Pericardial Mesothelioma, Pericardial Effusion & Pericardial Masses
Pericardial Mesothelioma
Pericardial Mesothelioma is a tumor that can occur at any age with a mean age of 46 years at presentation. Patients present with chest pain, dyspnea, cough, and palpitations. Although there appears to be a strong link to asbestos exposure, a definite association has not been established due to the rarity of this lesion. Surgery combined with radiation therapy may provide some palliation, but the prognosis is extremely poor. On CT there is irregular, diffuse pericardial thickening and a pericardial effusion. Pericardium is a thin lining of tissue surrounding the heart.
Pericardial Effusion
Pericardial effusion is the collection of fluid in the sac that surrounds the heart, a possible sign of cancer as well as many other conditions. When it is caused by cancer, it can be result of either direct spread of cancer from adjacent organs like the lung, or by metastatic spread from other parts of the body
Pericardial Masses
The most common primary mass is a congenital celomic cyst. Benign and malignant pericardial solid masses are equally common. Teratoma and malignant mesothelioma are the leading primary solid masses. Secondary malignancies are far more common than primary with seventy percent due to spread from lung, breast and lymphoproliferative disorders. Although primary tumors more commonly affect the myocardium than the pericardium the reverse is true of secondary tumors. In those with pericardial metastases 25% have reduced cardiac function and for the majority tamponade is the commonest cause of death.
CT features of masses that may elucidate their etiology include;morphology, location, extent, cyst or solid character, their effect on cardiac chambers as well as their enhancement characteristics and the amount of extracardiac disease. It is in the setting of malignancy with its ability to evaluate the whole thorax that CT has much to offer.
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PERICARDIAL MESOTHELIOMA - CASE STUDY
Primary pericardial mesothelioma:
Yuko Kobayashi1, , Ryusuke Murakami1, Junko Ogura1, Kanae Yamamoto1, Taro Ichikawa1, Kouichi Nagasawa2, Masaru Hosone3 and Tatsuo Kumazaki4
(1) Department of Radiology, Tama-Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-shi, Tokyo 206-8512, Japan
(2) Department of Internal Medicine, Tama-Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-shi, Tokyo 206-8512, Japan
(3) Department of Pathology, Tama-Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-shi, Tokyo 206-8512, Japan
(4) Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
Abstract. The imaging features of primary pericardial mesothelioma have rarely been described. Herein we present a case report of its diagnostic-pathologic features. Chest computed tomography (CT) revealed an irregularly enhanced mass occupying the entire pericardial space and surrounding the superior vena cava. At autopsy, the tumor was found to fill the pericardial space completely, and to extend to the superior vena cava through the superior pericardial sinus. The CT features of the tumor were correlated well with those revealed at autopsy, and provided satisfactory information regarding the presence and the extension of the tumor
Saturday, October 4, 2008
PLEURAL MESOTHELIOMA
PLEURAL MESOTHELIOMA
Pleural mesothelioma is of two kinds: (1) diffuse and malignant (cancerous), and (2) localized and benign (non-cancerous.)
Benign mesothelioma can often be removed surgically, are generally not life-threatening, and are not usually related to asbestos exposure. Malignant mesothelioma, however, are very serious. Fortunately, they are rare - about two thousand people are diagnosed with mesothelioma in the U.S. each year.
The remainder of this section is about diffuse malignant pleural mesothelioma.
Pleural mesothelioma is a cancer of the cells that make up the pleura or lining around the outside of the lungs and inside of the ribs. Its only known cause in the U.S. is previous exposure to asbestos fibers, including chrysotile, amosite or crocidolite. This exposure is likely to have happened twenty or more years before the disease becomes evident, since it takes many years for the disease to "incubate." It is the most common type of mesothelioma, accounting for about 75% of all cases.
Mesothelioma is sometimes diagnosed by coincidence, before there are any symptoms. For instance, tumors have been discovered through routine chest x-rays. However, when symptoms occur, they may include shortness of breath, weakness, weight loss, loss of appetite, chest pains, lower back pains, persistent coughing, difficulty in swallowing, alone or in combination. An initial medical examination often shows a pleural effusion, which means an accumulation of fluid in the pleural space - the area between the lungs and the chest wall.
