How do you know whether you have liver fibrosis

Only from clinical symptoms and signs or routine laboratory tests of liver function can not
know whether there is liver fibrosis. The current method of diagnosis of liver fibrosis can
be divided into three categories:
(1) pathological diagnosis: So far, pathological examination of liver biopsy diagnosis of
liver fibrosis is still the most reliable method. By pathological examination of liver
biopsy, not only to know whether they have been developed to liver fibrosis and liver
fibrosis in the end you can find out to what extent the development, which guide clinical
treatment and prognosis helpful. Currently in clinical practice, liver biopsy equipment and
technology has a perfect system, the patient's pain is also very small, in the hands of
experienced specialists in liver disease complications are rarely serious.
(2) Diagnostic Imaging: B Chao, CT and magnetic resonance imaging and other imaging studies
can be found some signs of liver fibrosis, such as the liver contour, size, and liver
changes in signal strength in real terms. Liver blood vessel diameter and blood flow
direction, speed changes, and changes in spleen size. However, at present these imaging
studies can not yet make a diagnosis of fibrosis, more difficult to accurately determine the
severity of liver fibrosis, it is only as a secondary diagnosis.
(3) serum markers: serum indicators are currently the most widely studied method for
diagnosis of liver fibrosis, including serum type Ⅲ procollagen amino terminal propeptide
(P-Ⅲ-P), Ⅲ procollagen (PC-Ⅲ), Ⅳ collagen, hyaluronic acid (HA), laminin (1N) and so is
widely used. The level of these serum markers and liver biopsy diagnosis is closely related
to the severity of liver fibrosis, which can be used for diagnosis of liver fibrosis. After
all, as a result of liver biopsy is more direct, for a patient, it is often difficult to
target based on a laboratory level to determine the degree of liver fibrosis. But the
advantage is taken of serum tests convenient, easy to review, if you can periodically check
(eg every six months or a year) you can increase or decrease in these indicators is to
understand the general trend of development and changes in liver fibrosis can also be
broadly understanding of the clinical effects of anti-fibrosis therapy.
What is a liver biopsy Liver biopsy Liver biopsy is, simply, is to use various methods from
the patient's liver to remove one o'clock liver tissue for pathological examination.
We know that the so-called liver disease is a problem within the liver. The internal
structure of the liver cells and liver appeared abnormal. However, long in the stomach
inside the liver, we do not see it. The internal structure of the liver cells and liver, is
even more not only because of its belly across the floor can not see, but also because cells
small size, no microscope to enlarge several times, impossible to see the hundreds of times.
Although we have a variety of tests, with advanced B-, CT, MRI, etc., but all these tests
are indirect, after all, there will be many errors. As we buy a watermelon, and then
experienced person picks across the board is not as open to look at, good or bad at a
glance, is accurate.
In fact, this cut of view - to see is the biopsy. Is there a liver disease, what is the
nature of disease and severity of how to provide the most definitive answers, only through
the liver tissue under the microscope and the case of liver cells, before reaching a
conclusion. So pathological examination is the final diagnosis magistrate.
Because biopsy unparalleled irreplaceable importance, so are active in clinical biopsy to
minimize diagnostic errors, and the progress of the disease to make the most accurate
evaluation. Surgeons remove the tumor, the first cut on the operating table, the tumor is
often sent to do frozen section pathology to see the tumor is benign or malignant. During
the exam, the doctor can not leave the operating room surgery. When the pathology report on
the fastest test results, the surgery the doctor and then decide the next - step how to do
surgery. If it is benign, can be sewn on after the removal. If it is malignant, it must be
checked immediately around the tumor has not been transferred. Do lymph node dissection, and
even larger area of excision.
As for the blood system diseases, it is inseparable from the bone marrow biopsy, bone marrow
does not make a check, most of the blood disease is not diagnosed. Liver, too, only liver
biopsy can give the most accurate diagnosis. So we should vigorously carry out liver biopsy,
so that the patient, the doctor's diagnosis and to treatment, prognosis is good for.

Serological test of liver fibrosis (liver fiber four)

Description:
Without creating a simple check of the advantages of this, but the accuracy is not high,
only as a reference and a preliminary screening and grading the degree of fibrosis, or rely
on pathological examination (liver biopsy) to determine the quantitative indicators of liver
fibrosis testing, general radioimmunoassay, the general determination of the four, it is
also referred to the liver fiber four.
Clinical significance of reference:
1, serum hyaluronic acid (HA) mainly by the liver endothelial cell uptake of decomposition,
a small amount of small molecules also increased from glomerular filtration. When the liver,
impaired renal function, serum HA increased, and increased with the disease and showed an
increasing trend. Detection of serum HA could reflect the development and outcome of hepatic
fibrosis.
2, laminin (LN), also known as laminin. A structural glycoprotein present in basement
membrane of the transparent layer. And liver fibrosis there is an important relationship is
the main basis for portal hypertension occurs. LN levels in serum are often associated with
type Ⅳ collagen, hyaluronic acid and other parallel, portal hypertension, especially in the
diagnosis of hepatic fibrosis has important value.

Alcoholic liver fibrosis clinical manifestations

Alcoholic liver fibrosis and the general non-specific symptoms, like alcohol. China-Japan
Friendship Hospital, 45 patients with alcoholic liver fibrosis according to the number of
symptoms and signs appear in the order as follows: 82.25 weakness, abdominal distension
66.7%, liver pain, anorexia 42.2%, 47%, 31% of limbs, numbness, memory loss and 22%,
diarrhea and sexual dysfunction was 11% each. Hepatomegaly 60%, 33% of liver palms, spider
angioma 29%, while the approval of which very little swelling.
Laboratory tests are nonspecific, but the pay is significantly increased GGT. The group
followed by GGT, triglyceride (TG) increased 60% and 58%, T BiL increased 49%, AST increased
total 42.2%, ALT increased 36%, D BiL share increased 33%, ALP 28.8% higher, while the
coagulation plasminogen activity decreased only 22%.
Iturriaga.H report (1993) GGT, and AST is a good determination of alcoholic liver injury
indicators, such as GGT> 110U, correctly forecast 80% of asymptomatic alcoholic liver
injury. Southwest Hospital Jiang Zhenghui report (1995) GGY in alcoholic liver disease in
the most characteristic expression in the alcoholic hepatitis, liver group proud to release
significantly increased GGT, alcohol quickly decreased to normal or near normal, and then
alcohol and increase in the ALT does not increase or increase is not significant.
Detection of liver fibrosis in more types of laboratory indicators, such as laminin (LN),
hyaluronic acid (HA), Ⅲ procollagen peptide (P Ⅲ P), Ⅳ collagen (Ⅳ-C) determination and
so on, each change only fibrosis of liver cells is mainly of fibrous connective tissue
extracellular matrix (ECM) synthesis and degradation. The mechanism of liver fibrosis due to
the complexity of non-current single test indicators are very sensitive and specific, the
sensitivity of each weight index and characteristics of both a certain limit, and in
patients with chronic hepatitis or cirrhosis of the liver occurs when the large overlap
Therefore, only those based on serological markers of liver fibrosis specific patient / or
diagnosis of cirrhosis or to a specific patient's anti-fibrosis markers in order to improve
diagnostic accuracy.

"Liver fiber four check" the results usually takes much time

Four fiber liver test results are different than the other tests, such as liver function
only of blood, and liver fibrosis in patients with primary liver cells to determine whether
there damage, the liver is somewhat hard, and if there is cirrhosis of the liver phenomenon,
so check the liver are more particular about the time of their examination results generally
longer, but usually within 3-5 days.

