Malignant pleural mesothelioma (malignant pleuralmesothelioma, MPM) is the primary organization in the pleural mesothelial a rare cancer of the pleura, its high degree of malignancy, the lack of effective treatment and poor prognosis. Malignant pleural mesothelioma (malignant pleuralmesothelioma, MPM) is the primary organization in the pleural mesothelial a rare cancer of the pleura, its high degree of malignancy, the lack of effective treatment and poor prognosis. In recent years many countries, especially in Western industrial countries showed an upward trend in the incidence of major health threat, to be aroused our attention, is on the clinical treatment of MPM progress summarized below.

1 incidence

2 O in the early MPM was the first report, 6 O in contact with asbestos and the relationship between the MPM was confirmed that the report of its incidence rate increased gradually, because the incidence of MPM incubation period can be achieved for decades, so strictly limit the use of asbestos 30 ~ 4O years of time, the incidence rate will continue to increase. In the United Kingdom, is expected in 2010 and 2020 will reach between the peak incidence in each of MPM led to the death toll could reach a maximum of about 2,700 people. Now the United States each year about 3,000 patients were diagnosed with MPM E. Zhang Jianguo, such as the domestic from 1980 to 1999 reported 382 cases of MPM 1 for statistical analysis: Men 908 cases, 474 cases of women, men and women ratio was 1.92:1, the age of 15 to 83-year-old, of which 45 ~ 6 O-year-old accounted for 61.2, Average 47-year-old.

2 causes

MPM 2.1 asbestos exposure and about the relationship between the 8 O MPM cases were considered in the environmental and occupational exposure on all kinds of asbestos fibers, blue: brown asbestos: chrysotile ratio of 500:100:1 E. MPM led to the current asbestos on the mechanism although there are physical stimulation theory, theory and the dissolution of molecular mechanisms, but the exact mechanism is unclear, and 2 O cases without a clear professional reasons, was considered the relevant factors and the etiology: including non-contact Industrial fibers such as wool and zeolite contact monkey virus 40 (SV40), and so on.

2.2 SV40 and the relationship between SV4O MPM is a monkey-derived within the DNA tumor virus believed to be infected by the spread of polio vaccine to humans in recent years, the human MPM specimens found SV40 in the homologous gene sequences And experimental animals can be induced by subcutaneous injection of SV40 is a MPM], there are studies that SV4O and the people of asbestos in the mesothelial cells malignant transformation may have synergies. MPM now SV4O in the etiology of great concern, and that this may have developed a new treatment methods. But there are many recent results indicate that SV40 was infected with the polio vaccine and there was no correlation between MpM relations.

2.3 MPM other factors lead to other possible factors tuberculous pleural scarring, chronic inflammation, infection, radiation, non-specific history of exposure to industrial compounds and genetic factors. On the relationship between smoking and MPM is generally believed that smoking does not increase the incidence of MPM, but will the deterioration.

3 pathological type

Because of skin on the morphology of the characteristics of two-way division, mesothelioma cells can differentiate into shape, but also can be turned into fibroblast cells normally form the basis of tumor growth pattern and shape will be roughly divided into pleural mesothelioma localized and Diffuse, according to cytology morphology and biological behavior is divided into benign and malignant. Is generally believed that localized tissue from the pleura, more benign, a small number of low-grade, vicious coverage ratio varies from diffuse pleural itself, almost all high grade. Limitations of benign pleural mesothelioma often divided into fiber types, epithelial and mixed, diffuse type MPM into sarcoma (12.1), E-(60.6) and mixed.

4 diagnosis

4.1 MPM clinical diagnosis diverse and have a cough, Bieqi, chest pain and other symptoms, imaging examination showed pleural effusion, pleural thickening or pleural nodules, but less specific, the time of diagnosis to be considered, confirmed the need to rely on Histological examination. Percutaneous pleural biopsy and pleural effusion cytology easy, but the diagnosis rate is not high, were reported in the literature for 6 to 38 _8 and 0 to 22 _9], or B-CT-guided pleural more to puncture, The positive rate of increase, but the result is still not satisfactory. Thoracoscopy can peep the whole chest, directly observed lesions the size, distribution and the approach of the organs of the situation and look to take adequate biopsy specimens, literature positive rate of up to 91 ~ 100 Do3, is the diagnosis of MPM The best means

4.2 As early diagnosis of MPM high degree of malignancy, treatment, many patients already in advanced, in recent years, MPM in the early diagnosis and differential diagnosis also had a lot of exploration. Robinson, and so _ I detected 44 cases of patients with MPM of soluble inter-related protein Paper (sol-uble mesothelin-related proteins, SMR) found that 37 cases (84) in patients with elevated concentrations of SMR, and 16 O in the case of cancer or other diseases pleural Patients, only three cases (2) increased, the authors suggest that SMR concentration and the tumor size and progress on, can be used to monitor tumor growth, further study showed that SMR can also be used to infer the incidence of MPM crowd. Although chemical organizations have been widely applied, but there are still 1 O ~ 15 cases of MPM in cancer diagnosis and difficult to distinguish between _ I2]. Malle, such as "MPM found in the effusions, N cadherin increased significantly, but adenocarcinoma of the effusions do not have this expression, and about 9 o cases of adenocarcinoma of E-cadherin protein, the authors also found that healthy seepage Out of CD44 (one of the adhesion molecule) than the expression of malignant effusion increased, those found to be MPM, cancer and benign oozed from the differential to provide a new approach.