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Clinical presentation, diagnosis, and staging of malignant pleural mesothelioma

INTRODUCTION

Malignant mesothelioma is an insidious neoplasm with a dismal prognosis. It arises from mesothelial surfaces of the pleural and peritoneal cavities, the tunica vaginalis, or the pericardium.

The clinical presentation, evaluation, and staging of malignant pleural mesothelioma will be reviewed here. The epidemiology and pathology of malignant mesothelioma, as well as treatment considerations of both pleural and peritoneal mesothelioma, are discussed separately. (See "Epidemiology of malignant mesothelioma" and "Pathology of malignant mesothelioma" and "Localized treatment approaches for malignant pleural mesothelioma and solitary fibrous tumor of the pleura" and "Systemic treatment approaches for unresectable malignant mesothelioma" and "Malignant peritoneal mesothelioma".)

PRESENTATION

Malignant pleural mesothelioma most commonly presents in the fifth to seventh decades of life. A large proportion of patients diagnosed at an earlier age have a history of childhood exposure to asbestos.

Symptoms and signs — The most frequent presenting symptoms of pleural mesothelioma are dyspnea and nonpleuritic chest pain. Rarely, asymptomatic patients present with a unilateral pleural effusion that is found incidentally on routine chest radiograph.

Common physical findings at the time of diagnosis include unilateral dullness to percussion at the lung base, palpable chest wall masses, and scoliosis towards the side of the malignancy [1-4].
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