Total bile acid and liver fibrosis four joint determination of clinical significance in

Abstract Objective To investigate the serum hyaluronic acid (HA), laminin (LN), Ⅳ of the
original (Ⅳ  C), Ⅲ procollagen (PC Ⅲ) and total bile acid (TBA) level of content in
chronic liver disease patients changes. Method of radioimmunoassay and enzyme, respectively,
in 250 patients with chronic liver disease in patients with serum HA, LN, IV  C, PC Ⅲ and
the level of determination of TBA and 50 normal controls were analyzed. The results between
the groups with chronic liver disease HA, LN, PC Ⅲ, Ⅳ  C and TBA levels were
significantly different (P <0.01); HA, LN, Ⅳ  C, PC Ⅲ and the increasing tendency for
the TBA: chronic hepatitis (mild ) <chronic hepatitis (moderate) <chronic hepatitis (CAH)
(severe) <liver cirrhosis (LC) <liver cancer (HCC); the levels of serum HA, LN, Ⅳ  C, PC
Ⅲ and TBA levels were high in the control group (P <0.01). Conclusions The combined
determination of serum HA, LN, Ⅳ  C, PC Ⅲ and TBA levels, while reflecting the severity
of liver fibrosis in patients with liver disease, but also understand the inflammatory
activity and liver cell damage, the clinical diagnosis, treatment and prognosis of important
value.
Liver disease in recent years on serum markers of liver fibrosis in the detection of a new
progress, however, accurately determine the degree of liver fibrosis is currently rely
mainly on detection of liver pathology, but its limitations. So people always looking to
joint monitoring of serum markers of liver fibrosis in the development process. To
investigate the serum hyaluronic acid (HA), laminin (LN), Ⅳ of the original (Ⅳ  C), Ⅲ
procollagen (PC Ⅲ) and total bile acid (TBA) in patients with chronic liver changes, we
have 250 patients with liver diseases and 50 normal subjects had serum HA, LN, Ⅳ  C, PC
Ⅲ level of content and TBA test, the results reported below.
Subjects and methods
1. Survey
Hospital in-patients were patients with liver disease, male 130 cases, 120 cases of women
aged 30 to 60 years, mean age 41 ± 6 years; which is divided into: chronic hepatitis (mild)
50 cases of chronic hepatitis (moderate) 50 cases, chronic hepatitis (CAH severe 50 cases),
liver cirrhosis (LC) 50 cases of liver cancer (HCC) 50 cases. Diagnostic criteria:
hepatitis, liver cirrhosis diagnosis and clinical classification of the 1995 Fifth National
Conference on Infectious and Parasitic revised classification standards; diagnosis based on
clinical manifestations of liver cancer, AFP and B-test, CT and other results confirmed.
Normal control group of 50 patients, 25 males and 25 females, aged 29 to 58 years, mean age
40 ± 7 years old.
2. Detection.
HA, LN, Ⅳ  C, PC Ⅲ using kits by radioimmunoassay using the 262 state-owned production
plants in Xi'an XH  6020γ-immune counter determined. TBA limited liability company with
technology to provide the kit, to use enzyme Hitachi 7060 automatic biochemical analyzer. 3.
Statistical methods measuring data - ± s said that differences between groups using u test,
P <0.05 was statistically significant.
Results
The group of patients with liver disease and normal control group, serum HA, LN, Ⅳ  C, PC
Ⅲ, TBA levels were measured in the results were significantly different (P <0.01), and with
the severity of disease increased (P <0.01) concrete in Table 1. Table 1 The serum HA, LN,
Ⅳ  C, PC Ⅲ, TBA level was (slightly) Note: The type of liver disease in patients with PC
Ⅲ, HA, LN, Ⅳ  C and TBA levels of concentration and the normal control group were
significant (P <0.01). ※ moderate group and mild group compared the test items, P <0.01, △
and the moderate group and severe group comparison of the test items, P <0.01, ▲ cirrhosis
and severe HA, LN, Ⅳ  C, TBA comparison , P <0.01, ● cirrhosis group and severe group
compared PC Ⅲ, P <0.05, ○ liver cancer and cirrhosis of the test items compared, P <0.01

The diet should be noted that liver fibrosis

1, careful medication. Drugs on the market today there are at least hundreds of harmful to
the liver, sometimes in the case of abnormal liver function, even if the normal dose can
also cause liver damage. Therefore, the most drugs go through a doctor or expert guidance.
2, eat greasy, fried, pickled products, moldy food and contain artificial colors, artificial
additives in food. Patients with liver fibrosis because of their lack of bile excretion, and
fatty foods affect the decomposition and absorption of fat-soluble vitamins, so digestion is
poor, so greasy, fried, fermented foods and pickled products such as sausage, bacon, etc.
The most Good eating is wonderful; the same time the principle of the best to take smaller
meals to reduce the burden on the digestive system.
3, eat zinc, magnesium-rich foods. Patients with liver fibrosis generally low level of serum
zinc, urinary zinc excretion increased zinc content of liver cells is also reduced,
appropriate consumption of lean pork, beef, eggs, fish and other foods more zinc. In order
to prevent the lack of magnesium ions, such as eating more green leafy vegetables, peas,
dairy products and cereals and other food.
4, the rational application of protein. The liver is the place for the synthesis of protein,
albumin synthesized by the liver every 11 to 14 grams. When liver fibrosis, the liver
protein synthesis was not well. Then need to make reasonable arrangements to protein intake,
to prevent the occurrence of hepatic encephalopathy. Can choose from a variety of sources of
protein food. To enable patients to better adapt, can be mixed to the right amount of
cheese, chicken, fish, lean meat, eggs, every day there is a reasonable amount of protein
meal.
5, appropriate to add vitamin C. Vitamin C directly involved in liver metabolism and
glycogen formation. Increase the concentration of vitamin C can protect the liver cells and
promote regeneration resistance. Ascites, the concentration of vitamin C content of blood is
equal, it should be added in the ascites, large quantities of vitamin C. Fruit should be
peeled or pressed into juice for drinking.
6, alcohol cessation, the first is the need to stay away from alcohol, because alcohol
mainly by liver metabolism, and when the liver cell is damaged, low on alcohol metabolism,
in addition to increasing burden of the liver, but also likely to cause liver function
deterioration, outweigh the benefits.

ABOUT Pleural mesothelioma

MPM is the most common cause of exposure to asbestos; also infected with TB, the Ganges simian virus 40, contact nitrosamines, glass fibers, radiation, oxygen thorium, zeolite, beryllium, and hydrocyanic acid, and lipid aspiration pneumonia, may be as a risk factor, causing human genetic mutations or deletions, leading to occurrence of MPM; another study said MPM may be a family of autosomal dominant genetic disease. Zhongshan Hospital of Dalian University of Cardiothoracic Surgery, ZHAO Zhi
Australia, the world's highest incidence of MPM, 20 million people over the age is 3.54/10. Around the incidence of MPM is very large, ~ 0.6/10 0.1/10 million million, the overall upward trend. Among them, the most high Dayao County of Yunnan Province, the incidence rate of 8.5/10 million per year (1977 to 1983), 17.75/10 million (1987 ~ 1995). Male to female ratio, of 2:1 ~ 3:1, 6:1 in Australia.
Incidence of asbestos exposure to MPM the first time, usually 20 to 65 years. In the nineties of last century, European and American developed countries banned the production and use of asbestos, the incidence of MPM is expected to peak around 2020. China's industrial development and labor protection lagging behind, still the use of asbestos, the incidence of MPM will continue to grow in a very long time.

CT diagnosis of malignant pleural mesothelioma and progress

Malignant pheural mesothelioma, MPM, is a rare, closely related to exposure to asbestos primary pleural malignancy. The incidence rate increasing year by year [1 ~ 4], atypical clinical manifestations of the disease, early diagnosis and treatment than those in difficult imaging examination to discover the best means of disease, CT is currently recognized as the best imaging inspection methods.
    
    1 MPM the CT manifestations
    
    1.1 more than in the surrounding localized malignant pleural, a few in the leaves of the pleura, Chengbian mound-shaped, round or oval soft tissue mass, surface finishing, can also be slightly uneven or lobulated, the majority of the tumor and pleura was obtuse angle, a few may acute angle, and the size of the tumor, the tumor is often large acute angle with the pleura, while the small, mostly obtuse, rarely pedunculated, pedunculated tumor often showed an acute angle and with the position or breathing and movement. Extrapleural layer of fat mass and clear interface, tumor density, tumor calcification even seen, the majority of enhanced scan was homogeneous enhancement, the enhanced value of the average increase 121HU, the larger the tumor enhanced heterogeneous, there are low-density cystic degeneration, hemorrhage and necrosis District, CT can show a tumor 0.5cm. Located in the cleft between the tumor often has leaves oval, smooth edges, uniform or irregular tumor adjacent pleural thickening, nodular surface uneven or changed. May be associated with pleural effusion, rib and other damage or chest wall invasion, and occasionally great mesothelioma can compress the trachea, resulting in atelectasis or mediastinal shift.
    
