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• W2518783721 abstract "Patients with malignant pleural mesothelioma (MPM) are rarely diagnosed at their early stages. It is not fully recognized what is the earliest event in the development of MPM and how it progresses. The aim of this study was to elucidate the early microscopic changes of MPMs that were removed surgically and confirmed to be MPM by histological and immunohistochemical examination. Fourteen cases with MPM who underwent exrapleural pneumonectomy between 1995 and 2006 were investigated. We arbitrarily defined mesothelioma at early stage as tumor whose thickness was equal to or less than 6mm. We used a panel of immunohistochemical markers to confirm the diagnosis of mesothelioma. The age of the patients ranged from 40 to 66 and all were male. Four were with Stage IB, five with Stage II, five with Stage III, and one with Stage IV mesothelioma. Seven of these patients were designated at early stage according to our definition. Five cases were epithelioid mesothelioma, one was biphasic, and one was sarcomatoid. There was pleural cavity between parietal and visceral pleura and the surface of the lung looked normal, but both pleura were fused focally in some cases. There was no visible nodule in these cases, but white flat maculae or small yellow nodules were observed at the surface of the pleura in some of the cases. Microscopically mesothelioma cells proliferated both on the parietal and visceral pleura and invaded into it. They proliferated in solitary, trabecular, papillary, or solid patterns in epithelioid mesothelioma. The lesions were discontinuous and multifocal. Microscopic invasion into the lung and/or diaphragm was observed after evaluation of many blocks even in MPM with clinical stage I. Interlobar pleura and interlobular connective tissue was also invaded by the mesothelioma cells. The size of the lesion in the parietal pleura was larger than that in the visceral pleura. In an extremely early case, the lesions existed mainly in the parietal pleura, but a few foci of visceral pleural invasion were observed. Seeding of the mesothelioma cells on the tract of thoracoscopy was observed in three cases, and recurrence occurred in four of seven early stage MPMs. One-year and two-year overall survival rates for the early stage mesothelioma were 100% and 83.3%, respectively, and those for the advanced stage mesothelioma were 41.7% and 0%, respectively (p<0.0023). Histopathologically, there were few cases with stage I mesothelioma. Invasion was observed even in extremely early stage MPMs in our series. Once MPM develops, mesothelioma cells may exfoliate easily into the pleural effusion or extend in lymphatic vessels and disseminate diffusely onto the parietal and visceral pleura, thereafter proliferating as in situ neoplasm before invasive nodules are formed. Although MPM may first develop at some point of parietal pleura, it soon invades into both parietal and visceral pleura, disseminates, proliferates and invades adjacent tissue rapidly. Because MPM with stage IA is rarely recognized, it is not practical to categorize stage I into stage IA or IB." @default.
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• W2518783721 date "2007-08-01" @default.
• W2518783721 modified "2023-10-12" @default.
• W2518783721 title "P1-126: Pathological study of malignant pleural mesothelioma resected with extrapleural pneumonectomy" @default.
• W2518783721 doi "https://doi.org/10.1097/01.jto.0000283741.65406.41" @default.
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