Localized pleural mesothelioma

Introduction to localized pleural mesothelioma Localized pleural mesothelioma, formerly known as benign mesothelioma, is currently known as pleural localized fibroids, or localized mesothelioma, but pleural localized fibroids (limited mesothelioma) include benign and malignant class. basic knowledge The proportion of illness: 0.0008% Susceptible people: no specific population Mode of infection: non-infectious Complications: cough, atelectasis

The cause of localized pleural mesothelioma

(1) Causes of the disease

The localized pleural mesothelioma cells are immature interstitial cells, which are present in the loose connective tissue under the pleural mesothelial cell layer, and are not derived from the pleural mesothelial cells, so the best noun is considered to be " A limited type of benign (or malignant) fibroma of the pleura. In addition, indirect evidence is observed in patients with this disease without a history of asbestos exposure, which is significantly different from diffuse malignant mesothelioma, which has asbestos exposure in more than 60% of patients. History, mostly benign, potentially malignant, 30% have malignant transformation, pleural effusion is easy to relapse, mostly epithelial or mixed type, clinically less common.

1. Classification Some patients have localized mesothelioma into the following three types: epithelial, fibrous and mixed.

2. The vast majority of benign localized pleural fibroma (BLFT) is located in the pleural pleural or interfacial pleura, which grows in a nodular manner, protrudes into the pleural cavity with pedicles, and also has no pedicle attached to the pleural surface. Lung parenchymal growth is not common, and only a few of the BLFT in the lung are related to the pleura. Most of them are interstitial cells with interlobular septa, or even lung tissue. The tumor can also be located in the fissure. Benign BLFT can also be found in various parts. Wall pleura, however, tumors and lobes in these areas or in the lungs of the long-term are often suggestive of malignancy.

(two) pathogenesis

Benign pleural mesothelioma is a hard-and-encapsulated tumor with yellow-stem-like tumors. There are many blood vessels on the surface, mainly veins. Sometimes the tumors partially invade the lungs and chest wall. Benign mesothelioma grows from the visceral pleura. %, while 30% long from the wall layer, microscopically characterized by uniformly elongated spindle-shaped cells and various amounts of colloidal and reticular fiber structures, forming a number of collagen bundles of varying sizes (Figure 1) .

The source of these tumor cells is still unclear. The tumor may grow from the subpleural tissue, but some people think that musculocutaneous cells are the source of these tumors. There is a hypothesis that malignant or benign pleural mesothelioma is derived from the subcutaneous mesenchymal tissue. Various potential cells may also develop from mesothelial fibroblasts and surface mesothelial cells. These spindle-like cells have micronuclear polymorphism, lack of mitosis, may have necrosis or glassy changes, and have pedicles and limitations. Lesions, benign mesothelioma that does not invade the lungs and surrounding structures have a good prognosis; the nucleus has a high polymorphism or mitosis rate, and no capsules do not indicate a poor prognosis, but if not treated in time, these tumors may be localized. Invasion and squeezing of important vital organs usually kills within 2 to 3 years after diagnosis.

Localized pleural mesothelioma prevention

Prevention: There is no effective preventive measure for this disease. Pay attention to health, do a good job of safety protection, reduce and avoid the irritating and accidental injury of adverse factors, can play a certain preventive role; In addition, early detection, early diagnosis and early treatment are also the key to prevention and treatment of this disease. In case of onset, active treatment should be actively treated to prevent complications.

Localized pleural mesothelioma complications Complications, cough, atelectasis

The main complication of this disease is local compression. There is generally no complication for small tumors. Larger tumors can be transplanted due to pulmonary compression. For left pleural mesothelioma, It can also affect the function of the heart, so it can have clinical manifestations such as palpitations and chest tightness. ECG examination can have ST-T changes, but the degree is usually very slight.

Localized pleural mesothelioma symptoms Common symptoms Night sweats, cold joints, joint stiffness, shortness of breath, chest, heavy feeling, hemoptysis, pleural effusion

Benign pleural mesothelioma is common in 50 to 60 years old. Children under 10 years old and 80-89 years old also have this disease. Women are slightly more than males. The tumor is on the left and the right chest is equal, and malignant mesothelioma is more. Seen in the right chest, most patients with benign pleural mesothelioma have no symptoms. They were found when examining X-ray films. If the tumor is large, there may be compression symptoms. Compression of the bronchi can cause atelectasis. Cough can occur at this time. The chest is heavy and short of breath. The fever without any indication of infection accounts for about 25% of all symptomatic cases. Benign fibrous thoracic mesothelioma is often accompanied by two groups of neoplastic syndromes, namely hypertrophic pulmonary osteoarthropathy. And hypoglycemia, 20% can have hypertrophic pulmonary osteoarthrosis and clubbing, joint stiffness and pain, ankle edema, etc. Most patients with hypertrophic pulmonary osteoarthritis, the diameter of the intrathoracic tumor is >7cm, This syndrome is relieved after the tumor is resected. It can be seen that patients with hypertrophic pulmonary osteoarthrosis and massive intrathoracic mass cannot be considered as advanced primary bronchogenic carcinoma and refused surgery. 4% benign Skin tumor has low blood Syndrome, its pathogenesis is still unknown, it is possible that the tumor consumes glucose and tumor products inhibit lipid breakdown and hepatic gluconeogenesis. After the tumor is removed, the syndrome disappears. The less common symptoms are hemoptysis, chills, nighttime. Night sweats and weight loss, a small number of patients have pleural effusion.

Localized pleural mesothelioma

1. Chest X-ray examination: visible spherical lesions with uniform density around the lungs, clear boundary, tumor size 1 ~ 36cm, average diameter 6cm, no calcification, also occur in the inter-leaf pleura, visible long diameter and oblique The split direction is consistent, about 10% of cases with pleural effusion, but does not indicate poor prognosis, a small number of tumors are huge, occupying the half of the chest, moving the heart and mediastinum to the opposite side, seriously affecting cardiopulmonary function.

2. CT examination is helpful in determining the location of the tumor and its relationship with the surrounding tissue.

Diagnosis and diagnosis of localized pleural mesothelioma

diagnosis

Imaging examination of benign pleural mesothelioma is difficult to confirm, mainly relying on CT or ultrasound-guided needle biopsy, or pleural biopsy in thoracoscopy or thoracotomy, pathological examination confirmed.

Differential diagnosis

The disease should be differentiated from pleural tuberculosis and sputum. For patients with pleural tuberculosis, it is usually accompanied by obvious pleural effusion, respiratory symptoms such as cough and hemoptysis, and symptoms of systemic tuberculosis such as weight loss, fatigue, and hot flashes in the afternoon. For hernia of the pleura, chest X-ray examination can be found that the pleura has prominent masses, sometimes difficult to separate from the disease, but CT enhanced scan can be clearly identified.

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