    1.2 Diffuse
    
    1.2.1 pleural thickening ring is surrounded by any level of the chest wall pleural thickening can be uneven thickness, including the involvement of mediastinal pleura throughout the hemi, or violation of surrounding lung tissue, so that smaller capacity, extensive irregular pleural thickening of the pleura to form a thick shell, was surrounded by armor-like lung, pulmonary gas gap loss, pleural cavity disappeared. Specificity of 100%.
    
    1.2.2 parietal pleural thickening parietal pleural thickening> 1cm [5], specificity 94%.
    
    1.2.3 refers to diffuse pleural thickening or pleural lesions in the upper and lower transverse diameter> 5cm, with a large number of pleural effusion, and mediastinal shift was no fixed form, intercostal space is not widened, narrow thorax to the lower part of the more common chest [ 2,3]. CT is easily detected in pleural effusion, lateral position can be detected <15ml of the liquid [6,7].
    
    1.2.4 crescent irregular soft tissue mass (> 4cm) or within the margin of irregular wavy appearance, reduced pressure in varying degrees in lung tissue, pleural thickening and irregular interface with adjacent lung, pleura and nodules of varying moderately enhanced levels. Precontrast CT value of the 45 ~ 54HU, enhanced CT value of 78.6 ~ 106.2HU, increased 25 ~ 45HU, average 33HU, specificity of 94%. Mesothelioma is sometimes lower in the CT value of the plain with effusion is difficult to distinguish, but mesothelioma is obviously enhanced after injection enhancer, the two can be different.
    
    1.2.5 pleural calcification is less common and rarely calcification within the tumor. Some scholars believe that calcification within the tumor may be the type of MPM osteosarcoma sarcoma degeneration [8] or the performance of MPM of ectopic bone formation [9].
    
    1.2.6 asbestos pleural plaques are the most common manifestation of contact, long-term history of asbestos exposure in patients with pleural plaques visible on the CT slices, calcified pleural plaques which accounted for 67%, 26% transparent plaques [10], also seen round a small number of pulmonary Zhang. Mainly involving the lateral parietal pleura Ministry (the equivalent of 7 to 10 ribs), very few violations of apex, the anterior chest wall and costophrenic angle. HRCT is superior to the detection of pleural plaques and conventional chest CT. Aberle [11] have reported that a group of patients with pleural plaques, conventional CT in the detection rate of 93%, while HRCT was 100%. HRCT also helps pleural plaques and lung nodules, and the identification of EPF. HRCT also the early detection of pleural thickening and the leaves of the plaque.
    
    1.2.7 Round atelectasis caused mainly due to asbestos exposure, is closely related with the occurrence of MPM [12,13], its characteristic comet tail sign of change. Including thickening of the pleura, the external mass and accumulation of bronchovascular bundles extending to the hilum. Diagnostic criteria [14 ~ 16]: (1) round or oval mass, diameter 3.5 ~ 7.0cm, and close to the pleura in the lung periphery; (2) contains blood vessels and bronchi into the mass of bending stripes, and to the lung tumor door side of the edge blur. (3) pleural thickening.
    
    1.2.8 between the invasion and metastasis often leaves pleura, mediastinal pleura violated. Direct violation of the tumor adjacent structures such as mediastinum, pericardium, chest wall, through the posterior mediastinum to the contralateral chest or abdominal cavity through the diaphragm directly to the invasion, it was suspected MPM should be routine, including the upper abdomen scan. Lymphatic, hematogenous metastasis and ribs, vertebrae were damaged in a rare, usually occur late in the course of the disease, late distant metastasis.
    
    1.2.9 CT and pathological relationship between CT and Pathology have a certain relationship between the type of sarcoma that affected 91% of the mediastinal pleura, interlobar pleural involvement in 87%, 48% lung involvement; and epithelial 61%, 35%, 4 %; mixed 65%, 10%, 10%; III in lymph nodes, pericardium, chest wall, no difference in the violation. Generally believed that the violations are usually broader based sarcoma [14].
    
    1.3 MPM CT manifestations Kawashima et al [2] reported 50 cases of MPM CT were as follows: nodular pleural thickening (92%), interlobar pleural thickening (86%), pleural effusion (74%), ipsilateral pleural shrinking (42%), chest wall involvement (18%), mediastinal shift to the contralateral (14%), mesothelioma calcification (12%), rib destruction (10%), subphrenic peritoneal involvement (8%), pericardial effusion (6%), contralateral pleural involvement (4%). Ng et al [15] reported 70 cases of MPM CT showed pleural thickening (94%), pleural effusion (76%), ipsilateral pleural reduced (27%), enlargement (10%), calcified pleural plaques (16%) . CT is the most common signs of unilateral pleural thickening ring, nodular pleural thickening, pleural thickening> 1cm, and mediastinal pleural involvement [15,16].
    
    2 stages
    
    2.1 Butchart staging [17] and Autman staging [18] Ⅰ of: tumor confined to the parietal pleura of the "envelope" (ie involving only the unilateral pleural, lung, pericardium, and diaphragm); Ⅱ period: the tumor violations of the chest wall or mediastinal organs (ie esophagus, heart, opposite pleura), intrathoracic lymph node metastasis; Ⅲ of: tumor invasion through the diaphragm and abdominal, contralateral pleural involvement, chest lymph node metastasis; Ⅳ: distant metastasis .
    
    2.2 Chahinian stage [19] Ⅰ on: T1N0M0; Ⅱ period: T1 ~ 2N1M0 T2N0M0; Ⅲ on: T3 any N1M0; Ⅳ of: T4 any N1M0, M1. Note: T-primary tumor; N-lymph node; M-transfer; T1: only limited to the side of the pleura (parietal pleura, visceral pleura); T2: limited to superficial invasion (diaphragm, chest fascia, the ipsilateral lung fissure); T3: local deep infiltration (chest over chest fascia); T4: extensive direct invasion (contralateral pleura, peritoneum, retroperitoneal); N0 no positive lymph nodes; N1 ipsilateral hilar lymph nodes; N2 mediastinal lymph nodes; N3 contralateral hilar lymph nodes; M0 without metastasis; M1 have bloody or lymph node metastases.
    
    2.3 UICC staging [20] Ⅰ on: T1N0M0 T2N0M0; Ⅱ of: T1N1M0 T2N1M0; Ⅲ period: T3N0M0, T3N1M0, T1N2M0, T2N2M0, T3N2M0; Ⅳ of: any T, N3M0; T4 any N1M0; any T, any N1M1 ; clinical stage as cTNM, pathological stage as pTNM. Both the same standard. Note: T: primary tumor and scope; TX: primary tumor can not be determined; T0: No primary tumor; T1: confined to one side of the primary parietal and (or) visceral pleura; T2: tumor invasion of the ipsilateral lung thoracic vein, diaphragm, or pericardium; T3 tumors invading one of the following: ipsilateral chest wall muscle, ribs, mediastinal organs or tissues; T4: tumor invasion of one of the following: a direct violation of the contralateral pleura, or lung, a direct violation of peritoneal , retroperitoneal, or abdominal organs, neck tissue; N: lymph node; NX: regional lymph nodes can not be determined; N0: No regional lymph node metastasis; N1: ipsilateral bronchopulmonary or hilar lymph node metastasis; N2: ipsilateral mediastinal lymph node metastasis; N3: contralateral mediastinal, internal mammary, supraclavicular or scalene lymph node metastasis; M: metastasis; MX: distant metastasis can not be determined; M0: no (confirmed) distant metastasis; M1: distant metastasis.
    