The first step in detecting pleural mesothelioma is, typically, a chest x-ray or CT scan. This is often followed by a bronchoscopy, using a viewing scope to look inside the lungs.
The actual diagnosis usually requires obtaining a piece of tissue through a biopsy. This could be a needle biopsy, an open biopsy, or through a tube with a camera (thoracoscopy or chest scope.) If an abnormality is seen through the camera then a tissue sample can be taken at the same time, using the same tube. This is a hospital procedure that requires anesthesia, but is not usually painful. The tissue sample is tested by a pathologist.
Fluid build-up from the pleural effusion can generally be seen on a chest x-ray and heard during a physical examination, but a firm diagnosis of mesothelioma can only be made through a biopsy and pathological testing. This is important because there are also benign pleural effusions and other tumors that have a similar appearance to mesothelioma. Diagnosing mesothelioma can be quite difficult; it requires special lab stains, and much experience in understanding them.
The spread of the tumor over the pleura causes pleural thickening. This can reduce the flexibility of the pleura and encase the lungs in an increasingly restrictive girdle. With the lungs restricted, they get smaller and less functional, and breathing becomes more difficult. At first a person with mesothelioma may be breathless only when he or she exercises, but as lung function drops, he or she can become short of breath even while resting.
The tumor spreads by direct invasion of surrounding tissue. As it spreads inward it can compress the lungs. As the tumor spreads outward it can invade the chest wall and ribs, and this can be extremely painful.
Current medical science does not know exactly how and why, at a cellular level, asbestos fibers cause mesothelial cells to become abnormal (malignant or cancerous.) Thus it is not known whether only one fiber causes the tumor or whether it takes many fibers. It seems that asbestos fibers in the pleura can start a tumor as well as promote its growth; the tumor does not depend on any other processes for its development.
There is as yet no known cure for malignant mesothelioma. The prognosis depends on various factors, including the size and stage of the tumor, the extent of the tumor, the cell type, and whether or not the tumor responds to treatment. KMESA has represented many clients who lived for five to ten years after diagnosis, most of them in good health for a majority of those years. Some mesothelioma victims succumb within a few months; the average survival time is about a year.
The treatment options for people with mesothelioma have improved significantly, especially for those whose cancer is diagnosed early and treated vigorously. Many people are treated with a combination of therapies, sometimes known as multimodal therapy.
Specific types of treatment include:
Chemotherapy and other drug-based therapies
Radiation therapy
Surgery and
Intra-operative photodynamic therapy
There are also experimental treatments like gene therapy and immunotherapy, angiogenesis inhibitors, and clinical trials for various new treatments and combinations of treatments.
Treatments that reduce pain and improve lung function, are becoming more successful (although they cannot cure mesothelioma.) Pain control medications have become easier to administer. Debulking is a surgical process of removing a substantial part of the tumor and reducing the pleural thickening; this can provide significant relief. X-ray therapy has also been successfully used to control the tumor and the pain associated with it for a while.
Information provided by: www.meetyourdoctor.net
Mesothelioma (benign-fibrous)
Definition:
A noncancerous tumor of the pleura (lining of the lung and chest cavity).
Causes, incidence, and risk factors:
Nonmalignant mesothelioma is usually a localized tumor that affects men more frequently than women. The tumor may grow to a large size and compress the lung, causing the symptoms of shortness of breath.
Symptoms:
chronic cough
shortness of breath
chest pain
Signs and tests:
A physical examination reveals the clubbed appearance of the fingers.
Tests that may show benign mesothelioma:
chest X-ray
CT scan of the chest
open lung biopsy
Treatment:
Surgery is indicated for a solitary tumor.
Expectations (prognosis):
The outcome is expected to be good with prompt treatment.
Complications:
Pleural effusion (fluid escaping into the membranes around the lungs) is a complication.
Calling your health care provider:
Call for an appointment with your health care provider if you notice a chroniccough or other signs of mesothelioma.
Prevention:
There is no known prevention for this very rare disorder.
Pleural mesothelioma is of two kinds: (1) diffuse and malignant (cancerous), and (2) localized and benign (non-cancerous.)
Benign mesothelioma can often be removed surgically, are generally not life-threatening, and are not usually related to asbestos exposure. Malignant mesothelioma, however, are very serious. Fortunately, they are rare - about two thousand people are diagnosed with mesothelioma in the U.S. each year.
