pleural and pericardial mesothelioma

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Pleural and Pericardial Mesothelioma:

Pleural and Pericardial Mesothelioma Prof. Abdulsalam Y Taha School of Medicine Faculty of Medical Sciences University of Sulaimaniyah Sulaimaniyah/ Region of Kurdistan/ Iraq https://univsul.academia.edu/AbdulsalamTaha

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Case 1 * 51 year old housewife * Left-sided chest pain for 4 days. * Normal chest exam. *CXR :

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* lateral CXR : * ECG: normal apart from ventricular ectopics. *Echo. Cystic mass separate but close to the heart. *Bronchoscopy: First: normal. Second(haemoptysis while waiting for op.) a streak of old blood from LUL proper br.

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*Provisional Dx. Pulmonary hyadtid cyst. *Exploratory thoracotomy:completely normal lung, a big rounded solid mass attached by very fine pedicle to visceral pleura of LUL, with many prominent blood vessels on surface. *No obvious pul. Lesion. *Resection by ligation & division of pedicle. * Biopsy: Localized Benign Mesothelioma. *Follow-up: perfect health 11 mo. Postop.

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Postop photograph

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Case 2: *A 65 yr. old housewife from Basrah- Karma, referred as a case of complicated pulmonary hydatid cyst. *Severe R-sided chest pain. *No bronchial symptoms ( cough or expectoration ). *She looked ill,pale and in pain. *CXR :

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Lat. CXR: * Chest sonograph: a complex mass ? Complicated PHC. *Abd. US: normal. *Fiberoptic bronchoscopy: normal. *Provisional Dx. RML mass.

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* Exploratory thoracot omy: moderate haemothorax + well- defined solid rounded mass 10 x 10 cm attached to ant.chest wall ,with many big blood vessels on its surface. The mass arised from parietal pleura by a wide base i.e, sessile. The lung was compressed but otherwise normal.

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* The blood was sucked. The mass was resected easily. There was no invasion of chest wall. The patient had a smooth postop. course; the pain disappeared. *Biopsy : localized malignant mesothelioma. *Postop.. She received DXT * She remained well for 3 months but thereafter presented with chest pain & right lower zone pulmonary infiltrate ;thus given chemotherapy.

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* CXR *Thoracentesis: no fluid. *MRI: pleural-based masses. *Fiberoptic bronchoscopy: a tumour involving bronchus intermedius. *Exploratory thoracotomy and biopsy: Diffuse malignant pleural mesothelioma.

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* Echocardiography: huge free effusion *Subxyphoid pericardiocentesis: straw-coloured fluid. *Open pericardiostomy : normal pericardium; drainage & biopsy. *Biopsy :no TB or malignancy.

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*Postoperative CXR normal-sized heart. *Anti-TB drugs were given for 2 weeks.

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* 2 weeks lator: recollection of fluid indicating no response to anti-TB drugs.

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* CT scan: a tumour of the pericardium invading the right ventricle.

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*Median sternotomy : malignant pericardial mesothelioma. CXR:After debulking of tumour and total pericardie- ctomy.

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Conclusions 1. Pleural mesotheliomas are rare tumours. This paper reports 3 cases representing the three known types i.e., the localized benign, localized malignant and diffuse malignant mesotheliomas 2. Primary pericardial mesothelioma is very rare. One case is reported here. 3. All patients were housewives from the south of Iraq presented in the year 2000 4. No exposure to asbestos was documented in the patient with diffuse malignant mesothelioma 5. The localized mesotheliomas may mimic pulmonary hydatid cyst radiographically. However, careful history, physical examination and some investigations may enable a correct preoperative diagnosis

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6. Although tuberculous pleural effusion is common; the malignant aetiologies like diffuse pleural mesotheliomas should not be forgotten 7. The patient with primary pericardial mesothelioma has presented initially as cardiac tamponade. Only one previous case similarly presented has been reported before; thus our case may be just the second. 8. While the benign mesothelioma is curable by surgery, the malignant forms are difficult to diagnose and treat with a bad prognosis even with the modern multimodality treatment. 9. We feel that the aetiology of many malignancies including mesothelioma have changed after the American aggression on our country in 1990; a point that deserves study

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