TB or not TB : an unexpected case of malignant pleural mesothelioma / Ralph Allan D. Aguinaldo.

By:

Aguinaldo, Ralph Allan D., MD [author]

Language: ENGLISH Publication details: Fairview, Quezon City Department of Medicine, FEU-NRMF, 2016Description: 13 pages: (in folder)Content type:

rdacontent

Media type:

rdamedia

Carrier type:

rdacarrier

LOC classification:

MED20160002

Summary: ABSTRACT: A 40-year old male was admitted due to difficult of breathing and right-sided chest pain. He was initially treated as a case of pulmonary tuberculosis for 2 months but was reevaluated afterrecurrence of symptoms. Upon obtaining an occupational history wherein he had worked in various textile and furniture factories but denied history of asbestos exposure, further diagnostics including repeat pleural fluid analysis, chest CT scan with contrast and pleural biopsy revealed he has malignant pleural mesothelioma (MPM), rare yet emerging disease of the 21st century. It is most often associated with asbestos exposure, but patients can still develop the disease without vacuolating virus (SV40) as other possible causative agents. With long latency period between exposure and diagnosis between 20-60 years, the incidence of MPM is expected to peak in the year 2020. The disease most commonly develops when large amphibole asbestos fibers enters the lung parenchyma upon inhalation and then deposits into the lymph nodes and pleura, where they cause oxidative stress over a long period of time, eventually leading to cancer. Diagnosis involves recognition of typical signs and symptoms of MPM, namely dyspnea due to large pleural effusion and chest wall pain due to tumor invasion. In such patients, comprehensive occupational history with emphasis on asbestos exposure is warranted. Tissue biopsy is essential in the diagnosis, and immunohistochemistry should be done whenever possible. Treatment mainly involves combination chemotheraphy with cisplatin/carboplatin plus pemetrexed/raltitrexed, but surgery and radiotheraphy may be useful adjuvants. To date, prognosis is poor in all stages of the disease. In conclusion, as the incidence of MPM has been steadily increasing over the years, awareness of the disease can increase the chances of early diagnosis and improve quality of life.

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Holdings
Item type	Current library	Call number	Status	Date due	Barcode
Research	Far Eastern University - Nicanor Reyes Medical Foundation Research	MED20160002 (Browse shelf(Opens below))	Available		R000522

Includes appendices and bibliographical references.

ABSTRACT: A 40-year old male was admitted due to difficult of breathing and right-sided chest pain. He was initially treated as a case of pulmonary tuberculosis for 2 months but was reevaluated afterrecurrence of symptoms. Upon obtaining an occupational history wherein he had worked in various textile and furniture factories but denied history of asbestos exposure, further diagnostics including repeat pleural fluid analysis, chest CT scan with contrast and pleural biopsy revealed he has malignant pleural mesothelioma (MPM), rare yet emerging disease of the 21st century. It is most often associated with asbestos exposure, but patients can still develop the disease without vacuolating virus (SV40) as other possible causative agents. With long latency period between exposure and diagnosis between 20-60 years, the incidence of MPM is expected to peak in the year 2020. The disease most commonly develops when large amphibole asbestos fibers enters the lung parenchyma upon inhalation and then deposits into the lymph nodes and pleura, where they cause oxidative stress over a long period of time, eventually leading to cancer. Diagnosis involves recognition of typical signs and symptoms of MPM, namely dyspnea due to large pleural effusion and chest wall pain due to tumor invasion. In such patients, comprehensive occupational history with emphasis on asbestos exposure is warranted. Tissue biopsy is essential in the diagnosis, and immunohistochemistry should be done whenever possible. Treatment mainly involves combination chemotheraphy with cisplatin/carboplatin plus pemetrexed/raltitrexed, but surgery and radiotheraphy may be useful adjuvants. To date, prognosis is poor in all stages of the disease. In conclusion, as the incidence of MPM has been steadily increasing over the years, awareness of the disease can increase the chances of early diagnosis and improve quality of life.

Research - Department of Medicine

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