    2.4 features a variety of MPM is a rare tumor stage, there is no accurate and generally accepted staging. Application to determine whether the surgical tumor stage, prognosis, and to provide more treatment outcomes. Based only on the length of the original course of the disease to determine the surgical indication of mesothelioma, prognosis and treatment results comparing the sub-laws have been completely eliminated, is widely used staging system proposed by Butchart, etc.. Butchart and so currently the most commonly used staging method [21]. But the Butchart staging for primary tumor and metastatic lymph nodes is not accurate enough description, not possible to estimate survival, and the scholars have not talked about staging the tumor, lymph nodes and a description of the transfer (TNM) and only provide information on lymph node involvement, chest wall by invasion of the fuzzy situation. For example, a phase Ⅰ pleural tumors, including small lesions, chest free adhesions, pleural effusion, and those integrated into the thick of the tumor disappeared but there is no violation of the pleural space or contralateral mediastinal pleura who, In addition, the accuracy of the MPM incidence of lymph node metastasis and its effect on prognosis is unclear. The provisions of intrathoracic lymph node metastases in stage Ⅱ and the provisions of the chest lymph node metastasis in stage Ⅲ are empirical. The earliest clinical application of the design and scope of regional lymph node involvement and local invasion situation TNM staging system, stage, etc. Chahinian proposed staging, more accurate than the Butchart staging, but not fully reflect the open heart surgery often see, for example difficult to find T1 tumors involving the parietal and visceral pleura, the diaphragm surface has not been involved, because the MPM is a disseminated disease, where the most frequent tumor in the lower half of the thorax and diaphragm, in order to improve and harmonize MPM staging, the International Union Against Cancer (UICC) TNM staging proposed by another program, compared with the previous solution, T the provisions of more detailed description of lymph node metastasis is directly borrowed is the current internationally accepted non-small cell lung cancer standards, but whether the long-term survival with the relevant regional lymph node involvement, visceral involvement, or invasion depth information is also determined [22]. Therefore, this program also need careful clinical and pathological contrast to affirm or modify. To find a suitable stage remains a difficult task [23].
    
    3 rating (value)
    
     
    Compared with ultrasound, CT can better observe the tumor location, shape and scope, easier and pleural disease, lung tumor, and other identification of, CT localization biopsy positive rate as high as 85% or more, than the B-and high-wear breast [25,27], CT locate the site of biopsy positive rate, including pleural nodules, pleural> 10mm of regional and mediastinal pleural thickening Department. CT-guided MPM intractable pain [28] and a variety of physical, chemical treatment, is currently a hot research.
    

    
    In conclusion, chest CT examination in the diagnosis of pleural mesothelioma has an important role, is the most accurate noninvasive method. By showing the degree and extent of disease and conditions involving the thoracic internal organs for disease stage, surgery is to determine the feasibility of the most reliable diagnostic method [30,31], and pleural resection or pleural pneumonectomy patients were followed up in other imaging or clinical recurrence before, CT can often suggest tumor recurrence, for monitoring the recurrence can also be used to determine the efficacy of such treatment is followed up the best way to condition changes. CT and MRI is more economical than, consider a more preferred from the titer [29]. However, the lack of specificity of CT signs, and other identifying pleural lesions seems to be difficult.

