Skip to main content
SpringerLink
Log in

Chirurgische Aspekte des malignen Pleuramesothelioms

Aus Sicht der Pathologie

Surgical aspects of malignant pleural mesothelioma

From the perspective of pathology

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Der Anstieg des Asbestverbrauchs in Deutschland in der Mitte der 1970er Jahre führt dazu, dass Arbeitsmediziner, Pneumologen, Thoraxchirurgen und Pathologen bis 2020 mit einer steigenden Inzidenz und Mortalität von Patienten mit Pleuramesotheliomen zu rechnen haben. Voraussetzung für die kurative operative Therapie ist die pathologisch-anatomische Tumorsicherung anhand der Biopsie und eine möglichst korrekte Stadieneinteilung. Um zu reproduzierbaren Ergebnissen in der Beurteilung maligner Pleuraerkrankungen zu kommen, sollte die pathologisch-anatomische Diagnostik maligner Pleuramesotheliome entsprechend den Richtlinien der „International Mesothelioma Interest Group“ (IMIG) erfolgen. Gegenwärtig verwandte multimodale thoraxchirurgische Therapiekonzepte stellen die pathologisch-anatomische Diagnostik vor neue Aufgaben und Probleme, die im Folgenden vorgestellt werden.

Abstract

The increased use of asbestos in Germany in the mid 1970s led occupational physicians, pulmonologists, thoracic surgeons and pathologists to the expectation of an increasing incidence and mortality in patients with pleural mesothelioma up to 2020. Prerequisite for curative surgery is a pathological anatomical tumor diagnosis on the basis of a biopsy and accurate tumor staging. In order to achieve reproducible results in the assessment of malignant pleural diseases, the pathological anatomical diagnosis of malignant pleural mesothelioma should be made according to the guidelines of the international mesothelioma interest group (IMIG). Currently used multimodal thoracic surgery therapeutic concepts present new challenges and problems to the pathological anatomical diagnosis and are discussed in this article.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Berufskrankheiten-Verordnung (BKV) (1997) Berufskrankheiten-Verordnung vom 31. Oktober 1997 (BGBl. I S. 2623), die zuletzt durch Artikel 1 der Verordnung vom 11.06.2009 (BGBl. I S. 1273) geändert worden ist. Bundesministerium der Justiz in Zusammenarbeit mit der juris GmbH

  2. Bölükbas S, Manegold C, Eberlein M et al (2011) Survival after trimodality therapy for malignant pleural mesothelioma: radical pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy. Lung Cancer 71(1):75–81

    Article  PubMed  Google Scholar 

  3. Wittekind C, Meyer HJ (Hrsg) (2010) TNM, Klassifikation maligner Tumoren. [S.l.]. Wiley-Vch, Weinheim

  4. Betta P, Magnani C, Bensi T et al (2012) Immunohistochemistry and molecular diagnostics of pleural malignant mesothelioma. Arch Pathol Lab Med 136:253–261

    Article  PubMed  Google Scholar 

  5. Bölükbas S, Eberlein M, Kudelin N et al (2012) Factors predicting poor survival after lung-sparing radical pleurectomy of IMIG stage III malignant pleural mesothelioma. Eur J Cardiothorac Surg

  6. Brockmann M (1991) Asbestassoziierte Lungen- und Pleuraerkrankungen – pathologische Anatomie. Pneumologie 45:422–428

    PubMed  CAS  Google Scholar 

  7. Brockmann M, Brockmann I, Fischer M, Müller KM (1990) Reactive lesions of the pleura. Immunohistochemical characterization. Pathol Res Pract 186:238–246

    Article  PubMed  CAS  Google Scholar 

  8. Delgermaa V, Takahashi K, Park E et al (2011) Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008. Bull World Health Organ 89:716–724, 724A–724C

    Article  PubMed  Google Scholar 

  9. Flores RM, Pass HI, Seshan VE et al (2008) Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg 135:620–626, 626.e1–e3

    Article  PubMed  Google Scholar 

  10. Husain AN, Colby T, Ordonez N et al (2013) Guidelines for pathologic diagnosis of malignant mesothelioma: 2012 update of the consensus statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med 137:647–667

    Article  PubMed  Google Scholar 

  11. Kadota K, Suzuki K, Colovos C et al (2012) A nuclear grading system is a strong predictor of survival in epitheloid diffuse malignant pleural mesothelioma. Mod Pathol 25:260–271

