Kyobu geka. The Japanese journal of thoracic surgery
-
The diagnosis of malignant pleural mesothelioma (MPM) is challenging although MPM is highly aggressive tumor. The current diagnostic gold standard is principally based on light microscopic examination of hematoxylin-eosin and immunohistochemical stains of large tissue sections. However, pathological diagnosis of MPM and classification of histological findings into 1 of the 3 subtypes (epithelial, sarcomatoid, biphasic) are difficult. ⋯ In 6 cases (28.6%) , initial diagnosis of MPM were not confirmed because of missing malignant tissue (1 case) and relatively small and sarcomatous element (5). In 2 cases examined by closed biopsy and in 3 examined by thoracoscopy under local anesthesia, initial diagnosis of MPM were not confirmed. To get the accurate diagnosis of MPM, obtaining large tissue samples in the initial examination by less invasive thoracoscopy is recommended.
-
Malignant pleural mesothelioma is an aggressive neoplasm with poor prognosis. Extrapleural pneumonectomy is performed as surgical therapy. It is difficult to obtain enough range of view at costophrenic angle. ⋯ With this procedure, a wide view of costophrenic angle and costal-pericardial angle can be obtained, and the resection margin can be placed outside the chest wall, costophrenic angle and costal-pericardial angle, which enables complete resection of masses at the costophrenic and costal-pericardial angles. Furthermore, extrapleural pneumonectomy with wide resection of the chest wall minimizes the resulting dead space, thereby minimizing the risk of postoperative hemorrhage and empyema. We consider that this procedure can be applied for malignant mesothelioma patients, especially those who have pleural masses at costophrenic angle.