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Mesothelioma, malignant

Last edited: 4/14/2026

Overview

Malignant mesothelioma is a rare and aggressive neoplasm primarily affecting the pleura, often linked to asbestos exposure, though cases without known exposure exist 1. It presents significant diagnostic and therapeutic challenges due to its aggressive nature and varied presentations 23.

Diagnosis

  • Clinical Presentation: Progressive breathlessness, chest pain, and pleural effusion 1.
  • Imaging: Chest CT showing pleural thickening and effusions 1.
  • Biopsy and Histopathology: Essential for definitive diagnosis; immunohistochemistry aids in distinguishing from lung adenocarcinomas 202526.
  • Serum Markers: Mesothelin levels may aid in early detection in asbestos-exposed individuals 10.
  • Occupational History: Detailed assessment crucial for identifying asbestos exposure 618.

    • Management

  • First-Line Treatment: Extrapleural pneumonectomy or pleurectomy/decortication for localized disease 9.
  • Chemotherapy: Combination regimens like pemetrexed plus platinum-based agents are standard 5.
  • Targeted Therapy: Tazemetostat shows antitumor activity, warranting further investigation 5.
  • Palliative Radiotherapy: Effective for symptom control, particularly chest wall pain, with response rates over 60% 1517.
  • Symptom Management: Radiotherapy and anterior cingulotomy for pain and dyspnea relief 12.

    • Special Populations

  • Elderly: Management tailored to comorbidities and functional status; palliative care often prioritized 19.
  • Comorbidities: Consider impact on treatment tolerance and efficacy; multidisciplinary approach recommended 19.

    • Key Recommendations

  • Comprehensive Occupational History: Essential for identifying asbestos exposure and guiding management 618 (Evidence: Strong).
  • Use of Immunohistochemistry: Critical for accurate diagnosis, distinguishing mesothelioma from lung adenocarcinomas 202526 (Evidence: Strong).
  • Palliative Radiotherapy for Symptom Control: Recommended for managing chest pain and other symptoms with moderate evidence of efficacy 1517 (Evidence: Moderate).
  • Consider Mesothelin Levels: Useful in monitoring asbestos-exposed individuals for early detection 10 (Evidence: Moderate).
  • Multidisciplinary Approach: Necessary for managing elderly patients and those with comorbidities 19 (Evidence: Expert opinion).

