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Home VIDEO Pleural mesothelioma asbestos cancer. Debate

Pleural mesothelioma asbestos cancer. Debate

Features of morphological diagnosis of pleural mesothelioma asbestos cancer

Morphological diagnosis of pleural mesothelioma asbestos cancer is difficult, especially in terms of the differential diagnosis of metastatic cancer of the pleura on the breast, lung, kidney, colon, ovary, with pleural synovial sarcoma. The diagnosis is usually set according to the cytology of pleural fluid, thoracoscopy, pleural biopsy.

In difficult cases, immunohistochemical study. Mesothelial cells can be differentiated from fibroblast and epithelial only with electron microscopy and immunophenotyping.

Experience in diagnosis and surgery of pleural mesothelioma asbestos cancer

For 1999-2006 in 14 patients used thoracoscopy, as the final method for diagnosis of pleural mesothelioma asbestos cancer. In the analyzed cases, the results of clinical examination, including the data of morphological studies material transthoracic puncture and pleural fluid is not allowed to establish the morphologic diagnosis. Indications for diagnostic thoracoscopy thus considered tumor on the pleura, hydrothorax unknown etiology. Thoracoscopy was performed by the standard technique, life-threatening complications were observed. Unfortunately, the prevalence of the process - in the form of massive, mostly multiple tumor nodules do not allow radical removal of the tumor.

Endoscopic diffuse mesothelioma asbestos cancer presented merging tumors (benign, white nodes, with patches of yellow or red) that infiltrated thickened visceral and parietal pleura, lung, pericardium, protrudes into the pleural cavity, followed by the presence of sero-fibrinous or hemorrhagic pleural fluid. In all cases, the material obtained by thoracoscopy was sufficient for histological and immunnogistohimichesky study. In one patient, due to the impossibility of operations in VATS mode due to severe obliteration of the pleural space and the inability to create a work space in it, surgery was transformed (the converted) in the thoracotomy. Mean operative time was 38 minutes. Postoperative period in all patients was uneventful. Drain is removed, usually at night II, and their abandonment of a longer term due pronounced accumulation of fluid in 4 (27%) cases. Noted that surgical trauma was not significant: narcotic analgesics were used only for the first night.

Performing diagnostic thoracoscopy in patients with pleural mesothelioma asbestos cancer shows the great benefits of this technology to increase diagnostic capabilities of surgery, along with a decrease in postoperative pain and a shorter stay in hospital. The patient operated on 26 years (03/11/04) in the abdominal compartment RCRC about tumors localized in the left pleural (extrapulmonary adjacent the costal pleura, the size 4h7h7 cm), and in the abdomen (left subphrenic, size 7h11h13 cm). Intraoperative diagnosis of pleural mesothelioma asbestos cancer and peritoneal. Deleted pleural mesothelioma asbestos cancer, with resection of the lower lobe of the left lung and gastrectomy (with pancreatectomy with splenectomy) combined abdomino-thoracic access to the left (Academician M.I.Davydov). Postoperative period without complications. Subsequently, chemotherapy Gemzar and cisplatin. The patient remains under the supervision of the CRC.

Surgery localized mesothelioma asbestos cancer lung and pleura

Authors: Vladimir Shevtsov, Popov M., Kuzmin IV, Chizhov, NV (Moscow Oncological Hospital № 62) Solitary (localized) fibrous tumor (SFD) formerly known as localized (benign) mesothelioma asbestos cancer. described in 1870 E.Wagner. During thoracic lesions in 80% of the tumor based on the visceral leaf, 20% - the parietal and mediastinal. Quite a long time it was thought that the tumor originates from the mesothelial cells. New studies using electron microscopy, immunohistochemistry indicate its mesenchymal origin. For the description of the tumor, the definitions "benign", "reduced", "localized". Also used the term "focal fibrous mesothelioma asbestos cancer." In the international nomenclature, SFO is considered normative.

Localized pleural mesothelioma asbestos cancer occur 3-4 times less common than malignant. Abroad, described hundreds of patients with localized mesothelioma asbestos cancer, in Russia - a few dozen. Age was 50-70 years. Pleural occurs mainly in women. Appearance of the tumor is quite typical. This is a round or oval dense texture formation of 6-20 cm in diameter with a smooth outer surface, covered with a piece of the pleura. Tissue on the cut gray-pink, layered, with foci myxomatosis and, sometimes, small foci of hemorrhage. The tumor may be broad-based, but more often grows in thin connective stalk.

