Skip to main content

Clinical and Radiologic Features

  • Chapter
  • First Online:

Abstract

Diffuse malignant pleural and peritoneal mesothelioma often have an insidious onset and patients frequently present with nonspecific symptoms. Patients with diffuse mesothelioma are most commonly adult men presenting with dyspnea and chest pain (pleural mesothelioma), abdominal distension (peritoneal mesothelioma), and signs and symptoms associated with third-spacing, namely pleural effusions and/or ascites. The interval between symptoms and diagnosis is typically 2–3 months, but can be several months to years. Such insidious behavior can progress rapidly and aggressively, posing several challenges both clinically and radiologically. This chapter addresses the clinical and radiological characteristics of this disease emphasizing conventional wisdom and practices. Newer techniques for detecting early disease, enhancing staging and prognostic accuracy, and providing targeted individualized treatment are also briefly described.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Robinson BW, Musk AW, Lake RA. Malignant mesothelioma. Lancet. 2005;366:397–408.

    Article  CAS  PubMed  Google Scholar 

  2. Ismail-Khan R, Robinson LA, Williams CC Jr, Garrett CR, Bepler G, Simon GR. Malignant pleural mesothelioma: a comprehensive review. Cancer Control. 2006;13:255–63.

    PubMed  Google Scholar 

  3. van Meerbeeck JP, Scherpereel A, Surmont VF, Baas P. Malignant pleural mesothelioma: the standard of care and challenges for future management. Crit Rev Oncol Hematol. 2011;78:92–111.

    Article  PubMed  Google Scholar 

  4. Sheard JD, Taylor W, Soorae A, Pearson MG. Pneumothorax and malignant mesothelioma in patients over the age of 40. Thorax. 1991;46:584–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Alkhuja S, Miller A, Mastellone AJ, Markowitz S. Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review. Am J Ind Med. 2000;38:219–23.

    Article  CAS  PubMed  Google Scholar 

  6. Seely JM, Nguyen ET, Churg AM, Muller NL. Malignant pleural mesothelioma: computed tomography and correlation with histology. Eur J Radiol. 2009;70:485–91.

    Article  PubMed  Google Scholar 

  7. Adams VI, Unni KK, Muhm JR, Jett JR, Ilstrup DM, Bernatz PE. Diffuse malignant mesothelioma of pleura. Diagnosis and survival in 92 cases. Cancer. 1986;58:1540–51.

    Article  CAS  PubMed  Google Scholar 

  8. British Thoracic Society Standards of Care Committee. BTS statement on malignant mesothelioma in the UK, 2007. Thorax 2007;62(Suppl 2):ii1–19.

    Google Scholar 

  9. Larsen BT, Klein JR, Hornychova H, et al. Diffuse intrapulmonary malignant mesothelioma masquerading as interstitial lung disease: a distinctive variant of mesothelioma. Am J Surg Pathol. 2013;37:1555–64.

    Article  PubMed  Google Scholar 

  10. Rossi G, Cavazza A, Turrini E, et al. Exclusive intrapulmonary lepidic growth of a malignant pleural mesothelioma presenting with pneumothorax and involving the peritoneum. Int J Surg Pathol. 2006;14:234–7.

    Article  PubMed  Google Scholar 

  11. Heki U, Fujimura M, Kasahara K, Matsubara F, Matsuda T. Malignant mesothelioma presenting as pulmonary metastasis ahead of growth of primary tumour. Respirology. 1999;4:279–81.

    Article  CAS  PubMed  Google Scholar 

  12. Musk AW, Dewar J, Shilkin KB, Whitaker D. Miliary spread of malignant pleural mesothelioma without a clinically identifiable pleural tumour. Aust NZ J Med. 1991;21:460–2.

    Article  CAS  Google Scholar 

  13. Nind NR, Attanoos RL, Gibbs AR. Unusual intraparenchymal growth patterns of malignant pleural mesothelioma. Histopathology. 2003;42:150–5.

    Article  CAS  PubMed  Google Scholar 

  14. Gunday M, Erinanc H, Geredeli C. Unusual region for pericardial malignant mesothelioma: cutaneous manifestation in a Turkish woman. Rare Tumors. 2013;5:e41.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Wild K, Sankaran P, Nagy A, Sington J. Meningeal and brainstem infiltration by a malignant mesothelioma. BMJ Case Rep. 2010.