    • References

    1 Rao D P, Vijayan S, Vananjakar SS, T PK. Malignant pleural mesothelioma. BMJ case reports 2025. link 2 Cugliari G. FKBP5, a Modulator of Stress Responses Involved in Malignant Mesothelioma: The Link between Stress and Cancer. International journal of molecular sciences 2023. link 3 Iczkowski KA. Malignant Mesothelioma of Tunica Vaginalis Testis: Update for 2022. Advances in anatomic pathology 2023. link 4 Sağnıç S, Birge Ö, Alpsoy A, Doğan S, Tuncer HA, Peştereli E et al.. Malignant mesothelioma of the peritoneum mimicking primary peritonitis carcinomatosis. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2023. link 5 . Tazemetostat Shows Antitumor Activity in Malignant Pleural Mesothelioma. Cancer discovery 2022. link 6 Scopa P. Reconstruction of asbestos exposure in workers suffering from pleural neoplasms and employed in sectors not generally associated with high exposure levels: the importance of an accurate standardized assessment of occupational medicine. Journal of preventive medicine and hygiene 2021. link 7 Ihara H, Harada N, Shimada N, Kanamori K, Hayashi T, Uekusa T et al.. Malignant Pleural Mesothelioma with Bone Marrow Metastases. Internal medicine (Tokyo, Japan) 2018. link 8 Churg A, Attanoos R, Borczuk AC, Chirieac LR, Galateau-Sallé F, Gibbs A et al.. Dataset for Reporting of Malignant Mesothelioma of the Pleura or Peritoneum: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Archives of pathology & laboratory medicine 2016. link 9 MacLeod N, Kelly C, Stobo J, McMahon L, Taggart D, Fallon M et al.. Pain in Malignant Pleural Mesothelioma: A Prospective Characterization Study. Pain medicine (Malden, Mass.) 2016. link 10 Smolková P, Nakládalová M, Zapletalová J, Jakubec P, Vildová H, Kolek V et al.. Validity of mesothelin in occupational medicine practice. International journal of occupational medicine and environmental health 2016. link 11 Magnani C, Bianchi C, Chellini E, Consonni D, Fubini B, Gennaro V et al.. III Italian Consensus Conference on Malignant Mesothelioma of the Pleura. Epidemiology, Public Health and Occupational Medicine related issues. La Medicina del lavoro 2015. link 12 Pereira EA, Paranathala M, Hyam JA, Green AL, Aziz TZ. Anterior cingulotomy improves malignant mesothelioma pain and dyspnoea. British journal of neurosurgery 2014. link 13 Mensi C, Termine L, Garberi A, Meroni S, Levi D, Balzarini L et al.. Spinal cord compression: an unusual presentation of malignant pleural mesothelioma. A case report and review of the literature. Tumori 2012. link 14 Frauenfelder T, Tutic M, Weder W, Götti RP, Stahel RA, Seifert B et al.. Volumetry: an alternative to assess therapy response for malignant pleural mesothelioma?. The European respiratory journal 2011. link 15 Jenkins P, Milliner R, Salmon C. Re-evaluating the role of palliative radiotherapy in malignant pleural mesothelioma. European journal of cancer (Oxford, England : 1990) 2011. link 16 Shin MK, Lee OJ, Ha CY, Min HJ, Kim TH. Malignant mesothelioma of the greater omentum mimicking omental infarction: a case report. World journal of gastroenterology 2009. link 17 Waite K, Gilligan D. The role of radiotherapy in the treatment of malignant pleural mesothelioma. Clinical oncology (Royal College of Radiologists (Great Britain)) 2007. link 18 Porru S, Placidi D, Scotto di Carlo A, Campagna M, Mariotti O, Barbieri PG et al.. Malignant mesothelioma and the working environment: the viewpoint of the occupational physician. La Medicina del lavoro 2005. link 19 Senan S. Indications and limitations of radiotherapy in malignant pleural mesothelioma. Current opinion in oncology 2003. link 20 Betta PG, Andrion A, Donna A, Mollo F, Scelsi M, Zai G et al.. Malignant mesothelioma of the pleura. The reproducibility of the immunohistological diagnosis. Pathology, research and practice 1997. link80054-4) 21 Sheibani K, Stroup RM. Immunopathology of malignant mesothelioma. Pathology (Philadelphia, Pa.) 1996. link 22 Lerman Y, Learman Y, Schachter P, Herceg E, Lieberman Y, Yellin A. Radiation associated malignant pleural mesothelioma. Thorax 1991. link 23 Bissett D, Macbeth FR, Cram I. The role of palliative radiotherapy in malignant mesothelioma. Clinical oncology (Royal College of Radiologists (Great Britain)) 1991. link80582-5) 24 Uri AJ, Schulman ES, Steiner RM, Scott RD, Rose LJ. Diffuse contralateral pulmonary metastases in malignant mesothelioma. An unusual radiographic presentation. Chest 1988. link 25 Pfaltz M, Odermatt B, Christen B, Rüttner JR. Immunohistochemistry in the diagnosis of malignant mesothelioma. Virchows Archiv. A, Pathological anatomy and histopathology 1987. link 26 Lee I, Radosevich JA, Chejfec G, Ma YX, Warren WH, Rosen ST et al.. Malignant mesotheliomas. Improved differential diagnosis from lung adenocarcinomas using monoclonal antibodies 44-3A6 and 624A12. The American journal of pathology 1986. link 27 Blobel GA, Moll R, Franke WW, Kayser KW, Gould VE. The intermediate filament cytoskeleton of malignant mesotheliomas and its diagnostic significance. The American journal of pathology 1985. link 28 Bejui-Thivolet F, Patricot LM, Vauzelle JL, Viac J. Keratins in malignant mesotheliomas and pleural adenocarcinomas: comparative immunohistochemical analysis with polyclonal and monoclonal antibodies. Pathology, research and practice 1984. link80063-1) 29 Vaglini M, Bozzetti F, Viganotti G. Malignant pleural mesothelioma. Tumori 1978. link

