Mesothelioma: Epidemiology, Presentation, and Diagnosis

Abstract

Malignant pleural mesothelioma is an unrelenting, invariably fatal disease. Clinical diagnosis is based on several nonspecific signs and symptoms that usually accompany a unilateral pleural effusion. Many patients will report a history of asbestos exposure if a thorough environmental and occupational history is taken. Imaging studies usually reveal pleural-based abnormalities and help determine local and regional disease progression. Tissue samples should be obtained early in the disease course, preferably when the diagnosis is initially suspected. The differential diagnosis includes other causes of exudative pleural effusions, benign mesothelial hyperreactivity, and metastatic pleural adenocarcinoma. Careful sampling by thoracoscopic or open pleural biopsy will help confirm the diagnosis, which usually requires a complete panel of histochemical and immunohistochemical tests in addition to morphological examination and electron microscopy.