Malignant Pleural Mesothelioma Caused by Environmental Exposure to Asbestos in the Southeast of Turkey: CT Findings in 117 Patients

Abstract

Background and Objectives: Malignant pleural mesothelioma (MPM) is reported to be common in the southeast of Turkey, as a result of environmental asbestos exposure. The aim of this study was to evaluate the computed tomography (CT) features of MPM in patients with a history of asbestos exposure. Methods: The CT scans of 117 patients who had a diagnosis of MPM were retrospectively evaluated. Additionally, CT findings of histologic subtypes were compared. Results: The most common CT findings included pleural effusion (n = 104, 89%), pleural thickening (n = 96, 82%), mediastinal pleural involvement (n = 77, 66%) and interlobar fissural involvement (n = 62, 53%). Histologic subtype analysis was performed in 89 patients; of these, epithelial, sarcomatous and mixed types were identified in 46, 23 and 20 patients, respectively. An analysis of CT findings demonstrated that the involvement of mediastinal pleural (91%), interlobar fissure (87%) and lung parenchyma (48%) was significantly more frequent in sarcomatous type, as compared to epithelial (61% and p < 0.01; 35 and 4%, p < 0.0001, respectively) and mixed types (65% and p < 0.05; 10% and p < 0.0001; 10% and p < 0.01, respectively). Furthermore, there was a significant correlation between pericardial involvement and chest wall involvement (r = 0.42, p < 0.05) in sarcomatous type. Similarly, lymphadenopathy and parenchymal involvement (r = 0.23, p < 0.02), pericardial and chest wall involvement (r = 0.25, p < 0.01), chest wall and interlobar fissural involvement (r = 0.25, p < 0.01) were significantly correlated, when CT findings of all histologic subtypes were combined. Conclusions: These results suggest that although CT findings of MPM vary, they may provide valuable clues to the diagnosis, at least in patients with a history of asbestos exposure. In addition, the presence of extensive lesions may suggest MPM of sarcomatous subtype.

Clinicopathological and Survival Characteristics of Malignant Pleural Mesothelioma: A Single-Institutional Experience

“…[5,6] Since respiratory exposure to asbestos which plays a pivotal role in the etiology pleura is the most commonly (90%) encountered location. [4,7,8] In a number of series published, exposure to asbestos has been reported in 50-80% of cases with malignant pleural mesothelioma. In our study, six (11.3%) patients declared exposure to asbestos by anamnesis.…”

A Clinical, Radiographic and Laboratory Evaluation of Prognostic Factors in 363 Patients with Malignant Pleural Mesothelioma

“…In our region, asbestos exposure is mostly environmental [15,16,17] and begins at birth. Therefore, MPM is detected at earlier ages.…”

“…However, there is no study on prognostic markers of MPM in our region [15,16,17]. The southeastern region of Turkey has a volcano, Mount Karacadag, and thus, asbestos-related diseases are common in our region [15,16,17]. …”

Mesothelioma and Asbestos-Related Pleural Diseases

“…Preliminary removal of fluid improves the visualization of pleural abnormalities. Unilateral pleural effusion, nodular pleural thickening and interlobar fissure thickening are the most frequent features observed [83, 84]. It is not rare to see a contraction of the affected hemithorax with associated mediastinal shift, narrowed intercostal spaces and elevation of ipsilateral diaphragm [83].…”