One study is called, “Immunohistochemical reactivity in mesothelioma and
adenocarcinoma: A stepwise logistic regression analysis” by Annika
Dejmek, Anders Hjerpe - 1994 Acta Pathologica, Microbiologica et
Immunologica Scandinavica – APMIS Volume 102, Issue 1-6, pages 255–264,
January 1994. Here is an excerpt: “Histological sections from 103
malignant mesotheliomas and 43 adenocarcinoma metastases in pleural
biopsies were investigated for reactivity against a panel of 11
different antibodies. The size of the material allowed the evaluation by
stepwise logistic regression analysis, which selected five parameters
of major importance: vimentin reactivity in epithelial cells, reactivity
to low-molecular-weight keratins in fibrous cells, strong membrane
accentuation of EM A reactivity, and lack of reactivity to LeuM1 and
BerEp4.
Three of these criteria were sufficient to identify a
mesothelioma with high specificity and with a sensitivity of
approximately 70%. Whilst the monoclonal anti-CEA tested was the most
valuable single parameter, it did not add any diagnostic information to
the combination of criteria selected by the stepwise logistic regression
analysis. However, this antibody can be used to exclude most of the
adenocarcinomas from further analysis with the more extensive panel.”
Another study is called, “Ectopic thymoma mimicking diffuse pleural
mesothelioma: A case report” - Volume 29, Issue 4, Pages 409-410 (April
1998) by Hiroaki Fushimi, MD, Yoshiro Tanio, MD, Kiyoshi Kotoh, MD. Here
is an excerpt: “Abstract - A case of ectopic thymoma of the pleura with
a particular growth pattern mimicking diffuse pleural mesothelioma is
reported. Diagnostic imaging showed that the pleural tumor encased the
entire left lung.
The specimen biopsied from the tumor was composed of
lymphocytes and epithelial cells, consistent with the mixed type of
thymoma. The autopsy found no evidence of a mediastinal tumor. An
involuted thymus was found in the parietal pleural tissue adhered to the
apex of the left lung. The thymoma was thought to originate from the
ectopic thymic tissue in the parietal pleura, as a lesion independent
from the primary mediastinal thymoma, and spread along the pleura like
diffuse mesothelioma.
Another study is called, “Dose-Dependent Pulmonary Toxicity After
Postoperative Intensity-Modulated Radiotherapy for Malignant Pleural
MesotheliomaPresented at the 48th Annual Meeting of the American Society
for Therapeutic and Radiation Oncology (ASTRO), Philadelphia, PA,
November 5–9, 2006. - International Journal of Radiation Oncology
Biology Physics - Volume 69, Issue 2 , Pages 350-357, 1 October 2007 by David C. Rice, M.B., B.Ch. Affiliations - Department of Thoracic and
Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer
Center, Houston, TX. Here is an excerpt: “Purpose: To determine the
incidence of fatal pulmonary events after extrapleural pneumonectomy and
hemithoracic intensity-modulated radiotherapy (IMRT) for malignant
pleural mesothelioma. Methods and Materials: We retrospectively reviewed
the records of 63 consecutive patients with malignant pleural
mesothelioma who underwent extrapleural pneumonectomy and IMRT at the
University of Texas M. D. Anderson Cancer Center. The endpoints studied
were pulmonary-related death (PRD) and non–cancer-related death within 6
months of IMRT.
Results: Of the 63 patients, 23 (37%) had died within 6 months of IMRT
(10 of recurrent cancer, 6 of pulmonary causes [pneumonia in 4 and
pneumonitis in 2], and 7 of other noncancer causes [pulmonary embolus in
2, sepsis after bronchopleural fistula in 1, and cause unknown but
without pulmonary symptoms or recurrent disease in 4]). On univariate
analysis, the factors that predicted for PRD were a lower preoperative
ejection fraction (p = 0.021), absolute volume of lung spared at 10 Gy
(p = 0.025), percentage of lung volume receiving e20 Gy (V20; p =
0.002), and mean lung dose (p = 0.013). On multivariate analysis, only
V20 was predictive of PRD (p = 0.017; odds ratio, 1.50; 95% confidence
interval, 1.08–2.08) or non–cancer-related death (p = 0.033; odds ratio,
1.21; 95% confidence interval, 1.02–1.45).
Conclusion: The results of our study have shown that fatal pulmonary
toxicities were associated with radiation to the contralateral lung. V20
was the only independent determinant for risk of PRD or
non–cancer-related death. The mean V20 of the non-PRD patients was
considerably lower than that accepted during standard thoracic
radiotherapy, implying that the V20 should be kept as low as possible
after extrapleural pneumonectomy.
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