Response to pleural mesothelioma - the difficulties and hopes

There is a malignant tumor, the global annual incidence of 15,000 cases in the following, the incidence mainly concerned with exposure to asbestos,
Incubation period is usually 20 to 40 years, the majority of patients to the disease was discovered late, while median survival time of patients
Only 4 of 9 months, oncologists are very difficult to face it all - it is malignant pleural mesothelioma.
Recently, Eli Lilly and Company in Chengdu, "organized by the National Forum on pleural mesothelioma", the country nearly one hundred cancer professionals
Home for the first time to diagnosis and treatment of malignant pleural mesothelioma, treatment options and difficult problems and the latest academic research carried out. By
General Assembly and the relevant experts on interview, the reporter learned that the treatment of malignant pleural mesothelioma is difficult is that surgery
And little effect of conventional chemotherapy on the disease, and a target mechanism of action with three new chemotherapy drugs pemetrexed
Cypriot disodium (Pemefrexed disodium, Alimta), for the treatment of the disease brings hope.
Stripping cocoon spinning - diagnosis and treatment of many difficult
Malignant pleural mesothelioma is very familiar to many people: it is what kind of diseases? What is the original
Because it led to the occurrence? Can I prevent it from occurring? How to ... ... for the treatment of these problems,
At this forum, the Shanghai Chest Hospital, Professor Liao Meilin from the cause to the diagnosis and treatment of malignant pleural mesothelioma
Tumors are discussed and analyzed.
■ exposure to asbestos is the major cause of
"Malignant pleural mesothelioma from pleural mesothelial cells, the progress is a rare malignant tumor of the chest
Tumor. "Professor Liao Meilin points clear in the nature of malignant pleural mesothelioma, then the incidence of this disease and the causes for
Introduced.
Malignant pleural mesothelioma, accounting for 5% of pleural neoplasms, accounting for 0.02% of all cancer 0.4%, the foreign hair
Disease rate was 0.07% ~ 0.11%, 0.04% incidence of domestic.
Disease in the United States now new cases each year from 2000 to 3000 cases; Western Europe the incidence is about 5000 cases per year;
Australia since 1981, incidence increased year by year, the male population of 59.8 million people the disease, women
There are 10.9 million people, of human cases reported around the world countries with the highest incidence of the disease.
Malignant pleural mesothelioma is asbestos exposure the major pathogenic factors. Studies have shown that blue asbestos can cause cancer
By 10 times, amosite, and carcinogenicity of amosite chrysotile capacity of 10 times. But it is not only a direct connection with asbestos
Contact will be risk of malignant pleural mesothelioma, a report shows, by touching the clothes of staff indirect contact
Asbestos who also malignant pleural mesothelioma. In addition, 20% of the incidence of the disease may be associated with exposure to patients
Zeolite, glass fibers, radiation, SV40 virus, thorium dioxide, and family history (autosomal dominant inheritance
) Related.
Health hazards of asbestos in industrialized countries has received increasing attention. Start the United States since 1971
Prohibiting the use of asbestos in the workplace, so far the U.S. has passed the peak of the disease occurred. Related ban in Europe
Ling Wan in the United States, the estimated peak incidence of the disease in Europe in 2020. National awareness of the dangers of asbestos exposure
Slightly later, the peak incidence is estimated the disease has not yet come.
■ Most patients are diagnosed at late stage have to
Professor Liao Meilin pointed out that almost all patients were diagnosed with pleural mesothelioma, it already has a
Some of the symptoms of cancer, usually presents severe pain, breathing difficulties, weight loss and fatigue, 95% of patients will be out
Is pleural effusion. It is important to malignant pleural mesothelioma is the most severe symptoms of pain, this is because many
Nerve endings in the pleura, the tumor growth stimulation of nerve endings, so that patients achieve the incredible pain
Level. In addition, the lung tumor compression or compression, limiting diaphragm mobility, so that patients can not breathe properly.
Other symptoms of the disease include cough, hoarseness, fever, night sweats, breath sounds decreased or disappeared, showed unilateral pleural
"Frozen breast" shape, chest movement is limited.
■ the lack of specific diagnostic criteria
"The clinical manifestations of malignant pleural mesothelioma, no typical characteristics, and tuberculous pleurisy, pleural metastasis of lung cancer
With pleural effusion in the clinical manifestations, imaging features and the nature of pleural effusion have more in common, so the capacity
Easy to pleural mesothelioma misdiagnosed as tuberculous pleurisy, pleural metastasis of lung cancer. In this regard special attention should be! "Liaomei
Professor Lin stressed.
Diagnosis of malignant pleural mesothelioma are imaging, pleural effusion smears, cytology, and pleural
Such as biopsy and thoracoscopy. A typical chest X-ray showed diffuse irregular pleural thickening of the medial and the sudden to the chest
Membrane cavity multiple nodules, wavy (If this does not exist in the lung nodules but only widespread in the pleura,
Should be vigilant.) Visible lesions of human specimens often occurred in the parietal pleura or diaphragmatic pleura, diffuse growth,
The pleural thickening, fusion occurred the formation of nodule or mass; for pleural cavity tumor growth could disappear, common bad
Dead and bleeding. Light microscope, mimicking adenocarcinoma tumor cells arranged in papillary, cable strip, adenoid structure. In addition,
Immunohistochemistry in the diagnosis of malignant pleural mesothelioma has an important position.
According to pathological type, epithelioid malignant mesothelioma are divided into type - accounting for 50% to 60%. Common tubular milk
Head shape, and solid sheet adenomatous variant; sarcomatoid type - accounting for 7% to 10%; mixed - containing epithelioid
And sarcomatoid type two components.
■ a variety of treatments simultaneously
Currently, the method of treatment of malignant pleural mesothelioma, including surgery, radiotherapy, chemotherapy and combined multi-disciplinary treatment
Treatment and so on. Professor Liao Meilin them one by one were introduced.
Surgical resection of malignant pleural mesothelioma to achieve the cure for the disease is unlikely, only for early
Patients. The early detection of malignant pleural mesothelioma, diagnosis is difficult, wait until patients are often found when the disease
More than can meet the complete range of surgical resection. The goal of surgery is to relieve symptoms and reduce the tumor load, hand
Surgery often due to lesions involving very wide chest top, apex, mediastinum, and diaphragm flank, and sometimes invading
Abdominal cavity. Currently, thoracoscopic pleural resection not useful (or stripping) procedure clear cut the entire pleural stripping reports
The surgical extrapleural pneumonectomy in patients with resection from the extrapleural tumor en bloc together with the pleura, including the side
Whole lung, pericardium and diaphragm.
Post-operative radiotherapy is the adjuvant therapy of patients in order to reduce the tumor volume, preventing pleural biopsy, pleural
Mirror and the surgical wound after seeding spread. However, due to a wide range of diseases, lung tissue around the tumor was surrounded
Result of chemotherapy is very difficult.
Chemotherapy is mainly used in patients with non-surgical conditions, is the most common treatment of malignant pleural mesothelioma hand
Segment. However, most chemotherapy drugs for the disease remission rate of less than 20%. Currently, Pemetrexed disodium + cisplatin,
In the treatment of malignant pleural mesothelioma has obvious advantages.
Malignant pleural mesothelioma multidisciplinary treatment including surgery, chemotherapy, radiotherapy combined immunodeficiency, gene therapy and
Photodynamic therapy.
There are reports that 14 cases combined with procarbazine radiotherapy, the median survival time was 10.9 months; 33 cases should be
Radiotherapy combined with cyclophosphamide, the median survival time was 10.8 months, while 13 patients received only radiotherapy, the median of Health
Deposit of only 7.8 months.
Malignant pleural mesothelioma, a molecular biology research found that a lot of autocrine tumor growth factor high
Degree of expression of the phenomenon (including angiogenesis factor, epidermal growth factor, cox protein), the study
Who suggested that inhibition of growth factors with the corresponding biological targets for therapeutic drugs, such as vascular endothelial growth factor
(VEGF) receptor tyrosine kinase inhibitor SU5416 (semaxamib) and anti-human anti-VEGF monoclonal antibody
Body, you can block VEGF and its receptors.
There are many of malignant pleural mesothelioma is still in the multidisciplinary treatment of basic or clinical research, human
We look forward to the results of these studies come out as soon as possible.
Raise the survival rate of new treatment modalities
Tumor Hospital, Sun Yat-sen Professor of tension pemetrexed disodium as the advent of watershed, referred to the reporter
Introduce the development of the treatment of malignant pleural mesothelioma. He said the advent of pemetrexed disodium ago, almost all
Chemotherapy of malignant pleural mesothelioma results were negative, and only cisplatin showed 10% to 15%
Response rates, can bring people a little comfort. Pemetrexed disodium come, so that the treatment of malignant pleural mesothelioma
With the first line drugs, which prolong survival in the show on the advantages of reversing the malignant pleural
The plight of the treatment of skin tumors. Professor Zhang Li, respectively, related to these two different periods of study, the selection of a
Representative studies to support his above assessment.
■ poor efficacy of cisplatin alone
In 2002, an international Meta (combined research findings and results of homogeneity test system
Count method) analysis of 1965 to 2001 53 different countries of chemotherapy of malignant pleural mesothelioma
Clinical studies (involving a total of 2320 cases of patients with systemic chemotherapy) were retrospectively reviewed. The study root
According to 2320 cases of different drug in patients, divided into 4 groups. The first group of non-drug cisplatin-doxorubicin; s
Two groups of agents with non-doxorubicin and cisplatin; third group of drugs containing both doxorubicin and cisplatin; fourth group with
Also contain non-drug doxorubicin and cisplatin. Result, the first group is 23% efficient; the second group was 11%;
The third group is 28% efficient; fourth group is 11% efficient. "This shows that the treatment of patients can not
Doxorubicin, but not without cisplatin. Even so, the efficacy of cisplatin is not really encouraging. "Tension
Professor of the Meta analysis, so that journalists have a sense of mountain heavy water.
■ pemetrexed disodium and cisplatin significant clinical advantages
"In 2003, one from the 19 countries, 456 cases showed that the registration of clinical research, training and the U.S.
Qu plug disodium and cisplatin chemotherapy significantly increased in patients with malignant pleural mesothelioma survival. "Soon,
Professor Zhang Li a way out again into the realm of news.
The study began in 1988. Researchers in these 456 cases 448 cases of patients (surgery and should not be missed
By chemotherapy) were divided into two groups: the first group 226 patients were treated with pemetrexed disodium (500 mg / m 2 body surface area
) And cisplatin (75 mg / m 2 body surface area) treatment; second group of 222 patients only treated with cisplatin. Two
Group were administered intravenously.
Initially, the first group had neutropenia, severe diarrhea, dry mouth and other severe lack of vitamin
Lack of toxicity. Subsequently, the researchers added the first group of folic acid and vitamin B12, which significantly reduced
The blood of drug toxicity and gastrointestinal toxicity (including drug-related deaths).
The results show that the first group, the median survival time was 12.1 months, the second group was 9.3 months; s
A group of disease progression was 5.7 months, the second group was 3.9 months; the first group of the effective rate of 41.3%
The second group, 16.7%; to add folic acid and vitamin B12 on the survival time of the first group is not adversely affected; s
A set of quality of life was significantly better in the second group.
Professor Zhang Li said that based on the results of the study in early 2004, the U.S. Food and Drug Administration approval of training U.S.
Qu plug disodium and cisplatin for malignant pleural mesothelioma. In mid-August of this year, access to our national drug
Food and Drug Administration approval, has officially entered China market.
Professor Zhang Li that pemetrexed disodium effect, due to its unique mechanism of action, that it is a
Species can inhibit thymidylate synthase, dihydrofolate reductase, glycine, ribose nucleoside anti-A acyltransferase leaves
Acid metabolism of chemotherapy drugs. It is the process of cell replication by interfering with folic acid-dependent metabolism play a role. This
Kinds of multi-target anti-tumor effect, it was also in Europe and the United States for the treatment of non-small cell lung cancer second-line drugs.