    Google Scholar 

  16. Elbahaie AM, Kamel DE, Lawrence J, Davidson NG. Late cutaneous metastases to the face from malignant pleural mesothelioma: a case report and review of the literature. World J Surg Oncol. 2009;7:84.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Sussman J, Rosai J. Lymph node metastasis as the initial manifestation of malignant mesothelioma. Report of six cases. Am J Surg Pathol. 1990;14:819–28.

    Article  CAS  PubMed  Google Scholar 

  18. Yakirevich E, Sova Y, Drumea K, Bergman I, Quitt M, Resnick MB. Peripheral lymphadenopathy as the initial manifestation of pericardial mesothelioma: a case report. Int J Surg Pathol. 2004;12:403–5.

    Article  PubMed  Google Scholar 

  19. Craig FE, Fishback NF, Schwartz JG, Powers CN. Occult metastatic mesothelioma–diagnosis by fine-needle aspiration. A case report. Am J Clin Pathol. 1992;97:493–7.

    CAS  PubMed  Google Scholar 

  20. Zhang Y, Taheri ZM, Jorda M. Systemic lymphadenopathy as the initial presentation of malignant mesothelioma: a report of three cases. Patholog Res Int. 2010;2010:846571.

    PubMed Central  PubMed  Google Scholar 

  21. Lloreta J, Serrano S. Pleural mesothelioma presenting as an axillary lymph node metastasis with anemone cell appearance. Ultrastruct Pathol. 1994;18:293–8.

    Article  CAS  PubMed  Google Scholar 

  22. Wills EJ. Pleural mesothelioma with initial presentation as cervical lymphadenopathy. Ultrastruct Pathol. 1995;19:389–94.

    Article  CAS  PubMed  Google Scholar 

  23. Tammilehto L, Maasilta P, Kostiainen S, Appelqvist P, Holsti LR, Mattson K. Diagnosis and prognostic factors in malignant pleural mesothelioma: a retrospective analysis of sixty-five patients. Respiration. 1992;59:129–35.

    Article  CAS  PubMed  Google Scholar 

  24. Tanrikulu AC, Abakay A, Kaplan MA, et al. A clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma. Respiration. 2010;80:480–7.

    Article  PubMed  Google Scholar 

  25. Yates DH, Corrin B, Stidolph PN, Browne K. Malignant mesothelioma in south east England: clinicopathological experience of 272 cases. Thorax. 1997;52:507–12.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Bani-Hani KE, Gharaibeh KA. Malignant peritoneal mesothelioma. J Surg Oncol. 2005;91:17–25.

    Article  PubMed  Google Scholar 

  27. Bridda A, Padoan I, Mencarelli R, Frego M. Peritoneal mesothelioma: a review. Med Gen Med. 2007;9:32.

    Google Scholar 

  28. Eltabbakh GH, Piver MS, Hempling RE, Recio FO, Intengen ME. Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma. J Surg Oncol. 1999;70:6–12.

    Article  CAS  PubMed  Google Scholar 

  29. Asensio JA, Goldblatt P, Thomford NR. Primary malignant peritoneal mesothelioma. A report of seven cases and a review of the literature. Arch Surg. 1990;125:1477–81.

    Article  CAS  PubMed  Google Scholar 

  30. Acherman YI, Welch LS, Bromley CM, Sugarbaker PH. Clinical presentation of peritoneal mesothelioma. Tumori. 2003;89:269–73.

    PubMed  Google Scholar 

  31. Ribak J, Lilis R, Suzuki Y, Penner L, Selikoff IJ. Malignant mesothelioma in a cohort of asbestos insulation workers: clinical presentation, diagnosis, and causes of death. Br J Ind Med. 1988;45:182–7.

    PubMed Central  CAS  PubMed  Google Scholar 

  32. Salemis NS, Tsiambas E, Gourgiotis S, Mela A, Karameris A, Tsohataridis E. Peritoneal mesothelioma presenting as an acute surgical abdomen due to jejunal perforation. J Dig Dis. 2007;8:216–21.

