Der Pneumologe

, Volume 7, Issue 1, pp 19–27 | Cite as

Klinik und Diagnostik des malignen Pleuramesothelioms

Leitthema

Zusammenfassung

Das maligne Pleuramesotheliom ist ein seltener Tumor mit schlechter Prognose. In den nächsten Jahren muss mit einer steigenden Inzidenz gerechnet werden. Der Großteil der Pleuramesotheliome wird erst im fortgeschrittenen Stadium diagnostiziert. Typischerweise klagen die Patienten über progrediente Dyspnoe und thorakale Schmerzen. Mittels CT oder MRT können neben einem Pleuraerguss solide pleurale Gewebsvermehrungen und diffuse Pleuraverdickungen dargestellt werden. Dennoch haben beide Untersuchungsverfahren erhebliche Limitationen. Die Diagnose kann nur histologisch-immunhistochemisch an ausreichend großen Gewebeproben gestellt werden. Hier gilt die videoassistierte Thorakoskopie als Goldstandard. Aufgrund der Heterogenität des Tumors ist die Differenzialdiagnose schwierig, insbesondere in Abgrenzung zum Adenokarzinom. Neben benignen Veränderungen müssen sekundäre pleurale Neoplasien bei anderen Tumorentitäten abgegrenzt werden.

Schlüsselwörter

Malignes Pleuramesotheliom Staging PET-CT VATS Biomarker 

Abkürzungen

AJCC

American Joint Committee on Cancer

ERS / ESTS

European Respiratory Society / European Society of Thoracic Surgeons

IMIG

International Mesothelioma Interest Group

MPM

Malignes Pleuramesotheliom

MRT

Magnetresonanztomographie

PET

Positronen-Emissions-Tomographie

UICC

International Union Against Cancer

VATS

Videoassistierte Thorakoskopie

WHO

Weltgesundheitsorganisation

Clinical findings and diagnosis of malignant pleural mesothelioma

Abstract

Malignant pleural mesothelioma is a rare tumor with a poor prognosis. However, an increase in its incidence is to be expected in coming years. The majority of pleural mesotheliomas are diagnosed when they are already at an advanced stage. Patients typically complain of progressive dyspnea and chest pains. In addition to pleural effusions, CT or MRI are able to identify solid pleural tissue formation and diffuse pleural thickening. Nevertheless, both examination procedures have significant limitations. A diagnosis can only be obtained histologically and immunohistochemically using tissue probes of sufficient size. Video-assisted thoracoscopy is considered the gold standard. Due to the heterogeneity of this tumor, the differential diagnosis is complex, particularly its differentiation from adenocarcinoma. In addition to benign lesions, secondary pleural neoplasms need to be distinguished from other tumor entities.

