Difference between revisions of "IPLab:Lab 12:Thoracic Mesothelioma"

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== Clinical Summary ==
 
== Clinical Summary ==
This 61-year-old white male had a known history of asbestos exposure when in his twenties he had worked on a construction crew installing insulation in public buildings. The patient had a 40 pack-year history of smoking and a history of coronary artery disease requiring a coronary artery bypass graft ten years prior to his final admission. Two years prior to this admission, an open lung biopsy showed the patient to have a thoracic mesothelioma for which he was treated with radiation therapy. The patient was then placed on steroidal and nonsteroidal pain medications and a nerve block was performed to help alleviate the discomfort. On final admission, the patient complained of shortness of breath, orthopnea, and pedal edema. Physical examination revealed mild respiratory distress on nasal oxygen, a dull left hemothorax, and right basal bronchial breath sounds with scattered rales. Chest x-ray demonstrated a left hemothorax opacity, small right pleural effusions, and pleural plaques. The patient subsequently developed atrial fibrillation and immediately prior to his death he suffered a stroke.
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This 61-year-old white male had a known history of asbestos exposure as well as a 40 pack-year history of smoking and coronary artery disease. Two years ago an open lung biopsy showed a thoracic mesothelioma. At this admission the patient complained of shortness of breath, orthopnea, and pedal edema. Physical examination revealed mild respiratory distress on nasal oxygen and a dull left hemothorax. Chest x-ray demonstrated a left hemothorax opacity, small right pleural effusions, and pleural plaques. The patient subsequently developed atrial fibrillation and immediately prior to his death he suffered a stroke.
  
== Autopsy Findings ==
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At autopsy tumor plaque covered 100% of the left lung, 50% of the right lung, and extended into the thoracic wall, the diaphragm, and the heart.
Tumor plaque covered 100% of the left lung, 50% of the right lung, and extended into the thoracic wall, the diaphragm, and the heart. No evidence of tumor metastases was found outside the thoracic cavity. The brain showed acute hypoxic injury of the hippocampus although no thrombus was found.  
 
  
 
== Images ==
 
== Images ==
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File:IPLab12Mesothelioma11.jpg|Scanning electron micrograph of asbestos bodies. Note the rough surface and the beaded appearance caused by the material adhering to the surface of the asbestos fiber.  
 
File:IPLab12Mesothelioma11.jpg|Scanning electron micrograph of asbestos bodies. Note the rough surface and the beaded appearance caused by the material adhering to the surface of the asbestos fiber.  
 
</gallery>
 
</gallery>
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== Virtual Microscopy ==
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<peir-vm>IPLab12Mesothelioma</peir-vm>
  
 
== Study Questions ==
 
== Study Questions ==
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Amphiboles, though less prevalent, are more pathogenic than chrysotiles, particularly with respect to induction of malignant pleural tumors (mesotheliomas). Indeed, some studies of mesotheliomas have shown the link is almost always to amphibole exposure.</spoiler>
 
Amphiboles, though less prevalent, are more pathogenic than chrysotiles, particularly with respect to induction of malignant pleural tumors (mesotheliomas). Indeed, some studies of mesotheliomas have shown the link is almost always to amphibole exposure.</spoiler>
 
* <spoiler text="What are asbestos bodies?">Asbestos bodies appear as golden-brown, fusiform or beaded rods with a translucent center. They are composed of an asbestos fiber coated with an iron-containing proteinaceous material. They arise when macrophages attempt to phagocytose asbestos fibers; the iron (ferritin) binds to the fiber within the phagocyte. Other inorganic particles may also be incorporated onto the asbestos fiber along with the ferritin.</spoiler>
 
* <spoiler text="What are asbestos bodies?">Asbestos bodies appear as golden-brown, fusiform or beaded rods with a translucent center. They are composed of an asbestos fiber coated with an iron-containing proteinaceous material. They arise when macrophages attempt to phagocytose asbestos fibers; the iron (ferritin) binds to the fiber within the phagocyte. Other inorganic particles may also be incorporated onto the asbestos fiber along with the ferritin.</spoiler>
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== Additional Resources ==
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=== Reference ===
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* [http://emedicine.medscape.com/article/359470-overview eMedicine Medical Library: Malignant Mesothelioma Imaging]
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* [http://emedicine.medscape.com/article/352900-overview eMedicine Medical Library: Asbestosis Imaging]
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* [http://www.merckmanuals.com/professional/pulmonary_disorders/environmental_pulmonary_diseases/asbestos-related_disorders.html Merck Manual: Asbestos-Related Disorders]
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=== Journal Articles ===
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* Whitaker D.  [http://www.ncbi.nlm.nih.gov/pubmed/10877273 The cytology of malignant mesothelioma].  ''Cytopathology'' 2000 Jun;11(3):139-51.
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* Johnson JS, Edwards JM.  [http://www.ncbi.nlm.nih.gov/pubmed/11256938 Malignant mesothelioma mimicking squamous carcinoma in a pleural fluid aspirate].  ''Cytopathology'' 2001 Feb;12(1):54-6.
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=== Images ===
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* [{{SERVER}}/library/index.php?/tags/180-mesothelioma PEIR Digital Library: Mesothelioma Images]
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* [http://library.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html#8 WebPath: Pulmonary Neoplasms]
  
 
{{IPLab 12}}
 
{{IPLab 12}}
  
 
[[Category: IPLab:Lab 12]]
 
[[Category: IPLab:Lab 12]]

Latest revision as of 20:53, 13 July 2020

Clinical Summary[edit]

This 61-year-old white male had a known history of asbestos exposure as well as a 40 pack-year history of smoking and coronary artery disease. Two years ago an open lung biopsy showed a thoracic mesothelioma. At this admission the patient complained of shortness of breath, orthopnea, and pedal edema. Physical examination revealed mild respiratory distress on nasal oxygen and a dull left hemothorax. Chest x-ray demonstrated a left hemothorax opacity, small right pleural effusions, and pleural plaques. The patient subsequently developed atrial fibrillation and immediately prior to his death he suffered a stroke.

At autopsy tumor plaque covered 100% of the left lung, 50% of the right lung, and extended into the thoracic wall, the diaphragm, and the heart.

Images[edit]

Virtual Microscopy[edit]

Study Questions[edit]


Additional Resources[edit]

Reference[edit]

Journal Articles[edit]

Images[edit]

A pack-year denotes smoking one pack of cigarettes per day for one year.

Shortness of breath is a common clinical manifestation of heart failure.

Pleural effusion is the presence of fluid in the pleural space. Increased hydrostatic pressure in the pulmonary vasculature, as seen in heart failure, is one cause of pleural effusion.

Anthracotic pigment is coal dust deposited in the lungs--it is seen in coal miners, city-dwellers, and smokers.

A normal PaCO2 is 35 to 45 mmHg.