Localized mesothelioma asbestos cancer can reach large sizes but are usually asymptomatic. It is usually detected by X-ray examination of the lungs. Period from identifying tumor before surgery is 3-5 years, but sometimes it lasts 8-20 years.

For 1998-2006 6 patients were operated on the solitary fibrous tumor ("benign" mesothelioma asbestos cancer). This is 0.6% of the operated on for cancer of the lungs and mediastinum. Age of the patients corresponded 43-69 years. Differential diagnosis (using thoracoscopy) was performed with tumors of the lung, mediastinum, and diaphragm.

All patients radically operated. Performed: removal of the tumor in a thoracoscopy, atypical lung resection. Tracked ranged from 3 months to 8 years. Recurrence was observed.

Two observations are of particular practical interest.

The patient received 69 years 02/16/1998, complaining of dry cough, subfertil temperature. Duration - 4 months. Examined at a tuberculosis dispensary, where specific lesion was confirmed. Radiographically in the posteromedial parts of the lower lobe of the left lung was found globular shade up to 5 cm in diameter, clearly defined, relatively homogeneous, lower pole is adjacent to the aperture. Tumor site was far from the mediastinal pleura tyazhistoy portion of lung tissue. The root of the left lung expanded to several small bronchopulmonary lymph nodes. Mediastinum - without features. On fibreoptic, ezofagoduodenoskopii, barium enema and abdominal ultrasound abnormalities were detected. Serum tumor markers: CEA - 4.6 ng / ml, CA 125 - 19.0 U / mL, CYFRA 21-1 - 1-1,8 ng / ml.

Performed thoracoscopy, revealed no pathological changes in the visceral, parietal, slide fragmalnoy and mediastinal pleura. Immediately made thoracotomy 5 intercostal space on the left. Solid tumors up to 6 cm in diameter located in the tenth segment of the lung. Pleura over it is not changed. Connection with mediastinal pleura tumors also were found. Cytology detected punctate tumor lymphoid cells with no signs of malignancy. Performed wedge resection of the lung. Postoperative period without complications.

Histological examination of the diagnosis of the SFO lower lobe of the left lung (the drug concentration sultirovan prof. I.G.Olhovskoy). Patients were examined in 2006 revealed no recurrence. This observation is the first in the Soviet literature, a rare observation intrapulmonary localization solitary mesothelioma asbestos cancer.

Patient 43 years old was admitted to hospital on 10.11.2000 with complaints of weakness, sweating. increase of temperature. When X-rays and CT scans in the projection V segment of the right lung was situated soft tissue tumor size of 1.5 cm in diameter with a clear smooth contours, homogeneous structure. When ezofagogastro-duodenoscopy, bronchoscopy - no pathological changes. Performed thoracoscopy: the parietal pleura tumor up to 2 cm in diameter on the stem, covered with smooth, whitish capsule. In the legs nearby tissues of the chest wall and pleura are not changed. With the power cut by the pleura, indents 2-3 cm of the stem. Tumor was removed. Pathological examination revealed a solitary mesothelioma asbestos cancer.

Pressing is the question of malignant variants of the SFO. According to the literature, they are found in 8 (13.3%) cases and appear invasion into the chest wall, destruction of ribs. Syndrome "drum fingers" was observed only in benign form of the tumor. After surgery systemic symptoms disappeared and came back with recurrence. Histological structure of the recurrence may be quite benign. Therefore, the prognosis of the SFO is always questionable. 10-15% of patients relapse, so the lesion should be removed completely. However, there are cases by removing the SFO "kuskovaniya" with good long-term results. The use of modern diagnostic techniques (computed tomography, the study of tumor markers, thoracoscopy, cytological puncture) to select the correct treatment strategy, as well as an adequate amount of the transaction. Thoracoscopy is a leading method to define the relationship of the tumor and the pleura. For small amounts of tumor thoracoscopic resection is the treatment of choice. If there is doubt in the diagnosis and large-scale education shows a radical operation with VATS support.

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