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.