    Article  PubMed  Google Scholar 

  33. Yan TD, Popa E, Brun EA, Cerruto CA, Sugarbaker PH. Sex difference in diffuse malignant peritoneal mesothelioma. Br J Surg. 2006;93:1536–42.

    Article  CAS  PubMed  Google Scholar 

  34. Mani H, Merino MJ. Mesothelial neoplasms presenting as, and mimicking, ovarian cancer. Int J Gynecol Pathol. 2010;29:523–8.

    Article  PubMed  Google Scholar 

  35. Baker PM, Clement PB, Young RH. Malignant peritoneal mesothelioma in women: a study of 75 cases with emphasis on their morphologic spectrum and differential diagnosis. Am J Clin Pathol. 2005;123:724–37.

    Article  PubMed  Google Scholar 

  36. Manzini VP, Recchia L, Cafferata M, et al. Malignant peritoneal mesothelioma: a multicenter study on 81 cases. Ann Oncol. 2010;21:348–53.

    Article  Google Scholar 

  37. Schneiderman H. Mesothelioma and venous thrombosis. CMAJ. 2004;171:11, author reply -2.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Banayan S, Hot A, Janier M, Ninet J, Zurlinden O, Billotey C. Malignant mesothelioma of the peritoneum as the cause of a paraneoplastic syndrome: detection by 18F-FDG PET. Eur J Nucl Med Mol Imaging. 2006;33:751.

    Article  PubMed  Google Scholar 

  39. Socola F, Loaiza-Bonilla A, Bustinza-Linares E, Correa R, Rosenblatt JD. Recurrent thrombotic thrombocytopenic purpura-like syndrome as a paraneoplastic phenomenon in malignant peritoneal mesothelioma: a case report and review of the literature. Case Rep Oncol Med. 2012;2012:619348.

    PubMed Central  PubMed  Google Scholar 

  40. Bech C, Sorensen JB. Polyneuropathy in a patient with malignant pleural mesothelioma: a paraneoplastic syndrome. J Thorac Oncol. 2008;3:1359–60.

    Article  PubMed  Google Scholar 

  41. Archer HA, Panopoulou A, Bhatt N, Edey AJ, Giffin NJ. Mesothelioma and anti-Ma paraneoplastic syndrome; heterogeneity in immunogenic tumours increases. Pract Neurol. 2014;14(1):33–5.

    Article  PubMed  Google Scholar 

  42. Tanriverdi O, Meydan N, Barutca S, Ozsan N, Gurel D, Veral A. Anti-Yo antibody-mediated paraneoplastic cerebellar degeneration in a female patient with pleural malignant mesothelioma. Jpn J Clin Oncol. 2013;43:563–8.

    Article  PubMed  Google Scholar 

  43. Britton M. The epidemiology of mesothelioma. Semin Oncol. 2002;29:18–25.

    Article  PubMed  Google Scholar 

  44. Jarvholm B, Sanden A. Lung cancer and mesothelioma in the pleura and peritoneum among Swedish insulation workers. Occup Environ Med. 1998;55:766–70.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Hilliard AK, Lovett JK, McGavin CR. The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979–1999. Occup Med (Lond). 2003;53:209–12.

    Article  CAS  Google Scholar 

  46. Abakay A, Tanrikulu AC, Kaplan MA, et al. Clinical characteristics and treatment outcomes in 132 patients with malignant mesothelioma. Lung India. 2011;28:267–71.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Antman KH, Blum RH, Greenberger JS, Flowerdew G, Skarin AT, Canellos GP. Multimodality therapy for malignant mesothelioma based on a study of natural history. Am J Med. 1980;68:356–62.

    Article  CAS  PubMed  Google Scholar 

  48. Rosas-Salazar C, Gunawardena SW, Spahr JE. Malignant pleural mesothelioma in a child with ataxia-telangiectasia. Pediatr Pulmonol. 2013;48:94–7.

    Article  PubMed  Google Scholar 

  49. Fraire AE, Cooper S, Greenberg SD, Buffler P, Langston C. Mesothelioma of childhood. Cancer. 1988;62:838–47.

    Article  CAS  PubMed  Google Scholar 

  50. Moran CA, Albores-Saavedra J, Suster S. Primary peritoneal mesotheliomas in children: a clinicopathological and immunohistochemical study of eight cases. Histopathology. 2008;52:824–30.

