2008 Volume 48 Issue 3 Pages 165-170
The diagnosis of pleural mesothelioma should be based on a histological specimen obtained by needle or thoracoscopical biopsy. The tumor tissues are examined by pathologists using not only HE staining but also immunohistochemical staining such as positivity of calretinin and negativity of CEA for epithelioid mesothelioma. It is very important and difficult to make a differential diagnosis from pleomorphic lung cancer, pseudomesotheliomatous adenocarcinoma of the lung and fibrotic pleuritis (benign asbestos pleurisy). The therapeutic options for this disease are extremely limited, because radiotherapy by itself is not effective. Cases from the early stage up to stage III by the classification of IMIG have be indications for extrapleural pneumonectomy (EPP). However, cases of stage III with lymph node metastasis have poor prognosis. In cases of stage III or IV, it would be better to employ chemotherapy using cisplatin (CDDP) +pemetrexed. Treatment of EPP, chemotherapy and radiotherapy (trimodality) has been reported as obtaining best survival, but this therapy is limited to young cases with good performance status. No other reliable therapies have been reported.
