A mesothelioma is a primary malignant neoplasm of pleura.

Etiology

• It occurs in patients with prior exposure to asbestos.
• It has no correlation with cigarette smoking.

Pathology

• The neoplasm grows to encase the lung and chest wall and spreads locally.
• Microscopically, the neoplastic cells may resemble mesenchymal stroma (sarcoma) or appear like epithelial cells.

Clinical Features

• Patients present with SOB, cough, weight loss and chest pain.
• Pleural effusion is a common mode of presentation.
• Chest CT reveals pleural effusion and characteristic encasing of lung with tumor mass.
  • CXR
  • CT
• Diagnosis is difficult with pleural fluid cytology and pleural biopsy.
• Special stains and an experienced Pathologist are often required for diagnosis.
• The tumor tends to grow along needle tracks. This is one reason to avoid repeated thoracentesis.

Therapy

• No therapy has a proven benefit in prolonging life.
• Patients usually expire within 1-2 years.
• Extrapleural pneumonectomy is recommended by some centers.