    Article  CAS  PubMed  Google Scholar 

  51. Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77:507–13.

    Article  CAS  PubMed  Google Scholar 

  52. Gottehrer A, Taryle DA, Reed CE, Sahn SA. Pleural fluid analysis in malignant mesothelioma. Prognostic implications. Chest. 1991;100:1003–6.

    Article  CAS  PubMed  Google Scholar 

  53. Pass HI, Levin SM, Harbut MR, et al. Fibulin-3 as a blood and effusion biomarker for pleural mesothelioma. N Engl J Med. 2012;367:1417–27.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  54. Campbell NP, Kindler HL. Update on malignant pleural mesothelioma. Semin Respir Crit Care Med. 2011;32:102–10.

    Article  PubMed  Google Scholar 

  55. Pass HI, Lott D, Lonardo F, et al. Asbestos exposure, pleural mesothelioma, and serum osteopontin levels. N Engl J Med. 2005;353:1564–73.

    Article  CAS  PubMed  Google Scholar 

  56. Shi HZ, Liang QL, Jiang J, Qin XJ, Yang HB. Diagnostic value of carcinoembryonic antigen in malignant pleural effusion: a meta-analysis. Respirology. 2008;13:518–27.

    Article  PubMed  Google Scholar 

  57. Grigoriu BD, Grigoriu C, Chahine B, Gey T, Scherpereel A. Clinical utility of diagnostic markers for malignant pleural mesothelioma. Monaldi Arch Chest Dis. 2009;71:31–8.

    CAS  PubMed  Google Scholar 

  58. Fuhrman C, Duche JC, Chouaid C, et al. Use of tumor markers for differential diagnosis of mesothelioma and secondary pleural malignancies. Clin Biochem. 2000;33:405–10.

    Article  CAS  PubMed  Google Scholar 

  59. Frebourg T, Lerebours G, Delpech B, et al. Serum hyaluronate in malignant pleural mesothelioma. Cancer. 1987;59:2104–7.

    Article  CAS  PubMed  Google Scholar 

  60. Chiu B, Churg A, Tengblad A, Pearce R, McCaughey WT. Analysis of hyaluronic acid in the diagnosis of malignant mesothelioma. Cancer. 1984;54:2195–9.

    Article  CAS  PubMed  Google Scholar 

  61. Creaney J, Dick IM, Segal A, Musk AW, Robinson BW. Pleural effusion hyaluronic acid as a prognostic marker in pleural malignant mesothelioma. Lung Cancer. 2013;82:491–8.

    Article  PubMed  Google Scholar 

  62. Filiberti R, Parodi S, Libener R, et al. Diagnostic value of mesothelin in pleural fluids: comparison with CYFRA 21-1 and CEA. Med Oncol. 2013;30:543.

    Article  PubMed  Google Scholar 

  63. O’Rahilly R, Muller NL, Carpenter S, Swenson R. Basic human anatomy. A regional study of human structure. Chapter 22. In: O’Rahilly R, editor. Online version. Dartmouth Medical School and Dartmouth College, New Hampshire, USA; 2008.

    Google Scholar 

  64. Gray H, editor. Anatomy of the human body. New York: Bartleby.com; 2000.

    Google Scholar 

  65. Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma from the International Mesothelioma Interest Group. Lung Cancer. 1996;14:1–12.

    Article  CAS  PubMed  Google Scholar 

  66. Rusch VW, Giroux D. Do we need a revised staging system for malignant pleural mesothelioma? Analysis of the IASLC database. Ann Cardiothorac Surg. 2012;1:438–48.

    PubMed Central  PubMed  Google Scholar 

  67. Rusch VW, Giroux D, Kennedy C, et al. Initial analysis of the international association for the study of lung cancer mesothelioma database. J Thorac Oncol. 2012;7:1631–9.

    Article  PubMed  Google Scholar 

  68. Kawashima A, Libshitz HI. Malignant pleural mesothelioma: CT manifestations in 50 cases. AJR Am J Roentgenol. 1990;155:965–9.

    Article  CAS  PubMed  Google Scholar 

  69. Metintas M, Ucgun I, Elbek O, et al. Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases. Eur J Radiol. 2002;41:1–9.

