PROBLEMS OF DIAGNOSIS AND THERAPY IN MALI GNANT PLEURAL MESOTHELIOMA

The incidence of malignant pleural mesothelioma increased continuously during recent years. This is related to widespread use and processing of asbestos in the last decades. Characteristical symptoms like dyspn ea, cough and thoracic pain are common in almost all pulmonal diseases . Therefore the possible occurrence of a pleural tumor is often neglec ted. This leads to a delay between onset of symptoms and the establish ment of diagnosis. With X-ray and computed tomography 80% of the pleur al tumors can be proved. Only in few cases the histopathological analy sis of the pleural fluid leads to diagnosis. However, thoracoscopy or thoracotomy remain the most reliable means of obtaining a definitive t issue diagnosis. At the time of operation advanced stages are found in many cases, therefore palliative surgery is indicated. Due to high mo rbidity and mortality pleuropneumonectomy should be done only in selec ted patients. Pleurectomy or pleurodesis is often sufficient to releas e patients' symptoms. Chemotherapy and radiation have not proven effec tive in controlling malignant mesothelioma. In conclusion pleural meso thelioma remains a tumor with a very poor prognosis. Long term surviva l is occasional even in case of multimodal treatment.