Now, let's move on.
Mesothelioma is where we are. Mesothelioma,
remember, the only real precursor, the only
precursor that can give rise to mesothelioma
is asbestos. 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. Right?
Now, what happen next? There are two different
type of fibres. One was the amphibole. That
was a ...................... And the other one
was the serpentine and that was the chrysotile.
The one that was dangerous was the amphibole.
Okay. This may then give rise to mesothelioma.
This is a malignancy of the pleura associated
with asbestosis. Smoking is not the factor.
Clear? So, now, we have two major lung cancers
where smoking is not a factor. We have adenocarcinoma
in bronchogenic and then mesothelioma, but
this is dealing with asbestos, may result
in haemorrhagic pleural exudative effusion.
Let's take a look at the histology of mesothelioma.
They might describe the psammoma bodies as being
calcium deposit. Is that clear? That is a psammoma body
and that of course is completely non-specific.
You can find that in many cancers, including
meningioma. You can find this in, What’s
the most common thyroid cancer? Papillary
cancer of the thyroid. So, you can
find this in many. Here in mesothelioma as
Cytokeratin and what’s some of this? Calretinin.
Positive in almost all mesotheliomas. Whereas
calretinin is almost always negative in most
carcinomas. 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. 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. I wish to repeat
that very statement once again. You are involving
the pleura here in mesothelioma, no doubt.
It’s a malignancy. You can expect it to
be bloodiness, unfortunately.
Lung cancers, leading cause of death in men
and women. Presentation, cough, haemoptysis,
bronchial constriction, wheezing. The pneumonic
"coin" lesion on chest X-ray or non-calcified
nodule on CT. So, “coin” lesion on X-ray.
Literally looks like one nodule. Non-calcified
nodule on CT.
The sites of metastasis from the lung include
adrenal, brain, bone, liver. Metastasis to
the lung from the breast, colon, prostate,
bladder cancer. Liver can be put in there
as well, okay? So, it’s from the lung to
these organs, from these organs to the lung.
Breast being a big one.
Complications, 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. Therefore what happens?
Flushing of the face because you can’t drain
your upper extremities. Is that clear? Do
not confuse this with superior sulcus syndrome.
Here, the patient is not going to have flushing
of the upper face and upper extremity. It’s
a fact that this patient has drooping of the
eyelid. There’s going to be the pupils that
are rather tiny and there’s absolutely no
sweating. What happened? Well, this was a
tumour, maybe a small cell lung cancer in
the apex of the lung. Understand, Pancoast,
as you here, is not a separate lung cancer.
Do you understand that? It is a existing lung
cancer that happens to be superior sulcus
causing compression of the? Good, sympathetic
chain. So therefore you have unrestricted,
unregulated parasympathetic activity on the
pupil. Pimple pupil miosis. You’re going
to have absolutely no sympathetic activity
on your sweat glands. Therefore, you’re
going to have anhydrosis. And number 3,
the droopy eyelid, ptosis. Welcome to Horner.
Do not forget the other name, known as superior
sulcus. I beg you not to get this confused
with superior vena cava syndrome, where the
patient will have flushing in the head and
Paraneoplastic syndromes, we’ve talked
about plenty. You tell me about ADH and ACTH.
Small cell. If it’s PTHrP, it will be
Hoarseness, how is this occurring? “Doc,
I’m having a hard time.” Well, this is
going to be recurrent laryngeal nerve. And
as far as the effusions are concerned, these
will be haemorrhagic or bloody, either pericardial