Sample Types In The Diagnosis Of Mesothelioma

April 11, 2011 by Ann-Marie Waters · Leave a Comment
Filed under: Drugs and Treatment 

Depending on the type of mesothelioma and clinical presentation, there are several samples that may independantly and collectively be examined to diagnose mesothelioma. Optimisation of sampling is crucial as it can greatly affect and inhance the pathpologist’s ability to offer a correct diagnosis.

Although wedge biopsies – and even open biopsy via thoractomy – are sometimes required to establish a diagnosis for mesothelioma, there are several less invasive forms of sampling which may be diagnostic in some settings.

These latter samples are discussed as below:

Effusion Fluid

When a serous effusion is present an adequate sample (preferably over 50ml of fluid) should be collected and sent to the cytology laboratory; this will enable smears and a cell block to be prepared. In addition, som of the cell deposit can be set aside for ultrastructural examination. A definate diagnosis of malignant mesothelioma can be made on cytology of effusions in the majority of cases.

 

 

Closed Needle Biopsy

Although taking a close needle biopsy (of the Abrahams’ type) at the time of tapping the effusion was the standard practice in the past, there has been a reduction in this form of sampling related to a significant proportion of inadequate or inconclusive biopsies. The high diagnostic yield from effusion cytology has probably also influenced this decline.

 

 

Fine Needle Aspiration (FNA)

Over the past years – there has been an increase in thin core sampling for plueral-based lesions, especially where there is no accompanying serous effusion. This procedure is well tolerated by patients who require only a simple local anaesthetic.

 

 

 

Lung Disorders Associated With Dyspnea – Cancer, Mesothelioma

February 20, 2011 by Ann-Marie Waters · Leave a Comment
Filed under: Dyspnea 

 

It has been estimated that 49% of cancerpatients reported dyspnea as one of their symptoms. Dyspnea is particularly a common complaint among individuals with lung cancer and mesothelioma but can  also be a manifestation of other illnesses such as asthma and COPD.

 

 

 

 

What is Dyspnea?

Dyspnea is a breathing condition that is caused by labored breathing. The patient with dyspnea may feel like he or she is suffocating or fighting for air. Dyspnea often requires emergency treatment but the intensity and the level of laboured breathing can vary in intensity. Mesothelioma patients are more likely to experience a pleural effusion (a build of fluid in the lungs)  and the evacuation of any fluid build up will alleviate symptoms but may the fluid may re-cur.

 

Causes of Shortness of breath can come from various places in the lung due to the following complaints:

1. Channels disease Breath -> asthma, emphysema Adult respiratory distress syndrome (ARDS)

2. Parenchyma Disease

3. Pulmonary Vascular Disease -> Primary Pulmonary Hypertension

4. Pleural diseases -> Pneumothorax, Disease Wall lunktrauma,

5. Chronic bronchitis, CHF, Cor pulmonary, pleural effusion, bone abnormalities

6. Pneumonia, pulmonary embolism, hemotoraks, neurologic

7. Laryngeal obstruction, pulmonary infiltrates with eosinophilia (PIE). Venooklusi lung disease, fibrosis.

8. Lung cancer, Mesothelioma.

 

Severity of Dyspnea is usually determined by Hugh-Jones classification that is classified as follows:

- First Degree: work looks the same as those who have the same age, walking, climbing stairs may be like other healthy people.

-  Second Degree: even if obstruction is not obtained, the patient is unable to walk like other people the same age.

- Third degree: although not able to walk like a healthy person in normal levels, patients can still walk a mile or more to pace yourself.

- Fourth Degree: people walk 50 m or more in need of a break or not to continue it.

- Fith degree: shortness of breath occurs when changing clothes or rest, and the person is usually unable to leave home.

 

 Sudden onset of  dyspnea (over several hours) in otherwise healthy patients diagnosis:

• Channel respiratory (acute asthma attack),

• Parenchymal lung (acute pulmonary edema or acute infectious processes such as bacterial pneumonia),

• Pleural cavity (pneumothorax)

• Vascularization lungs (pulmonary embolism)

 

Presentation of sub acute (over several days to weeks) diagnosis:

• Exacerbation of existing respiratory disease before (asthma or chronic bronchitis)

• Infection parenkimal running slow (Pneumocystis carinii pneumonia in AIDS patients, mycobacterium or fungal pneumonia)

• Non-infectious inflammatory processes that run relatively slow (Wegener’s granulomatosis, eosinophilic pneumonia, bronchiolitis obliterans with organizing pneumonia, etc.)

• Neuro muscular disease (Guillain-Barre ‘syndrome, myasthenia gravis),

• Pleural disease (pleural effusions with various causes of heart disease or chronic)

 A chronic presentation (i.e. months to years) is often indicated for chronic obstructive pulmonary disease, chronic interstitial lung disease, or heart disease.

 

Dyspnea Treatment:

Surgery

Surgical removal of  Tumour, obstruction

Pleural Effusion

Drainage of fluid build-up in the lung

Oxygen Therapy

O2 Therapy is one of the respiratory therapies to maintain adequate tissue oxygenation. The main objective of O2 is (1) to overcome the state of hypoxemia in accordance with the results of Blood Gas Analysis, (2) to reduce the work of breath and reduce myocardial work.