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Mesotheliomas are primary tumors arising from the surface lining of the pleura (80% of cases) or peritoneum (20% of cases) About three-fourths of pleural mesotheliomas are diffuse (usually malignant) tumors, and the remaining onefourth are localized (usually benign) Men outnumber women by a 3:1 ratio Numerous studies have confirmed the association of malignant pleural mesothelioma with exposure to asbestos (particularly the crocidolite form) The lifetime risk to asbestos workers of developing malignant pleural mesothelioma is about 8% Sixty to 80 percent of patients with malignant mesothelioma report a history of asbestos exposure The latent period between exposure and onset of symptoms ranges from 20 to 40 years The clinician should inquire about asbestos exposure through mining, milling, manufacturing, shipyard work, insulation, brake linings, building construction and demolition, roofing materials, and a variety of asbestos products (pipe, textiles, paint, tile, gaskets, panels) Although cigarette smoking significantly increases the risk of bronchogenic carcinoma in asbestos workers and aggravates asbestosis, there is no association between smoking and mesothelioma

Chest radiographs usually show multiple spherical densities with sharp margins The size of metastatic lesions varies from a few millimeters (miliary densities) to large masses Nearly all are less than 5 cm in diameter The lesions are usually bilateral, pleural or subpleural in location, and more common in lower lung zones Cavitation suggests primary squamous cell tumor; calcification suggests osteosarcoma Lymphangitic spread and solitary pulmonary nodule are less common radiographic presentations of secondary lung cancer Conventional chest radiography is less sensitive than CT scan in detecting pulmonary metastases

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Once the diagnosis has been established, management consists of treatment of the primary neoplasm and any pulmonary complications Surgical resection of a solitary pulmonary nodule is often prudent in the patient with known current or previous extrapulmonary cancer Local resection of one or more pulmonary metastases is feasible in a few carefully selected patients with various sarcomas and carcinomas (breast, testis, colon, kidney, and head and neck) Surgical resection should be considered only if the primary tumor is under control, if the patient is a good surgical risk, if all of the metastatic tumor can be resected, if nonsurgical approaches are not available, and if there are no metastases elsewhere in the body Relative contraindications to resection of pulmonary metastases include (1) malignant melanoma primary, (2) requirement for pneumonectomy, (3) pleural involvement, and (4) simultaneous appearance of two or more metastases The overall 5-year survival rate in secondary lung cancer treated

The mean age at onset of symptoms of malignant pleural mesothelioma is about 60 years Symptoms include the insidious onset of shortness of breath, nonpleuritic chest pain, and weight loss Physical findings include dullness to percussion, diminished breath sounds and, in some cases, digital clubbing

Pleural fluid is exudative and often hemorrhagic VATS biopsy is usually necessary to obtain an adequate specimen for

histologic diagnosis; even then, distinction from benign inflammatory conditions and from metastatic adenocarcinoma may be difficult The histologic variants of malignant pleural mesothelioma are epithelial and fibrous (sarcomatous) Special stains and electron microscopy may be needed to confirm the diagnosis

Program MV45AFZC USEREXIT_CHECK_VBLB-USR01 USEREXIT_CHECK_VBLB-USR02 USEREXIT_CHECK_VBLB-USR03 USEREXIT_CHECK_VBLB-USR04 USEREXIT_CHECK_VBLB-USR05 Function Module V45L0001 General EXIT_SAPLVED4_004 Delivery Schedules EXIT_SAPLV45L_001 EXIT_SAPLV45L_002 Planned Delivery Schedules EXIT_SAPMV45L_001 EXIT_SAPMV45L_002 Delivery orders EXIT_SAPMV45A_005 Workflow EXIT_SAPLVED4_001 EXIT_SAPLVED4_002 EXIT_SAPLVED4_003 EXIT_SAPLVED4_005 EXIT_SAPLVED4_006 Self Billing EXIT_SAPLVED4_001 EXIT_SAPLVED4_005 EXIT_SAPLVED4_006 EXIT_SAPLVED5_002 EXIT_SAPLVED5_003 EXIT_SAPLVED5_004

Esophageal cancer usually develops in persons between 50 and 70 years of age The overall ratio of men to women is 3:1 There are two histologic types: squamous cell carcinoma and adenocarcinoma In the United States, squamous cell cancer is much more common in blacks than in whites Chronic alcohol and tobacco use are strongly associated with an increased risk of squamous cell carcinoma The risk of squamous cell cancer is also increased in patients with tylosis (a rare disease transmitted by autosomal dominant inheritance and manifested by hyperkeratosis of the palms and soles), achalasia, caustic-induced esophageal stricture, and other head and neck cancers Squamous cell cancer has a high incidence in certain regions of China and Southeast Asia Half of all cases occur in the distal third of the esophagus Adenocarcinoma is more common in whites It is increasing dramatically in incidence and now is as common as squamous carcinoma The majority of adenocarcinomas develop as a complication of Barrett s metaplasia due to chronic gastroesophageal reflux Thus, most adenocarcinomas arise in the distal third of the esophagus Obesity also is strongly associated with adenocarcinoma, even after controlling for gastroesophageal reflux; however, no causal relationship has been convincingly shown

Radiographic abnormalities consist of nodular, irregular, unilateral pleural thickening and varying degrees of unilateral pleural effusion There may be scoliosis toward the side of the lesion CT scan helps demonstrate the extent of pleural involvement

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