Alvydas Česas, Algirdas Šlepavičius, Aleksandras Bagajevas, Rugilė Česaitė
Malignant mesothelioma is an aggressive tumor of serosal surfaces, such as the pleura, the peritoneum, the pericardium and the tunica vaginalis. There is a substantial interest in this disease by part of medical community and the general public because millions of people have been exposed to asbestos fibers, and many articles about the dangers of asbestos had appeared in the press. 80 percent of patients with pleural malignant mesothelioma are male, commonly present with a pleural effusion, associated with breathlessness and often accompanied by chest-wall pain (more than 60 percent of patients). The main cause of malignant mesothelioma is exposure to asbestos – the carcinogen associated with malignant mesothelioma. Indeed, malignant mesothelioma was rare before the widespread use of asbestos, and increasing incidence worldwide is expected to peak in 5 to 10 years. The pathologic diagnostic of malignant mesothelioma is very difficult even with pathology experts in mesothelioma. Accurate and rapid diagnosis of malignant mesothelioma is important for therapeutic reasons. The most frequent diagnostic problem is the differentiation of malignant mesothelioma and adenocarcinoma – a distinction that is particularly difficult to make when the tumor has invaded the pleura. For many years surgery has proved to be most useful for palliation – for example, for local control of recurrent effusions. Debulking surgery is used in some centers until now. Systemic chemotherapy, cytoreductive surgery, HYPEC and multidisciplinary team discussion can help to cure or extend survival of patients. The case report showed successful multidisciplinary approach treatment for young man with malignant pleural and peritoneal mesothelioma.
Keyword(s): mesothelioma; asbestos; chemotherapy; HYPEC (hypertermic intra-peritoneal chemotherapy); cytoreductive surgery; DMPM (Differentiated Malignant Peritoneal Mesothelioma); multidisciplinary team; PCI (peritoneal carcinosis index).
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