Comprehensive use of imaging techniques improve the diagnosis
Pathology is the microscopic view, looking at macro-imaging. The famous image of China experts, Shanghai East China
Hospital Professor Zhang Guozhen to reporters in the imaging of malignant pleural mesothelioma diagnosis before the first sentence emphasizes
Is to conduct comprehensive diagnosis of the disease. Then, he was a more detailed imaging of the basic features of the disease,
The role of various diagnostic imaging techniques and imaging appear on the reasons for misjudgment were described and analyzed.
■ four key imaging features for diagnosing
"Imaging of malignant pleural mesothelioma have 4 basic characteristics: diffuse pleural thickening of the affected side, accompanied by enhanced Results
Section, and pleural effusion (60%); ipsilateral thoracic pleural contraction and collapse (25%); there chest wall, mediastinum, pericardium,
Ribs, spine and abdominal cavity metastasis (10%); ipsilateral pleural calcification (5%). "Professor Zhang Guozhen Introduction Introduction
Concise Gai. But in the next 4 analyzes the characteristics of this, he repeatedly stressed that special attention on the nodules, the
Imaging studies must be done to enhance the treatment, the tumor if it is found necessary to consider the issue nodules. The extensive pleural
Pan-thickening, and pleural effusion associated with nodules that enhance malignant pleural mesothelioma is a - can have a few nodules,
And a violation of the mediastinum, chest wall. Contraction of ipsilateral pleura and chest images prevalent in the non-collapse exposure to asbestos who suffer from
Had no pleural effusion, enhanced MRI can be seen after a wide range of nodules, and a violation of the mediastinum, pleura, this is the 2 performance.
Images show the chest wall, mediastinum, pericardium, ribs, spine, abdominal metastasis in patients with tumors more than 3 have been suffering from
Severe pain may occur. Pleural calcification of the affected images are often mistaken for clinical tuberculosis, so
Require special attention.
■ Integrated decision to reduce misdiagnosis
Professor Zhang Guozhen pointed out that in the imaging of malignant pleural mesothelioma diagnosis, traditional perspective, and chest X-ray inspection
Charles still can not be ignored, it can be found lesions, and its screening. B-can be used for patients with chest
Pumping fluids and biopsy. CT is the most commonly used for the disease, the most valuable and essential way to check. Enhanced CT scan
Scan can show pleural thickening, pleural nodules, pleural mass, especially in the TNM staging of tumor, CT
The chest was superior. Magnetic resonance imaging (MRI) diagnosis of the disease has important value, that is, the need was
Said chest wall, diaphragm and other fascia involvement, it can be difficult problems to solve as complementary imaging examination
Investigation. Positron emission tomography (PET) as a differential diagnosis of benign and evil nature of the tumor to some extent help
Its main value is for the TNM tumor staging and prognosis evaluation, is to complement other imaging
Charge, not as a routine use. "Uncertainty in the imaging diagnosis, the intervention should be combined with clinical data and puncture
Soft tissue biopsy or thoracoscopic comprehensive judgments, in order to make a diagnosis.
Professor Zhang Guozhen went on to misdiagnosis of patients with malignant pleural mesothelioma cases were analyzed. Patients may be
Misdiagnosed as lung cancer, miliary tuberculosis, tuberculous pleurisy with pleural effusion, pneumothorax, pulmonary tuberculosis, slow
Of lung abscess, pleural metastases and so on.
Professor Zhang Guozhen that led to misdiagnosis of patients was the main clinical symptoms of malignant pleural mesothelioma
No specific, easy and confused the symptoms of the disease; the tumor showed a diversity of imaging performance, some form
Is not easy and lung cancer, tuberculosis, lung abscess and other distinguished; pathological drawn parts are not allowed; doctors were the main
Do not attach importance to such complaints.
Professor Zhang Guozhen suggested that the cytological smears of pleural puncture, find, and nuclei associated with irregular shaped
Is a simple cuboidal or flat epithelial cells, can be combined with the typical radiographic signs of malignant pleural mesothelioma
Make a clinical diagnosis.
Jiujiang reporter Jing
Related links: TNM staging of malignant pleural mesothelioma
▲ T: primary tumor size and scope
T1a, tumor limited to ipsilateral parietal pleura, including mediastinal and diaphragmatic side of the pleura; not involving the visceral pleura.
T1b: Tumor involving the ipsilateral pleural surfaces (including the parietal or mediastinal, diaphragmatic and visceral pleura).
T2, tumor involving the ipsilateral pleural surfaces (including the parietal or mediastinal, diaphragmatic and visceral pleura), at least the next
Out an expression: involvement of the diaphragm; fusion of the visceral pleura (including leaves, split between segments) or breast tumor from the visceral
Membrane invasion of lung parenchyma.
T3, partial resection of extensive lesions but there is the possibility of involving all of the ipsilateral pleural tumor (including the parietal or longitudinal
Septum, diaphragm and visceral pleura), a manifestation of at least the following: involving thoracic fascia; invasion and mediastinal fat;
Isolated, complete resection of the tumor can be, but the soft tissue of chest wall invasion; involvement but did not invade the pericardium and myocardium.
T4, locally extensive disease technically unresectable tumor, all ipsilateral pleural involvement (including the wall
Layer or mediastinal, diaphragmatic and visceral pleura), a manifestation of at least the following: diffuse spread of tumor in the chest wall
Or showed a multifocal tumor, with or without ipsilateral rib destruction; directly through the diaphragm and peritoneal invasion; direct invasion and contralateral
Pleura; direct mediastinal invasion, and one or more organs; direct invasion and spine; tumor invasion and pericardial membrane, with or
Not associated with pericardial effusion, or tumor involving the myocardium.
▲ N: lymph node metastasis
Nx, regional lymph nodes could not be evaluated; N0, no regional lymph node metastasis; N1, metastasis to the ipsilateral bronchial
Lung or hilar lymph nodes; N2, transferred to the subcarinal or ipsilateral mediastinal lymph nodes, including ipsilateral internal mammary lymph nodes;
N3, metastasis to contralateral mediastinal lymph nodes, contralateral breast lymph nodes, ipsilateral or contralateral supraclavicular lymph node.
▲ M: distant metastasis
Mx, distant metastases could not be evaluated; M0, no distant metastasis; M1, distant metastasis;
Phase Ⅰ: Ⅰ a, including T1a, N0, M0; Ⅰ b, including T1b, N0, M0.
Phase Ⅱ: include T2, N0, M0;
Phase Ⅲ: including all T3, M0, N1, M0, N2, M0.
Ⅳ stage: including all T4.

Pleural mesothelioma

Pathology
The disease can be divided into two clinical types. 1. Localized pleural mesothelioma: occurred in the visceral pleura (70%). Tumor nodules of varying sizes, from small coins, a large majority to take the side of the chest, solid texture, coating integrity. Pedicle screw tumors often the primary site of the pleura and connected. Appearance resembling fibroma or fibrosarcoma, grayish yellow, the spindle cells and collagen fibers interwoven, hyaline degeneration may occur, and calcification. 2. Diffuse pleural mesothelioma: good hair in the parietal pleura, no capsule, the major expansion along the pleural invasion, often involving the visceral pleura, pericardium and mediastinum, and can be transferred to the lungs, liver. More viscous slurry with massive and bloody serous effusion. Which contains more hyaluronic acid. Pian callosum ipsilateral pleura was thick like or nodular thickening. Pleural thickening filling most of the pleural cavity occlusion. Cut surface markings like, bleeding and necrosis or cystic change. Examination arranged with nipple-like epithelial tissue or gland-like, but also the formation of sarcoma-like change, or both of the organizational structure.
Western diagnostic criteria
Diagnostic criteria for pleural mesothelioma:
1. Limitations:
① multiple asymptomatic, occasional chest pain;
② X-ray examination of pleural round or oval on the shadow block;
③ pleural biopsy with tumor cells.
2. Diffuse:
① Some patients have a long history of asbestos exposure;
② have chest tightness, shortness of breath and severe chest pain;
③ X-ray examination see the shadow of the wave-like pleural thickening, pleural effusion or a large number of patients complicated with hemothorax;
④ positive pleural biopsy, pleural plot fluid cytology with tumor cells.
Signs
The disease can be divided into two clinical types.
1. Localized pleural mesothelioma:
Localized onset occult, early and more asymptomatic. Some patients may have blunt chest pain, cough and shortness of breath, clubbing, pulmonary hypertrophic osteoarthropathy and so on. Most no abnormal signs. Larger tumors, X-ray of isolated round or oval shadow of high density, and sometimes lobulated.
2. Diffuse pleural mesothelioma:
Chest pain is often diffuse and progressive shortness of breath. Chest pain than drama, was persistent, difficult to alleviate the general analgesics. If the lesions in the diaphragmatic pleura, the ipsilateral shoulder area or upper abdominal pain. Located in the mediastinal pleura, may have chest pain. If lesions with massive pleural effusion and extensive, shortness of breath in patients, the frequency increased. In addition, you can have a dry cough, fever, weight loss and other symptoms. Patients with thoracic limited mobility, percussion was voiced, breath sounds reduced. X-ray findings as wavy or uneven hump-shaped high density shadows; large pleural effusion was large dense shadow and mediastinal shift to the contralateral, ipsilateral thorax chest fluid absorption can be contracted after the depression.
Western differential diagnosis
Pleural mesothelioma should be encapsulated pleural effusion, pleural effusion with metastatic cancer, lung cancer and other peripheral differentiated. When necessary, can be used for the following examinations. Made after artificial pneumothorax tangent line projected X-ray photography can be seen on the parietal pleura uneven nodular shadow with pleural thickening after general inflammation distinguished; a large number of thoracic fluid, fluid can be drawn for cytology and transparent quality acids; necessary, B-type X-ray or ultrasound-guided needle localization for pleural biopsy. If the selected bit properly, the positive rate of 50% -60; Thoracoscopy can directly get a glimpse of nodule morphology, and tumor tissue forceps directly, the positive rate of 80% -90%; bronchoscopy for chest examination can looking around the apex, the root of the lung at the end of the mediastinal pleura and lung, the method is simple, safe, and the positive rate is high; X-ray computed tomography (CT) to determine the extent of pleural thickening, and lesions involving the scope and identification of pleural disease and peripheral lung cancer.