    Article  PubMed  Google Scholar 

  70. Armato SG 3rd, Labby ZE, Coolen J, et al. Imaging in pleural mesothelioma: a review of the 11th International Conference of the International Mesothelioma Interest Group. Lung Cancer. 2013;82:190–6.

    Google Scholar 

  71. Corson N, Sensakovic WF, Straus C, Starkey A, Armato SG 3rd. Characterization of mesothelioma and tissues present in contrast-enhanced thoracic CT scans. Med Phys. 2011;38:942–7.

    Article  PubMed Central  PubMed  Google Scholar 

  72. Patz EF Jr, Shaffer K, Piwnica-Worms DR, et al. Malignant pleural mesothelioma: value of CT and MR imaging in predicting resectability. AJR Am J Roentgenol. 1992;159:961–6.

    Article  PubMed  Google Scholar 

  73. Heelan RT, Rusch VW, Begg CB, Panicek DM, Caravelli JF, Eisen C. Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. AJR Am J Roentgenol. 1999;172:1039–47.

    Article  CAS  PubMed  Google Scholar 

  74. Coolen J, De Keyzer F, Nafteux P, et al. Malignant pleural disease: diagnosis by using diffusion-weighted and dynamic contrast-enhanced MR imaging–initial experience. Radiology. 2012;263:884–92.

    Article  PubMed  Google Scholar 

  75. Byrne MJ, Nowak AK. Modified RECIST criteria for assessment of response in malignant pleural mesothelioma. Ann Oncol. 2004;15:257–60.

    Article  CAS  PubMed  Google Scholar 

  76. Sensakovic WF, Armato SG 3rd, Starkey A, Kindler HL, Vigneswaran WT. Quantitative measurement of lung reexpansion in malignant pleural mesothelioma patients undergoing pleurectomy/decortication. Acad Radiol. 2011;18:294–8.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Flores RM. The role of PET in the surgical management of malignant pleural mesothelioma. Lung Cancer. 2005;49(Suppl 1):S27–32.

    Article  PubMed  Google Scholar 

  78. Flores RM, Akhurst T, Gonen M, Larson SM, Rusch VW. Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2003;126:11–6.

    Article  PubMed  Google Scholar 

  79. Truong MT, Viswanathan C, Godoy MB, Carter BW, Marom EM. Malignant pleural mesothelioma: role of CT, MRI, and PET/CT in staging evaluation and treatment considerations. Semin Roentgenol. 2013;48:323–34.

    Article  PubMed  Google Scholar 

  80. Duysinx B, Nguyen D, Louis R, et al. Evaluation of pleural disease with 18-fluorodeoxyglucose positron emission tomography imaging. Chest. 2004;125:489–93.

    Article  PubMed  Google Scholar 

  81. Kinahan PE, Fletcher JW. Positron emission tomography-computed tomography standardized uptake values in clinical practice and assessing response to therapy. Semin Ultrasound CT MR. 2010;31:496–505.

    Article  PubMed Central  PubMed  Google Scholar 

  82. Margolis DJ, Hoffman JM, Herfkens RJ, Jeffrey RB, Quon A, Gambhir SS. Molecular imaging techniques in body imaging. Radiology. 2007;245:333–56.

    Article  PubMed  Google Scholar 

  83. Jeon KN, Bae K, Park MJ, et al. US-guided transthoracic biopsy of peripheral lung lesions: pleural contact length influences diagnostic yield. Acta Radiol. 2014;55(3):295–301.

    Article  PubMed  Google Scholar 

  84. Yang PC. Ultrasound-guided transthoracic biopsy of peripheral lung, pleural, and chest-wall lesions. J Thorac Imaging. 1997;12:272–84.

    Article  CAS  PubMed  Google Scholar 

  85. Law MR, Hodson ME, Turner-Warwick M. Malignant mesothelioma of the pleura: clinical aspects and symptomatic treatment. Eur J Respir Dis. 1984;65:162–8.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anja C. Roden .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Roden, A., Lee, C. (2015). Clinical and Radiologic Features. In: Allen, T. (eds) Diffuse Malignant Mesothelioma. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2374-8_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2374-8_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2373-1

  • Online ISBN: 978-1-4939-2374-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics