Benign mesothelioma

Benign mesothelioma

Overview

Benign mesothelioma, also referred to as “pleural fibrosis” or “fibrous mesothelioma,” is a benign (noncancerous) tumor disorder involving pleura, a fine tissue that defines the pleural cavity and licks the surface of the lungs. Although most cases of mesothelioma are malignant (cancerous), forms with less serious evolution and better prognosis may also occur. 

Benign tumors of this type occur more frequently in men than women and originate in pleural mesothelioma (hence the name). Similar tumors may develop in the peritoneum (also a serous foil but lining the abdominal cavity). Peritoneal damage is referred to as “the fibrous solitary tumor of the peritoneum.” The most important difference between malignant and benign forms is the lower invasiveness and diffusion capacity of fibrous mesothelioma. 

Unlike this, the malignant form is very aggressive, has a rapid evolution, and metastases at a distance, significantly aggravating the treatment. Although benign mesothelioma does not invade adjacent structures, they can grow significantly in size, having a negative impact on surrounding tissues due to the compression phenomena they cause. In severe cases, it can even prevent the pleural fluid from draining the lymphatic vessels, which will cause a dispneascent pleural effusion.

Causes

Like malignant mesothelioma, and benign form is correlated with chronic exposure to asbestos and asbestos dust. Benign mesothelioma is manifested much earlier, does not require asymptomatic as long as malignant (20-50 years from initial exposure). Because it has benign character, such a tumor can be treated very soon after it is discovered, its evolution being promptly stopped. 

There are cases of malignant degeneration of benign mesotheliomas, and this is the main reason why treatment should be promptly instituted. The presence of benign mesothelioma may also be an alarm signal, causing the doctor to look for other conditions associated with exposure to asbestos, as yet asymptomatic conditions but which may develop subclinically. Benign mesothelioma is more commonly diagnosed in men than women, because the professions that expose the patient to asbestos dust are: plumbers, pipe builders, construction workers, locksmiths, welders.

Symptoms

Over 50% of patients are asymptomatic (they have no clinically manifest symptoms). Benign mesotheliomas are quite rare. They account for less than 10% of internationally diagnosed mesothelioma. In cases where the tumor is extensively expanded, local compression phenomena, manifested at the level of pulmonary parenchyma, which may interfere with normal ventilation and may be clinically expressed by dyspnea , may occur 

There may also appear in the clinical picture: 
–  Chest pain
– Non-productive, dry, irritable chronic cough; 
– Alteration of the general state; 
– Changes in the fingers that change the angle of inclination (physical signs important in many cyanotic disorders).

Paraclinic investigations

Diagnosis of benign mesothelioma is based on anamnesis, which can provide useful information about the patient’s profession and possibly exposure to asbestos dust. This is the main risk factor that can cause the doctor to suspect such a disease. At the physical examination, the doctor may notice nail and finger changes, but these are not specific to the disease, but may also occur in congenital heart disease, cystic fibrosis,  bronchopulmonary cancer. 

If mesothelioma is suspected, other paraclinical investigations will also be performed, including: 
– Pulmonary radiographs: are first-time investigations used to diagnose many lung and pleural diseases;
–  Computerized tomographies: can localize the pleural node more precisely;
– Nuclear magnetic resonance.

In order to establish the diagnosis of certainty, pleural biopsies will most often be performed. In these procedures, often under general anesthesia, tissue fragments from the node and the pleura adjacent to it will be harvested to the laboratory of pathological anatomy. Here the exact nature of the tumor, as well as its histological origin, will be determined. 

There is a possibility that the tumor is benign or borderline, and the anatomopathological diagnosis can greatly guide the treatment to be instituted later. If the patient has pleural effusions, samples can also be collected from the thoracentesis to determine if it is a transudate  or exudate. 

Generally, exudates occur when there is a local aggression in the pleura and the lung, while transudates characterize more complicated systemic pathological processes. In addition, pleural fluid analysis can also determine if there are  cancer cells present in the pleural area, or if there are local infectious processes.

Treatment

Treatment consists of removing the tumor. Benign mesothelioma can be treated relatively easily, unlike the malignant variant, which has a very high mortality and benefits only from symptomatic and palliative treatment. Removal of the nodule is done surgically, with the prognosis of the patients being very good. If there is pleural effusion, patients will also be fitted with a drain tube to evacuate the fluid.

Prognostic

In the presence of prompt treatment, the prognosis of patients is very good. There is the possibility, in 1 out of 10 patients, that the node is recurring (the condition is recurrent). In some cases, recurrence occurs even 10 years after the removal of the first fibrous node.

All patients operated by benign mesothelioma should periodically conduct radiographic checks to monitor their progression. The appearance of a mesothelioma may be a sign of the existence of disseminated diseases due to exposure to asbestos. Therefore, it is recommended that the patient be thoroughly investigated for the early diagnosis of other pathologies of the same aetiology.

Complications

The most common complication of benign mesothelioma is the appearance of the pleural effusion. If it is large, it can aggravate dyspnea and may precipitate the onset of an acute respiratory failure. In some situations, especially if there are risk factors (smoking), benign mesothelioma can degenerate into malignant form.

Consult a specialist

Patients are advised to contact a specialist if they have a history of professional exposure to asbestos, even many years ago and if they develop signs and symptoms suggestive of a lung disease: dyspnoea, coughing, cyanosis .

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