Etiology

Genetics
Epidemiology
Mesothelioma
Clinical Picture
Gross features
Microscopic Features
Prognosis
 Introduction
• Malignancies involving mesothelial cells that normally
line body cavities (including the pleura, peritoneum,
pericardium, and testis) are known as malignant
mesothelioma (MM).
• Majority of MM are seen in pleura (~ 85%). At present, the
tumour is rarely seen in India.
• Elsewhere, incidence reported in males exposed to
asbestos is 7 - 13 per million per year. In unexposed
persons, incidence is 1 - 2 per million per year.
• It is three times more common in males and the peak
incidence is 35 - 40 years after exposure to asbestos.
• Two thirds of cases of MM develop in fifth to seventh
decade of life.
 Etiopathogenesis
• Principal carcinogen implicated in pathogenesis of pleural MM is
asbestos
• Three forms of asbestos are known - crocidolite, amosite and
chrysotile.
• Crocidolite and amosite are the principal forms implicated in MM.
• In persons heavily exposed to asbestos, lifetime risk of
developing MM is 7 - 10%.
• Risk of developing LC is also raised significantly in smokers
exposed to asbestos.
• Family members of workers exposed to asbestos are also at risk
of developing MM.
• Mutations in tumour suppressor genes p16 (CDKN2A on
chromosome 9p) and p14 (ARF) along with loss of function of NF2
gene is seen commonly in MM.
• Following industries are associated with asbestos exposure: -
– Mining
– Ship building involving the use of asbestos
– Asbestos cement manufacture
– Ceramics
– Paper milling
– Auto parts (asbestos brake lining)
– Railroad repair
– Insulation
• India is the second largest market of asbestos products in the
world.
• As a latent period of over 40 years is known for MM, an epidemic
of this tumour is waiting to happen in our country.
• For the same reason, MM will be seen even decades after total
ban on asbestos use.
 Prognosis
• Without treatment, malignant mesothelioma is
fatal within 4 - 8 months.

• With aggressive treatment, overall survival rate

was -

– 43% at one year

– 28% at two years, and

– 10% at three years

• 50% patients die within 12 months.

• Few survive beyond 2 years.

• According to the Indian Council of Medical Research, National
Cancer Registry Programme. the incidence is much lower in
India accounting for 0.05–0.08 per 100,000 among men and
0.05–0.1 among women.[
• in our study none of the cases had history of any occupational
exposure. The other etiological factors include simian virus 40
and history of prior irradiation (Hui et al 2018).
Diffuse
Mesothelioma
both lungs
Mesothelioma
Papillary Mesothelioma
Epithelioid Mesothelioma
Sarcomatoid Mesothelioma