleural mesothelioma patients more men than women (2:1), most patients between 40 and 70 years old, the average age of foreign patients is 60 years old, China is only 45.2 years old, the first symptoms are chest pain, cough and shortness of breath are the most common, About 10.2% of patients had fever and sweating, and 3.2% of patients had joint pain as the main symptom. Due to diaphragmatic involvement, chest pain can be transmitted to the upper abdomen and the affected shoulder. About 50% to 60% of patients have a large amount of pleural effusion with severe shortness of breath. Among them, bloody pleural effusion accounts for 3/4. Patients with no large pleural effusion have severe chest pain and common weight loss. Some patients have periodic hypoglycemia and hypertrophic pulmonary osteoarthrosis, but these indications are more common in benign mesothelioma.
Epithelial and mixed pleural mesothelioma are often accompanied by a large amount of pleural effusion, while the fibrous type usually has little or no pleural effusion. Epithelial patients seem to have more involvement of the supraclavicular or axillary lymph nodes and extend to the pericardium, contralateral pleura and peritoneum; There are many distant metastases and bone metastases.
Radiological indications: common chest X-rays found pleural effusion, often accounted for 50% of one side of the chest cavity, the ipsilateral lung is wrapped by tumor tissue, the mediastinum moved to the side of the tumor, the affected side of the chest cavity became small disease late chest X-ray Without longitudinal medial widening, pericardial exudate enlarges the heart shadow, showing soft tissue shadow and rib destruction.
The pleural disease on X-ray conventional chest radiographs can be masked by pleural effusion. For patients with suspected malignant pleural stromal tumors, CT is most useful. CT can show pleural thickening with irregular nodular inner edge. Malignant pleural mesothelioma is distinguished from other pleural thickening lesions. Due to fibrous tissue and tumor tissue and pleural effusion, the main interpulmonary fissures are significantly thickened. For tumor invasion, interpulmonary fissures may be nodular. Usually, CT can detect the degree of nodules in the lungs and the extent to which the lungs are shrunk by the tumor capsules and the collapse of the chest wall.
Pleural effusion: mesothelioma combined with pleural effusion is exudate, 50% is serum bloody liquid, if the tumor volume is huge, blood glucose and pH value in pleural effusion may be reduced, due to a large amount of transparent acid (>0.8mg/ml) The pleural effusion is thicker. The pleural effusion generally contains normal mesothelial cells, differentiated or undifferentiated malignant mesothelial cells and different amounts of lymphocytes and multinucleated white blood cells. The cytological examination of pleural effusion can help to make a diagnosis.
Examine
Diffuse malignant mesothelioma
1, chest CT can determine the diagnosis, chest CT can determine pleural calcification or bone structure damage, when the tumor invades the diaphragm and chest wall, magnetic resonance imaging is better than CT.
2, pleural effusion smear, chest pleural biopsy and pleural effusion cell block can make a malignant diagnosis, but can not identify pleural metastatic adenocarcinoma and malignant mesothelium.
3. Periodic acid-Schiff staining (PAS) is the only reliable histochemical method for distinguishing malignant pleural mesothelioma from adenocarcinoma. Although the characteristics of various metastatic adenocarcinomas are different, they appear after amylase digestion. Strong positive vacuoles can be diagnosed as adenocarcinoma rather than malignant pleural mesothelioma.
4, the immune peroxidase technology is the use of antibodies on keratin and carcinoembryonic antigen (CEA), this method is also effective in distinguishing malignant pleural mesothelioma in metastatic adenocarcinoma, immunosuppressive enzyme against carcinoembryonic antigen Dyeing, malignant pleural mesothelioma staining is generally light or not colored. On the contrary, adenocarcinoma staining is moderate and very concentrated. In addition, studies on immunoperoxidase on keratin have also shown that mesothelioma and adenocarcinoma have obvious Differences, 8 markers have been found to be used for identification: tumor with glycoprotein 72 (B72.3), Leu-Mi, Vimentin, thrombomodulin, mucin component, cancer antigen positive for adenocarcinoma with 100% specificity And sensitivity, because carcinoembryonic antigen test often has false negatives, it is best to use two tumor markers, generally using CEA and B72.3, such as positive for both adenocarcinoma with 100% specificity and 88% sensitivity If both are negative, 100% specificity and 97% sensitivity to mesothelioma.
5, electron microscopy for the identification of malignant pleural mesothelioma and pleural metastatic adenocarcinoma also have utility.
6, routine laboratory tests: thrombocytopenia can be found in the pathogenesis, platelets up to 1000 × 109 / L, serum carcinoembryonic antigen in some patients increased, serum immunoelectrophoresis IgG, IgA or IgM increased, The cause of the serum is not normal, serum fetal protein is generally normal.
Diagnosis
Diagnosis and diagnosis of diffuse malignant mesothelioma
Patients with this disease have exudative pleural effusion, especially those with a history of exposure to asbestos should consider the diagnosis of malignant pleural mesothelioma, chest CT can determine the diagnosis, chest CT can determine whether pleural calcification or bone structure is damaged, when When the tumor invades the diaphragm and chest wall, the imaging of magnetic resonance is better than CT. Although pleural smear, chest pleural biopsy and pleural effusion can make a malignant diagnosis, it can not identify pleural metastatic adenocarcinoma and malignant mesothelium. .
Electron microscopy is also useful for the diagnosis of malignant pleural mesothelioma and pleural metastatic adenocarcinoma. Malignant pleural mesothelioma is different from lung, breast cancer and upper gastrointestinal cancer. The surface of the adenocarcinoma is fine and long. Branches, rich in tension silk, small roots and sheets containing no microvilli; metastatic adenocarcinoma derived from ovary and endometrium with intrinsic tissue deformation, including abundant mucin droplets, large cilia, dense nuclear particles These changes are not present in stromal tumors, and the villi of adenocarcinoma are short and thick.