The remainder of this section is about diffuse malignant pleural mesothelioma.
Pleural mesothelioma is a cancer of the cells that make up the pleura or lining around the outside of the lungs and inside of the ribs. Its only known cause in the U.S. is previous exposure to asbestos fibers, including chrysotile, amosite or crocidolite. This exposure is likely to have happened twenty or more years before the disease becomes evident, since it takes many years for the disease to "incubate." It is the most common type of mesothelioma, accounting for about 75% of all cases.
Mesothelioma is sometimes diagnosed by coincidence, before there are any symptoms. For instance, tumors have been discovered through routine chest x-rays. However, when symptoms occur, they may include shortness of breath, weakness, weight loss, loss of appetite, chest pains, lower back pains, persistent coughing, difficulty in swallowing, alone or in combination. An initial medical examination often shows a pleural effusion, which means an accumulation of fluid in the pleural space - the area between the lungs and the chest wall.
The first step in detecting pleural mesothelioma is, typically, a chest x-ray or CT scan. This is often followed by a bronchoscopy, using a viewing scope to look inside the lungs.
The actual diagnosis usually requires obtaining a piece of tissue through a biopsy. This could be a needle biopsy, an open biopsy, or through a tube with a camera (thoracoscopy or chest scope.) If an abnormality is seen through the camera then a tissue sample can be taken at the same time, using the same tube. This is a hospital procedure that requires anesthesia, but is not usually painful. The tissue sample is tested by a pathologist.
Fluid build-up from the pleural effusion can generally be seen on a chest x-ray and heard during a physical examination, but a firm diagnosis of mesothelioma can only be made through a biopsy and pathological testing. This is important because there are also benign pleural effusions and other tumors that have a similar appearance to mesothelioma. Diagnosing mesothelioma can be quite difficult; it requires special lab stains, and much experience in understanding them.
The spread of the tumor over the pleura causes pleural thickening. This can reduce the flexibility of the pleura and encase the lungs in an increasingly restrictive girdle. With the lungs restricted, they get smaller and less functional, and breathing becomes more difficult. At first a person with mesothelioma may be breathless only when he or she exercises, but as lung function drops, he or she can become short of breath even while resting.
The tumor spreads by direct invasion of surrounding tissue. As it spreads inward it can compress the lungs. As the tumor spreads outward it can invade the chest wall and ribs, and this can be extremely painful.
Current medical science does not know exactly how and why, at a cellular level, asbestos fibers cause mesothelial cells to become abnormal (malignant or cancerous.) Thus it is not known whether only one fiber causes the tumor or whether it takes many fibers. It seems that asbestos fibers in the pleura can start a tumor as well as promote its growth; the tumor does not depend on any other processes for its development.
There is as yet no known cure for malignant mesothelioma. The prognosis depends on various factors, including the size and stage of the tumor, the extent of the tumor, the cell type, and whether or not the tumor responds to treatment. KMESA has represented many clients who lived for five to ten years after diagnosis, most of them in good health for a majority of those years. Some mesothelioma victims succumb within a few months; the average survival time is about a year.
The treatment options for people with mesothelioma have improved significantly, especially for those whose cancer is diagnosed early and treated vigorously. Many people are treated with a combination of therapies, sometimes known as multimodal therapy.
Specific types of treatment include:
Chemotherapy and other drug-based therapies
Radiation therapy
Surgery and
Intra-operative photodynamic therapy
There are also experimental treatments like gene therapy and immunotherapy, angiogenesis inhibitors, and clinical trials for various new treatments and combinations of treatments.
Treatments that reduce pain and improve lung function, are becoming more successful (although they cannot cure mesothelioma.) Pain control medications have become easier to administer. Debulking is a surgical process of removing a substantial part of the tumor and reducing the pleural thickening; this can provide significant relief. X-ray therapy has also been successfully used to control the tumor and the pain associated with it for a while.
Information provided by: www.meetyourdoctor.net
Mesothelioma (benign-fibrous)
Definition:
A noncancerous tumor of the pleura (lining of the lung and chest cavity).
