Sarcomatoid mesothelioma accounts for about 10% of these malignancies. It is much more aggressive and resistant to therapy than epithelial forms. Unlike epithelial cells, it does not consist of compacted cells, but rather disorganized chaotic spindle cells with elongated thick nuclei, which are arranged in bundles and which migrate and metastasize more readily. The fibrous components of this form with its high rigidity make it difficult for surgery and removal of this tumor, so surgery is especially difficult for sarcomatoid forms. Histologically, they can be mixed with fibrous sarcomas, ie fibrosarcoma. The subtypes are: transient, lymphohistiocytoid, demoplastic.
Anamnesis: it is extremely important to examine whether a patient has been exposed to asbestos during his or her lifetime, and whether someone from the family has been exposed to asbestos; it may be suspected to be mesothelioma although the symptoms are nonspecific
Physical examination: patients may have a physical finding such as patients with pneumonia, silenced decreased respiratory noise, decreased amplitude of thorax movement on the lesion side, decreased voice resonance, dyspnea, decreased oxygen saturation in arterial blood,…
Chest radiography : based on X-ray absorption; radiographic findings may reveal irregular pleural shadows of varying size depending on the stage of tumor growth, findings may be identical to diseases associated with asbestosis where shadows with possible calcifications are observed; possible detection of pleural effusion, although not sensitive enough because it requires a minimum of 300ml of fluid to visualize
CT or MSCT chest scan: the most useful and important imaging method that detects lesions at the earliest stage for which radiography is not capable, identifies tumors as large as 1 to 2mm, and is the most important method for detecting the earliest stages. A CT scan cuts both the disease stage and the extent to which the tumor has expanded and whether metastases have developed. Uses X rays
MRI : also an imaging method that visualizes the size of the tumor and the possible spread and metastasis, does not radiate
Positron emission tomography (PET) : a nuclear medicine method that registers ionizing radiation of applied radioactive glucose and, with a CT scan, the most important imaging method in the detection of tumors. If there is a dilemma as to whether the detected lesion is malignant or benign PET may provide an answer as this analyzes the metabolism of the targeted lesion by registering radiation of radioactive glucose metabolized by the tumor; abnormal hypermetabolism of radioactive glucose suggests a malignant lesion
CT / PET scan: CT and PET combined method, more sophisticated
Biopsy: the gold standard in the diagnosis of malignant pleural mesothelioma; A sample of tumor tissue is taken and analyzed by the pathologist under a microscope. Each tumor lesion must be biopsied because it is only by this method that it can be determined with certainty whether the tumor is malignant or benign, at the same time determining its characteristics and histological type on the basis of which therapy and prognosis can be determined; the pathologist is obliged to do immunohistochemistry on mesothelioma antigens to resolve concerns as mesothelioma can often be confused with some other malignancies. The methods used to obtain the biocycle allowance are thin needle aspiration, thoracocentesis, fluid aspiration if leakage and analysis of the resulting cells in the fluid sample occurred, thin tube thoracoscopy with video camera (VATS).
Laboratory biomarkers : SMRP (soluble mesothelin-related peptide) is a protein in the blood that is significantly elevated in patients with mesothelioma. Values may also be elevated in individuals who do not have this malignancy but who have been exposed to asbestos. It may be useful for screening this population because high values may suggest that malignancy has developed. Mesothelin protein levels are also elevated, however, it may occur in some other cancers. Also MPF, Osteopontin, 80HdG, Fibulin 3 test, PDGF, Estrogen beta receptor and EGFR can be used as a potential marker .