Advances in diagnosis and treatment of malignant pleural mesothelioma

Malignant mesothelioma, MPM is a derived from pleural mesothelial cells, mainly to local invasion, high grade rare disease.
1. Etiology and epidemiology
MPM is the most common cause of exposure to asbestos; also infected with TB, the Ganges simian virus 40, contact nitrosamines, glass fibers, radiation, oxygen thorium, zeolite, beryllium, and hydrocyanic acid, and lipid aspiration pneumonia, may be as a risk factor, causing human genetic mutations or deletions, leading to occurrence of MPM; another study said MPM may be a family of autosomal dominant genetic disease. Zhongshan Hospital of Dalian University of Cardiothoracic Surgery, ZHAO Zhi
Australia, the world's highest incidence of MPM, 20 million people over the age is 3.54/10. Around the incidence of MPM is very large, ~ 0.6/10 0.1/10 million million, the overall upward trend. Among them, the most high Dayao County of Yunnan Province, the incidence rate of 8.5/10 million per year (1977 to 1983), 17.75/10 million (1987 ~ 1995). Male to female ratio, of 2:1 ~ 3:1, 6:1 in Australia.
Incidence of asbestos exposure to MPM the first time, usually 20 to 65 years. In the nineties of last century, European and American developed countries banned the production and use of asbestos, the incidence of MPM is expected to peak around 2020. China's industrial development and labor protection lagging behind, still the use of asbestos, the incidence of MPM will continue to grow in a very long time.
2. Diagnosis
The majority of our region, MPM incidence rate is very low, while the lack of specific symptoms and signs, the high rate of misdiagnosis of the disease, up to 83.3% [2]. From the onset of symptoms to diagnosis MPM, about two or three months, 25% of patients 6 months after the onset of symptoms the diagnosis [3]. Therefore, clinicians should be better understanding of the disease.
Patients may be asymptomatic or only early performance of shortness of breath after exercise, with the lesions progress to a cough, shortness of breath, persistent chest pain. Terminally ill, there may be difficulty in breathing, chest deformity, cardiac arrhythmia, cardiac tamponade, and even abdominal mass and ascites, or with intestinal obstruction and other performance; 60% to 95% of the patients had pleural effusion, can be found at any stage, in particular, is the epithelial type; mostly bloody pleural effusion, a small number of grass yellow exudate, may, rich in hyaluronic acid, which was sticky, exhausted after the rapid regeneration [1, 4].
MPM is a major feature of local invasion, along the fine-needle aspiration, thoracoscopy, or surgical incision site metastasis, the incidence of 2% -51%. Autopsy found that 54% -82% of pleural metastasis, but often without any clinical symptoms, and rarely a cause of death. The most common peritoneal metastasis of liver, adrenal gland, kidney, brain metastasis occurred 3%, and more common in sarcomas of [1].
X ray and CT examination of the non-specific manifestations of pleural effusion, rib destruction, costophrenic angle blunting, widened mediastinum, the heart increases so film. Specific performance are: ① nodular pleural thickening, the general thickness of 5 ~ 15mm, sometimes up to 25mm, or pleural effusion due to cover the show is unclear; ② fissure pleural thickening; ③ limitations of mass; ④ ipsilateral chest volume reduction, if there is pleural effusion, can offset this performance [1, 4]. There are also manifested as solitary pulmonary lesions [5] or pulmonary distribution of sizes of spherical masses [6].
Pleural disease is the most valuable CT screening method. It is noteworthy that 20% of mesothelioma patients showed calcified pleural plaques, easily misdiagnosed as benign disease [1].
In the identification of liquid and non liquid lesions, when the trace effusion and pleural thickening, B-ultrasound has advantages over CT, and dynamic observation of pathological changes with the respiratory movement. Because of the high resolution of soft tissue, in particular, are particularly sensitive to the subpleural fat, MRI can identify the basement with pleural nodules or localized soft tissue fluid, in MPM diagnosis, staging and treatment evaluation, the high value of [1 ].
PET / CT can be used: ① benign and malignant pleural mesothelioma identification, especially in the history of asbestos exposure and pleural thickening in patients with diffuse; ② MPM staging; ③ pleural effusion, but CT and MRI examination was abnormal cases; ④ evaluation of tumor response to therapy [1, 7].
Pleural fluid cytology in the diagnosis rate is low; positioning organizations to increase under the fine-needle aspiration diagnosis [1, 4].
Surgical diagnostic methods including diagnostic thoracoscopy, surgical thoracoscopy, thoracotomy biopsy, mediastinoscopy, surgery, etc., have high sensitivity and specificity, which can impose thoracoscopy surgery treatment, such as control of pleural effusion, pleural decortication, etc. [1, 8].
In general, MPM is divided into localized and diffuse type; histologic classification, including epithelioid, sarcomatoid and biphasic three categories [1]. Light microscope, the epithelial and poorly differentiated adenocarcinoma pleural mesothelioma is difficult to identify, and sometimes requires the use of immunohistochemistry. CEA, CD15 expression in adenocarcinoma often, but not normally expressed in MPM, epithelial membrane antigen expression in MPM cell membrane, cytoplasm in cancer expression. In addition, CK5, CK6 retinal protein and calcium are more specific for MPM. When ambiguous immunohistochemical results, you can use electron microscopy - the gold standard for diagnosis, MPM has a long and branched microvilli, desmosomes and more tension wire [9].
Recently, we have a case of treatment in patients with epithelial MPM. The number of biopsy pathology expert consultation, some experts diagnosed as poorly differentiated adenocarcinoma, followed by immunohistochemical staining, calcium retinal protein (+), vimentin (+), CEA (-), thyroid transcription factor -1 (-), CD68 (+), the results support the diagnosis of MPM. Interestingly, three serum CEA examination before surgery, the patient has two highly expressed in tumor tissue but not expressed. This reflects the biological diversity of MPM.
At least five MPM staging system was born, is more reference to the 1995 International TNM staging group developed mesothelioma system, but compared with the staging of lung cancer, yet not fully reflect the survival rate of pathological and biological true character, but also influence the choice of treatment and efficacy evaluation.
3. The treatment of MPM
Without treatment, MPM patients, median survival time (MST) only a few months, most patients died of local tumor invasion. Treatment, and achieved good local control is the key to long-term survival. Surgery is the only possible means to achieve radical effect. However, a clear diagnosis for the small number of surgery [1, 4, 8, 9]. The absence of large randomized studies have been unable to confirm the maturity of the treatment model. MPM treatment mainly around two aspects of surgical and non surgical.
1) Surgical treatment of multi-disciplinary
Surgical methods are commonly used extrapleural pneumonectomy (EPP) and pleural decortication. EPP for the en bloc hemi pleura, diaphragm, pericardium and lungs, and its 2-year and 5-year survival rates were 30% to 40% and 5% to 15% [10, 11]; and significantly prolonged disease-free survival [11, 12]. Today, EPP mortality rate from 30%, has dropped 3.4% to 8%, but there are more than 50% incidence of postoperative complications, there is a big risk, highly skilled doctors can make more secure EPP [8, 13, 16].
For the localized MPM, pleural decortication also can obtain good results, and operative mortality and complication rates lower than the EPP [11]. For some early patients, video-assisted thoracoscopic decortication the pleura also showed better efficacy [17]. Compared with pleural decortication, EPP is more suitable for hemi-thorax after radiation therapy to strengthen, for the control of tumor recurrence seems to be more effective.
Including 945 patients a retrospective study: surgery can improve survival, surgical multidisciplinary treatment of patients median survival was 20.1 months. While increasing efficacy, EPP hemi-thoracic surgery plus radiotherapy, no increase in procedure-related concurrent [18].
A multi-center study: gemcitabine, cisplatin chemotherapy underwent three EPP, after chest radiotherapy, MST of 23 months [19]. Another 8 cases of MPM III or IV patients, four of gemcitabine and cisplatin chemotherapy underwent EPP, re-hemi-thoracic radiation therapy (54 cGy), MST 33.5 months [20]. Gemcitabine and carboplatin neoadjuvant chemotherapy I to III of MPM patients, re-operation and hemi thoracic radiotherapy EPP, but also achieve similar results [21]. Tip of the treatment model may be standard treatment for MPM.
After surgery, N2 lymph node recurrence of MPM patients faster, it seems appropriate surgical treatment [12]. The choice of surgical approach to the disease need to consider the scope of accompanying diseases, such as multi-disciplinary treatment modalities can only gain a better local control.
2) Non-surgical multidisciplinary treatment
Loss of timing of surgery patients can be chemotherapy, radiation therapy, and cytokines and other biological treatments.
Overall, MPM chemotherapy is not satisfactory, single drug or drug combination MST treatment of patients 13 to 17 months, efficiency <20% [22, 27].
A 1965 to 2001 based on the results of meta-analysis study showed that cisplatin is the most effective drugs, combination therapy can increase the response rate, but does not prolong survival [22].
Recent researches focus on gemcitabine, vinorelbine, pemetrexed less side effects such as drugs, as well as in combination with cisplatin. A group of patients with previous chemotherapy, the pemetrexed and cisplatin treatment, tumor response rate of 32.5%, 68.7% remission rate [23]. Although pemetrexed monotherapy with gemcitabine have shown a certain effect, but the two combined treatment MPM, compared with pemetrexed and cisplatin results slightly worse, MST was 8.08 months and 10.12 months [24] . Pemetrexed and carboplatin slightly worse than the efficacy of cisplatin, but a lower incidence of toxicity [25]. The MPM patients treated by gemcitabine plus vinorelbine treatment, remission rate was 43.3%, MST was 10.9 months [26]. Recently, two multicenter randomized controlled study of disappointing results, compared to best supportive care, vinorelbine combined with pemetrexed or best supportive care did not significantly prolong survival [27, 28]. Is clear that these drugs get a certain rate of tumor control and symptom relief; but the value of platinum drugs still can not be ignored.
Treatment when, MPM were mostly in the late extensive tumor growth, and adjacent to the heart and lungs and other vital organs, leading to the limitations of radiation field and dose, thus affecting the radiation effect.
Basic research and on the drainage port puncture or incision of the prophylactic irradiation of the study: sensitive to radiotherapy of malignant pleural mesothelioma [29]. Studies have shown [30-32], a single dose ≥ 4Gy, total dose of ≥ 40Gy, can reduce the local symptoms; but there are the opposite conclusion [33].
The only systematic review of the effects of radiation therapy shows: the lack of randomized controlled studies have shown that radiation therapy can cure or prolong the life of MPM patients; in improving the quality of life and symptom control, the role of radiation therapy are very limited [34]. However, the new technology carried out indicates that a glimmer of hope.
Conformal radiotherapy target volume can increase access to higher dose, and reduce the radiation dose of surrounding normal tissue. A group of 7 cases of MPM patients underwent radical surgery enhanced radiotherapy, despite the 6 cases of stage Ⅲ disease, but no case of local recurrence, and no serious complications [35].
Recently, a phase Ⅰ clinical trials have shown that pleural cavity injection of IFN-beta gene transfer of adenovirus to induce a certain cellular and humoral immune response and partial tumor regression [36].
In addition, the effect of protease inhibitors still need clinically proven [37]. The source of oral platelet growth factor receptor inhibitors and epidermal growth factor receptor tyrosine kinase inhibitor efficacy was disappointing [38, 39]. Pleural decortication, the use of multi-hematoporphyrin photosensitization mediated eradication of residual MPM cell therapy, Matzi so verify its safety, and some effect, but the sample size should be expanded [40].
4. Localized MPM
Localized MPM is extremely rare, and more than 1% [1]. A group of 218 cases of MPM in 10 patients with localized disease, its biological behavior and diffuse MPM there are differences. However, the epithelial type, type and bipolar sarcoma was limited to the growth of MPM can be. Including the chest wall and lung invasion and partial resection can achieve better results, but EPP is not required [5, 41].
In untreated cases, one case of women, limited type, epithelial type MPM patients survived for more than 12 years [42]. This seems to prove that women, epithelial type, limitations of MPM there is a link with a good prognosis [1]. But histology, immunophenotype and ultrastructural studies have shown the limitations of good prognosis diffuse type MPM MPM with no significant difference between the localized type is difficult to predict the biological behavior of MPM [43].
Recently, we have clinics one case MPM, for women, epithelial type, tumor limited the growth of the pleural effusion can grow fast, tumor blood supply is rich in local radical resection, although the line of intrapleural injection pemetrexed, gemcitabine and carboplatin chemotherapy, However, short-term disease recurrence, and rapid progress, only to survive for 6 months. That can be highly localized MPM malignant biological behavior.
5. Outlook
At present, few studies for the MPM, a case of less is in. Moreover, the disease is the lack of attention. The implementation of MPM patients in developed countries up, every 2-3 years, held a special forum for the disease, the participants, including thoracic surgery, radiology, oncology internal medicine, and large medical company personnel, the discussion covers all aspects of the disease [44] . Understanding and control of these measures on MPM very helpful.