Causes, incidence, and risk factors:
Nonmalignant mesothelioma is usually a localized tumor that affects men more frequently than women. The tumor may grow to a large size and compress the lung, causing the symptoms of shortness of breath.
Symptoms:
chronic cough
shortness of breath
chest pain
Signs and tests:
A physical examination reveals the clubbed appearance of the fingers.
Tests that may show benign mesothelioma:
chest X-ray
CT scan of the chest
open lung biopsy
Treatment:
Surgery is indicated for a solitary tumor.
Expectations (prognosis):
The outcome is expected to be good with prompt treatment.
Complications:
Pleural effusion (fluid escaping into the membranes around the lungs) is a complication.
Calling your health care provider:
Call for an appointment with your health care provider if you notice a chroniccough or other signs of mesothelioma.
Prevention:
There is no known prevention for this very rare disorder.
Mesothelioma (benign-fibrous)
Mesothelioma (benign-fibrous)
Definition:
A noncancerous tumor of the pleura (lining of the lung and chest cavity).
Causes, incidence, and risk factors:
Nonmalignant mesothelioma is usually a localized tumor that affects men more frequently than women. The tumor may grow to a large size and compress the lung, causing the symptoms of shortness of breath.
Symptoms:
chroniccough
shortness of breath
chest pain
Signs and tests:
A physical examination reveals the clubbed appearance of the fingers.
Tests that may show benign mesothelioma:
chest X-ray
CT scan of the chest
open lung biopsy
Treatment:
Surgery is indicated for a solitary tumor.
Expectations (prognosis):
The outcome is expected to be good with prompt treatment.
Complications:
Pleural effusion (fluid escaping into the membranes around the lungs) is a complication.
Calling your health care provider:
Call for an appointment with your health care provider if you notice a chroniccough or other signs of mesothelioma.
Prevention:
There is no known prevention for this very rare disorder
Definition:
A noncancerous tumor of the pleura (lining of the lung and chest cavity).
Causes, incidence, and risk factors:
Nonmalignant mesothelioma is usually a localized tumor that affects men more frequently than women. The tumor may grow to a large size and compress the lung, causing the symptoms of shortness of breath.
Symptoms:
chroniccough
shortness of breath
chest pain
Signs and tests:
A physical examination reveals the clubbed appearance of the fingers.
Tests that may show benign mesothelioma:
chest X-ray
CT scan of the chest
open lung biopsy
Treatment:
Surgery is indicated for a solitary tumor.
Expectations (prognosis):
The outcome is expected to be good with prompt treatment.
Complications:
Pleural effusion (fluid escaping into the membranes around the lungs) is a complication.
Calling your health care provider:
Call for an appointment with your health care provider if you notice a chroniccough or other signs of mesothelioma.
Prevention:
There is no known prevention for this very rare disorder
MALIGNANT MESOTHELIOMA
Malignant mesothelioma is a cancerous tumor of the lining of the lung and chest cavity (pleura) or lining of the abdomen (peritoneum) that is almost always caused by sustained exposure to asbestos.
Malignant mesothelioma is a diffuse tumor that affects men more frequently than women. Sustained exposure to asbestos is the predominant risk factor. However, smoking dramatically increases risk amongst the asbestos-exposed. The latent period between asbestos exposure and onset of symptoms can be 20 to 50 years or even longer.
The median age of diagnosis is 60. The tumor can spread rapidly to involve the pericardium (sac around the heart), mediastinum, and opposite pleura. Progressive pain and shortness of breath can occur. The tumor is usually associated with a pleural effusion.
Differentiation of the tumor from other conditions of the pleura and other types of cancer can be difficult, even when experienced pathologists are viewing biopsy samples.
Malignant mesothelioma is a diffuse tumor that affects men more frequently than women. Sustained exposure to asbestos is the predominant risk factor. However, smoking dramatically increases risk amongst the asbestos-exposed. The latent period between asbestos exposure and onset of symptoms can be 20 to 50 years or even longer.
The median age of diagnosis is 60. The tumor can spread rapidly to involve the pericardium (sac around the heart), mediastinum, and opposite pleura. Progressive pain and shortness of breath can occur. The tumor is usually associated with a pleural effusion.
Differentiation of the tumor from other conditions of the pleura and other types of cancer can be difficult, even when experienced pathologists are viewing biopsy samples.
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