Mesothelioma

00:00 Now, let's move on.

00:02 Mesothelioma is where we are.

00:03 Mesothelioma, remember, the only real precursor, the only precursor that can give rise to mesothelioma is asbestos.

00:12 With asbestos, who’s your patient? Maybe a roofer, maybe a plumber, maybe there was non-environmental, maybe you’re washing the clothes of an individual that was dealing with asbestos.

00:23 Right? Now, what happen next? There are two different type of fibres.

00:28 One was the amphibole.

00:30 That was a crocidolite.

00:32 And the other one was the serpentine and that was the chrysotile.

00:36 The one that was dangerous was the amphibole.

00:38 Okay.

00:39 This may then give rise to mesothelioma.

00:42 This is a malignancy of the pleura associated with asbestosis.

00:49 Smoking is not the factor.

00:51 Clear? So, now, we have two major lung cancers where smoking is not a factor.

00:57 We have adenocarcinoma in bronchogenic and then mesothelioma, but this is dealing with asbestos, may result in haemorrhagic pleural exudative effusion.

01:09 Thickened pleura.

01:11 Let's take a look at the histology of mesothelioma.

01:14 They might describe the psammoma bodies as being calcium deposit.

01:17 Is that clear? That is a psammoma body and that of course is completely non-specific.

01:22 You can find that in many cancers, including meningioma.

01:25 You can find this in, what’s the most common thyroid cancer? Papillary cancer of the thyroid.

01:31 So, you can find this in many.

01:32 Here in mesothelioma as well.

01:34 Cytokeratin and what’s some of this? Calretinin.

01:38 Positive in almost all mesotheliomas whereas calretinin is almost always negative in most carcinomas.

01:50 So that’s extremely specific, when it comes to mesothelioma, one thing that I wish to bring to your attention is when you have asbestosis, an asbestos.

01:58 What was that pathognomonic lesion that we found in the lung? Oh yes, that was pleural plaque and I told you at that time because there might be pleural plaque, that it’s not a precursor to mesothelioma.

02:09 I wish to repeat that very statement once again.

02:12 You are involving the pleura here in mesothelioma, no doubt.

02:15 It’s a malignancy.

02:16 You can expect it to be bloodiness, unfortunately.

02:21 Lung cancer is the leading cause of mortality from cancer.

02:24 Presentation, cough, haemoptysis, bronchial constriction, wheezing.

02:31 The pneumonic "coin" lesion on chest X-ray or non-calcified nodule on CT.

02:38 So, “coin” lesion on X-ray.

02:40 Literally looks like one nodule.

02:42 Non-calcified nodule on CT.

02:45 The sites of metastasis from the lung include adrenal, brain, bone, liver.

02:56 Metastasis to the lung from the breast, colon, prostate, bladder cancer.

03:05 Liver can be put in there as well.

03:07 So, it’s from the lung to these organs, from these organs to the lung.

03:14 Breast being a big one.

03:17 Complications.

03:19 What may then happen if you have a lung cancer in which, well, on the right side, it causes compression of the superior vena cava? It’s called superior vena cava syndrome.

03:30 Therefore what happens? Flushing of the face because you can’t drain your upper extremities.

03:36 Is that clear? Do not confuse this with superior sulcus syndrome.

03:42 Here, the patient is not going to have flushing of the upper face and upper extremity.

03:47 It’s a fact that this patient has drooping of the eyelid.

03:51 There’s going to be the pupils that are rather tiny and there’s absolutely no sweating.

03:58 What happened? Well, this was a tumour, maybe a small cell lung cancer in the apex of the lung.

04:05 Understand, Pancoast, as you here, is not a separate lung cancer.

04:11 Do you understand that? It is a existing lung cancer that happens to be superior sulcus causing compression of the...

04:21 Good, sympathetic chain.

04:23 So therefore you have unrestricted, unregulated parasympathetic activity on the pupil.

04:30 Pimple pupil miosis.

04:33 You’re going to have absolutely no sympathetic activity on your sweat glands.

04:37 Therefore, you’re going to have anhydrosis.

04:40 And number 3, the droopy eyelid, ptosis.

04:43 Welcome to Horner.

04:45 Do not forget the other name, known as superior sulcus.

04:48 I beg you not to get this confused with superior vena cava syndrome, where the patient will have flushing in the head and such.

04:56 Paraneoplastic syndromes, we’ve talked about plenty.

04:58 You tell me about ADH and ACTH.

05:00 Small cell.

05:01 If it’s PTHrP, it will be squamous cell.

05:05 Hoarseness, how is this occurring? “Doc, I’m having a hard time.” Well, this is going to be recurrent laryngeal nerve.

05:11 And as far as the effusions are concerned, these will be haemorrhagic or bloody, either pericardial or pleural.