Pleural cancer cure or mitigate any way

Condition analysis:
Pleurisy pleurisy is an inflammation of the pleura, the pleura is a double layer of moist mucous membranes, including around the lung, close to the ribs, pleurisy can make breathing extremely painful, if not immediately treated, can cause pleural effusion, pleural infiltration of the two room, known as pleural effusion, strictly speaking, pleurisy and pleural effusion is not a disease, but lung infections or diseases such as pneumonia, tuberculosis, complications of systemic lupus erythematosus and other diseases, such as congestive heart failure, chest trauma. viral infection caused by rheumatoid arthritis can also stimulate inflammation of the pleura, pleurisy and pleural effusion usually as bad as the original disease, to treat the primary disease should be a high note. ◆ symptoms of fever, deep breathing, coughing when the side of the chest pain. ◆ breath severe chest pain can disappear. ◆ pleural effusion. ◆ shortness of breath, dry cough. appears to be to seek medical treatment following ◆ If you have these symptoms, especially those without symptoms of primary disease, pleurisy, and pneumonia and pleural effusion may be the performance of lung cancer and other serious diseases. ◆ these symptoms accompanied by fever, no matter how mild, may have the infection, known as empyema, you need antibiotics. causes the surface layer plays a lubricating pleural and pulmonary protection. usually a small amount of fluid in the pleural cavity, so that the mutual sliding between the pleura on both sides but when the pleural disease due to chest infection, pleural rough with breathing, coughing. causing pain, this treatment is pleurisy. pleurisy in some pleural effusion cases, the excess liquid penetrated the pleural cavity, the increasing role of liquid lubrication. can reduce the pain caused by pleurisy, because the reduced friction between two layers of the pleura, but the additional pressure of liquid to the lungs , weakening their ability to freely caused shortness of breath, pleural effusion in some cases, excess fluid due to infection, can lead to empyema. diagnosis and examination to diagnose pleurisy, your doctor will use a stethoscope to listen to your chest when breathing, If the examination can demonstrate pleural friction - between the two pleural friction between sliding tones - diagnosis to clear. pleural friction in the suction and breathing began to produce a rough friction sound. pleurisy symptoms prompted the region, through the chest percussion, to feel a tremor, but also suggest pleurisy, the doctor can also chest X ray camera or pumping tests to diagnose some of effusion in the chest or back of local anesthesia, with a syringe pumping some liquid, for example, doctors can to clear mucus liquid test whether caused by cancer.
Suggestion:
Conventional treatment is usually for the treatment of pleurisy and pleural effusion caused by the primary disease treatment, in some cases, excessive pleural effusion must be withdrawn. Other treatment would help to alleviate the symptoms. In addition to conventional therapy for antibiotic treatment of primary disease and other appropriate medications, the doctor used a number of anti-inflammatory drugs or painkillers to treat inflammation, such as aspirin, sometimes cough syrup with codeine to control cough, pain, pleural effusion of patients to certain doctors Diuretics can be used to treat excessive fluid, as a preventive measure, use of antibiotics can prevent empyema, pleural effusion, such as excessive, the doctor will drain through the chest intubation, but need to be hospitalized. adjuvant treatment of other alternative Some treatments, including acupuncture, can reduce the discomfort caused by pleural effusion and symptoms. Chinese ephedra is an effective bronchodilator to help calm breathing, but note: Large doses of ephedra and large doses of epinephrine have the same effect, if there is high blood pressure, heart disease, not to use this medicine, the 5 grams of ephedrine, 4 grams of cinnamon, 1.5 grams of licorice, 5 grams of almonds mixed with cold water after a few minutes to cook hot drink