Keywords

Malignant pleuramesothelioma Staging PET-CT VATS Biomarker 

Notes

Interessenkonflikt

Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Antman KH (1993) Natural history and epidemiology of malignant mesothelioma. Chest 103(Suppl 4):373S–376SCrossRefPubMedGoogle Scholar
  2. 2.
    Benard F, Sterman D et al (1998) Metabolic imaging of malignantpleural mesothelioma with fluorodeoxyglucose positron emission tomography. Chest 114(3):713–722CrossRefPubMedGoogle Scholar
  3. 3.
    Boutin C, Rey F (1993) Thoracoscopy in pleural malignant mesothelioma: A prospective study of 188 consecutive patients. Part 1: Diagnosis. Cancer 72(2):389–393CrossRefPubMedGoogle Scholar
  4. 4.
    British Thoracic Society Standards of Care Committee (2001) Staging on malignant mesothelioma in the United Kingdom. Thorax 56:250–265CrossRefGoogle Scholar
  5. 5.
    Chang K, Pai LH et al (1992) Monoclonal antibody K1 reacts with epithelial mesothelioma but not with lung adenocarcinome. Am J Surg Pathol 16(3):259–268PubMedCrossRefGoogle Scholar
  6. 6.
    Flores RM, Akhust T et al (2003) Positron emmision tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma. J Thorac Cardiovasc Surg 126(1):11–15CrossRefPubMedGoogle Scholar
  7. 7.
    Greene (2002) AJCC Cancer Staging Manual, 6th edn. Springer, New YorkGoogle Scholar
  8. 8.
    Grigoriu BD, Scherpereel A et al (2007) Utility of Osteopontin and serum mesothelin in malignant pleural mesothelioma diagnosis and prognosis assessment. Clin Cancer Res 13(10):2928–2935CrossRefPubMedGoogle Scholar
  9. 9.
    Heelan RT, Rusch VW et al (1999) Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. AJR Am J Roentgenol 172(4):1039–1047PubMedGoogle Scholar
  10. 10.
    Ho L, Sugarbaker DJ, Skarin AT (2001) Malignant pleural mesothelioma. Cancer Treat Res 105:327–373PubMedGoogle Scholar
  11. 11.
    Husain AN, Colby TV et al (2009) Guidelines for Pathologic Diagnosis og Malignant Mesothelioma. A Consensus Statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med 133(8):1317–1331PubMedGoogle Scholar
  12. 12.
    Lee YC (2007) Hunting for a pleural fluid test for mesothelioma: is soluble mesothelin the answer? Thorax 62:561–562CrossRefPubMedGoogle Scholar
  13. 13.
    Orki A, Akin O et al (2009) The role of positron emission tomography/computed tomography in the diagnosis of pleural diseases. Thorac Cardiovasc Surg 57(4):217–221CrossRefPubMedGoogle Scholar
  14. 14.
    Pass HI, Lott D et al (2005) Asbestosis exposure, pleural mesothelioma, and serum osteopontin levels. N Engl J Med 353:1564–1573CrossRefPubMedGoogle Scholar
  15. 15.
    Pisani RJ, Colby TV et al (1988) Malignant mesothelioma of the pleura. Mayo Clin Proc 63(12):1234–1244PubMedGoogle Scholar
  16. 16.
    Renshaw AA, Dean BR et al (1997) The role of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. Chest 111(1):106–109CrossRefPubMedGoogle Scholar
  17. 17.
    Robinson BW, Creaney J et al (2003) Mesothelin-family proteins and diagnosis of mesothelioma. Lancet 362(9396):1612–1666CrossRefPubMedGoogle Scholar
  18. 18.
    Scherpereel A, Grigoriu B et al (2006) Soluble mesothelin-related peptides in the diagnosis of malignant pleural mesothelioma. Am J Respir Crit Care Med 173(10):1155–1160CrossRefPubMedGoogle Scholar
  19. 19.
    Scherperell A, Astoul P et al (2009) Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for management of Malignant Pleural Mesothelioma. Eur Respir J, Aug 28, Epub ahead of printGoogle Scholar
  20. 20.
    Senyigit Bayran H et al (2000) Malignant pleural mesothelioma caused by enviromental exposure to asbestos in the southeast of turkey: CT findings in 117 patients. Respiration 67(6):615–622CrossRefPubMedGoogle Scholar
  21. 21.
    Testa JR, Pass HI, Carbone M (2001) Benign and malignant mesothelioma. In: Devita VT Jr, Helmann S, Rosenberg SA (eds) Cancer: Principles and practice of oncology, 6th edn. Lippincott Williams Wilkins, Philadelphia, pp 1937–1943Google Scholar
  22. 22.
    Travis WD, Brambilla E et al (2004) World Health Organisation Classification of tumors. Pathology and Genetics of Tumors of the Lung, Pleura, Thymus and Heart. IARC Press, LyonGoogle Scholar
  23. 23.
    UICC International Union against Cancer (2002) TNM Classification of Malignant Tumors. In: Sobin LH, Wittekind CH (eds) John Wiley & Sons, Hoboken, New JerseyGoogle Scholar
  24. 24.
    Yildirim H, Metintas M et al (2009) Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural diseasse: an observational pilot study. J Thorac Oncol Oct 28, Epub ahead of printGoogle Scholar
  25. 25.
    Whitacker D, Shilkin KB (1984) Diagnosis of pleural malignant mesothelioma in life: a practical approach. J Pathol 143:147–175CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Klinik für Pneumologie und BeatmungsmedizinInterdisziplinäres Lungenzentrum, Klinikum Bremen-OstBremenDeutschland

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