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PLEURAL MESOTHELIOMA

Epidemiology

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Epidemiology
Incidence:

Approximately 3000 new cases per year in the U.S.

Incidence of 0.8 per 100,000 in the U.S. in 2016; decreased from 1.1 per 100,000 in 2000

Median age: 72 years
Male to female incidence rate ratio: 3.5:1

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov [accessed January 20, 2020]

Key Statistics About Malignant Mesothelioma. American Cancer Society. Available from https://www.cancer.org/cancer/malignant-mesothelioma/about/key-statistics.html [accessed January 20, 2020]

Peto J et al. Lancet 1995;345:535–539

Vogelzang NJ et al. Cancer 1984;53:377–383

Staging

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Staging
TNM Descriptors for Diffuse Malignant Pleural Mesothelioma
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Limited to the ipsilateral parietal, ± visceral, ± mediastinal, ± diaphragmatic pleura
T2 Involves each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with either involvement of diaphragmatic muscle, or extension of tumor from visceral pleura into the underlying pulmonary parenchyma, or both
T3 Locally advanced but potentially resectable, involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with involvement of the endothoracic fascia, extension into the mediastinal fat, with solitary focus of completely resectable tumor extending into the soft tissues of the chest wall and/or nontransmural involvement of the pericardium
T4 Locally advanced and technically unresectable, involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral) with diffuse extension or multifocal masses of tumor in the chest wall with or without rib destruction, direct transdiaphragmatic extension of tumor to the peritoneum, direct extension to the contralateral pleura, direct extension to mediastinal organs, direct extension to the spine, or extension through the internal surface of the pericardium with or without a pericardial effusion, and/or myocardium involvement
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastases
N1 Metastases in the ipsilateral bronchopulmonary, hilar, or mediastinal (including the internal mammary, peridiaphragmatic, pericardial fat pad, or intercostal) lymph nodes
N2 Metastases in the contralateral mediastinal, ipsilateral, or contralateral supraclavicular lymph nodes
M0 No distant metastasis
M1 Distant metastasis present
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Staging
AJCC Prognostic Stage Groups for Diffuse Malignant Pleural Mesothelioma
  T (Primary) N M
Stage IA T1 N0 M0
Stage IB T2 N0 M0
T3 N0 M0
Stage II T1 N1 M0
T2 N1 M0
Stage IIIA T3 N1 M0
Stage IIIB T1 N2 M0
T2 N2 M0
T3 N2 M0
T4 Any N M0
Stage IV Any T Any N M1
Amin MB et al. (editors). AJCC Cancer Staging Manual, 8th ed. New York: Springer; 2017

Pathology

H & E staining

  1. Epithelioid: 60% of cases = tubulopapillary, granular, solid (~5% 5-year survival)

  2. Sarcomatoid/mixed: 40% of cases (0% 5-year survival)

Immunohistochemical staining: Keratin positive, CEA negative, Leu M negative, calretinin positive

Cytogenetics: Deletion of short arm of chromosome 1 and 3 and long arm ...

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