    Article  PubMed  CAS  Google Scholar 

  12. Kadota K, Suzuki K, Sima CS et al (2011) Pleomorphic epithelioid diffuse malignant pleural mesothelioma: a clinicopathological review and conceptual proposal to reclassify as biphasic or sarcomatoid mesothelioma. J Thorac Oncol 6:896–904

    Article  PubMed  Google Scholar 

  13. King JE, Thatcher N, Pickering CAC, Hasleton PS (2006) Sensitivity and specificity of immunohistochemical markers used in the diagnosis of epithelioid mesothelioma: a detailed systematic analysis using published data. Histopathology 48:223–232

    Article  PubMed  CAS  Google Scholar 

  14. Lang-Lazdunski L, Bille A, Lal R et al (2012) Pleurectomy/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma. J Thorac Oncol 7:737–743

    Article  PubMed  Google Scholar 

  15. Luschka H (1861) Die Fascia pelvina in ihrem Verhalten zur hinteren Beckenwand

  16. Ordóñez NG (2007) What are the current best immunohistochemical markers for the diagnosis of epithelioid mesothelioma? A review and update. Hum Pathol 38:1–16

    Article  PubMed  Google Scholar 

  17. Ordóñez NG (2012) Mesotheliomas with small cell features: report of eight cases. Mod Pathol 25:689–698

    Article  PubMed  Google Scholar 

  18. Pasello G, Ceresoli GL, Favaretto A (2013) An overview of neoadjuvant chemotherapy in the multimodality treatment of malignant pleural mesothelioma. Cancer Treat Rev 39:10–17

    Article  PubMed  CAS  Google Scholar 

  19. Powell G, Roche H, Roche WR (2011) Expression of calretinin by breast carcinoma and the potential for misdiagnosis of mesothelioma. Histopathology 59:950–956

    Article  PubMed  Google Scholar 

  20. Richards WG, Godleski JJ, Yeap BY et al (2010) Proposed adjustments to pathologic staging of epithelial malignant pleural mesothelioma based on analysis of 354 cases. Cancer 116:1510–1517

    Article  PubMed  Google Scholar 

  21. Roberts F, Harper CM, Downie I, Burnett RA (2001) Immunohistochemical analysis still has a limited role in the diagnosis of malignant mesothelioma. A study of thirteen antibodies. Am J Clin Pathol 116:253–262

    Article  PubMed  CAS  Google Scholar 

  22. Savic S, Franco N, Grilli B et al (2010) Fluorescence in situ hybridization in the definitive diagnosis of malignant mesothelioma in effusion cytology. Chest 138:137–144

    Article  PubMed  CAS  Google Scholar 

  23. Scherpereel A, Astoul P, Baas P et al (2010) Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J 35:479–495

    Article  PubMed  CAS  Google Scholar 

  24. Schirren J, Muley T, Schneider P et al (1998) Behandlungsstrategie beim Pleuramesotheliom. Langenbecks Arch Chir Suppl Kongressbd 115:498–506

    PubMed  CAS  Google Scholar 

  25. Sheaff M (2011) Should cytology be an acceptable means of diagnosing malignant mesothelioma? Cytopathology 22:3–4

    Article  PubMed  CAS  Google Scholar 

  26. Sugarbaker DJ, Wolf AS (2010) Surgery for malignant pleural mesothelioma. Expert Rev Respir Med 4:363–372

    Article  PubMed  Google Scholar 

  27. Travis WD (2004) Pathology and genetics of tumours of the lung, pleura, thymus, and heart. IARC Press, Lyon, p 344

  28. Tsujimura T, Torii I, Sato A et al (2012) Pathological and molecular biological approaches to early mesothelioma. Int J Clin Oncol 17:40–47

    Article  PubMed  CAS  Google Scholar 

  29. Whitaker D (2000) The cytology of malignant mesothelioma. Cytopathology 11:139–151

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Institut für Pathologie und Zytologie, Dr.-Horst-Schmidt-Klinik (HSK-Klinik), Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland

    A. Fisseler-Eckhoff

Authors
  1. A. Fisseler-Eckhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Fisseler-Eckhoff.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fisseler-Eckhoff, A. Chirurgische Aspekte des malignen Pleuramesothelioms. Chirurg 84, 479–486 (2013). https://doi.org/10.1007/s00104-012-2431-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-012-2431-6

Schlüsselwörter

Keywords

Search

Navigation