    Original source

    1. [1]
      Malignant pleural mesothelioma. — Rao D P, Vijayan S, Vananjakar SS, T PK BMJ case reports (2025)
    2. [2]
      FKBP5, a Modulator of Stress Responses Involved in Malignant Mesothelioma: The Link between Stress and Cancer. — Cugliari G International journal of molecular sciences (2023)
    3. [3]
      Malignant Mesothelioma of Tunica Vaginalis Testis: Update for 2022. — Iczkowski KA Advances in anatomic pathology (2023)
    4. [4]
      Malignant mesothelioma of the peritoneum mimicking primary peritonitis carcinomatosis. — Sağnıç S, Birge Ö, Alpsoy A, Doğan S, Tuncer HA, Peştereli E et al. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology (2023)
    5. [5]
      Tazemetostat Shows Antitumor Activity in Malignant Pleural Mesothelioma. Cancer discovery (2022)
    6. [6]
      Reconstruction of asbestos exposure in workers suffering from pleural neoplasms and employed in sectors not generally associated with high exposure levels: the importance of an accurate standardized assessment of occupational medicine. — Scopa P Journal of preventive medicine and hygiene (2021)
    7. [7]
      Malignant Pleural Mesothelioma with Bone Marrow Metastases. — Ihara H, Harada N, Shimada N, Kanamori K, Hayashi T, Uekusa T et al. Internal medicine (Tokyo, Japan) (2018)
    8. [8]
      Dataset for Reporting of Malignant Mesothelioma of the Pleura or Peritoneum: Recommendations From the International Collaboration on Cancer Reporting (ICCR). — Churg A, Attanoos R, Borczuk AC, Chirieac LR, Galateau-Sallé F, Gibbs A et al. Archives of pathology & laboratory medicine (2016)
    9. [9]
      Pain in Malignant Pleural Mesothelioma: A Prospective Characterization Study. — MacLeod N, Kelly C, Stobo J, McMahon L, Taggart D, Fallon M et al. Pain medicine (Malden, Mass.) (2016)
    10. [10]
      Validity of mesothelin in occupational medicine practice. — Smolková P, Nakládalová M, Zapletalová J, Jakubec P, Vildová H, Kolek V et al. International journal of occupational medicine and environmental health (2016)
    11. [11]
      III Italian Consensus Conference on Malignant Mesothelioma of the Pleura. Epidemiology, Public Health and Occupational Medicine related issues. — Magnani C, Bianchi C, Chellini E, Consonni D, Fubini B, Gennaro V et al. La Medicina del lavoro (2015)
    12. [12]
      Anterior cingulotomy improves malignant mesothelioma pain and dyspnoea. — Pereira EA, Paranathala M, Hyam JA, Green AL, Aziz TZ British journal of neurosurgery (2014)
    13. [13]
      Spinal cord compression: an unusual presentation of malignant pleural mesothelioma. A case report and review of the literature. — Mensi C, Termine L, Garberi A, Meroni S, Levi D, Balzarini L et al. Tumori (2012)
    14. [14]
      Volumetry: an alternative to assess therapy response for malignant pleural mesothelioma? — Frauenfelder T, Tutic M, Weder W, Götti RP, Stahel RA, Seifert B et al. The European respiratory journal (2011)
    15. [15]
      Re-evaluating the role of palliative radiotherapy in malignant pleural mesothelioma. — Jenkins P, Milliner R, Salmon C European journal of cancer (Oxford, England : 1990) (2011)
    16. [16]
      Malignant mesothelioma of the greater omentum mimicking omental infarction: a case report. — Shin MK, Lee OJ, Ha CY, Min HJ, Kim TH World journal of gastroenterology (2009)
    17. [17]
      The role of radiotherapy in the treatment of malignant pleural mesothelioma. — Waite K, Gilligan D Clinical oncology (Royal College of Radiologists (Great Britain)) (2007)
    18. [18]
      Malignant mesothelioma and the working environment: the viewpoint of the occupational physician. — Porru S, Placidi D, Scotto di Carlo A, Campagna M, Mariotti O, Barbieri PG et al. La Medicina del lavoro (2005)
    19. [19]
      Indications and limitations of radiotherapy in malignant pleural mesothelioma. — Senan S Current opinion in oncology (2003)
    20. [20]
      Malignant mesothelioma of the pleura. The reproducibility of the immunohistological diagnosis. — Betta PG, Andrion A, Donna A, Mollo F, Scelsi M, Zai G et al. Pathology, research and practice (1997)
    21. [21]
      Immunopathology of malignant mesothelioma. — Sheibani K, Stroup RM Pathology (Philadelphia, Pa.) (1996)
    22. [22]
      Radiation associated malignant pleural mesothelioma. — Lerman Y, Learman Y, Schachter P, Herceg E, Lieberman Y, Yellin A Thorax (1991)
    23. [23]
      The role of palliative radiotherapy in malignant mesothelioma. — Bissett D, Macbeth FR, Cram I Clinical oncology (Royal College of Radiologists (Great Britain)) (1991)
    24. [24]
      Diffuse contralateral pulmonary metastases in malignant mesothelioma. An unusual radiographic presentation. — Uri AJ, Schulman ES, Steiner RM, Scott RD, Rose LJ Chest (1988)
    25. [25]
      Immunohistochemistry in the diagnosis of malignant mesothelioma. — Pfaltz M, Odermatt B, Christen B, Rüttner JR Virchows Archiv. A, Pathological anatomy and histopathology (1987)
    26. [26]
      Malignant mesotheliomas. Improved differential diagnosis from lung adenocarcinomas using monoclonal antibodies 44-3A6 and 624A12. — Lee I, Radosevich JA, Chejfec G, Ma YX, Warren WH, Rosen ST et al. The American journal of pathology (1986)
    27. [27]
      The intermediate filament cytoskeleton of malignant mesotheliomas and its diagnostic significance. — Blobel GA, Moll R, Franke WW, Kayser KW, Gould VE The American journal of pathology (1985)
    28. [28]
      Keratins in malignant mesotheliomas and pleural adenocarcinomas: comparative immunohistochemical analysis with polyclonal and monoclonal antibodies. — Bejui-Thivolet F, Patricot LM, Vauzelle JL, Viac J Pathology, research and practice (1984)
    29. [29]
      Malignant pleural mesothelioma. — Vaglini M, Bozzetti F, Viganotti G Tumori (1978)
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