Pathophysiology: The 3 major histological types of mesothelioma are sarcomatous, epithelial, and mixed. Pleural mesothelioma usually begins as discrete plaques and nodules that coalesce to produce a sheetlike neoplasm. Tumor growth usually begins at the lower part of the chest. The tumor may invade the diaphragm and encase the surface of the lung and interlobar fissures.
The tumor may also grow along drainage and thoracotomy tracts. As the disease progresses, it often extends into the pulmonary parenchyma, chest wall, and mediastinum. Pleural mesothelioma may extend into the esophagus, ribs, vertebra, brachial plexus, and superior vena cava.
Asbestos is the principal carcinogen implicated in the pathogenesis. The industries associated with asbestos exposure include ship building, construction, ceramics, paper mill, auto parts, railroad and insulation.
Most malignant mesotheliomas have complex karyotypes, with extensive aneuploidy and rearrangement of many chromosomes. A loss of a single copy on chromosome 22 is the most common abnormality.
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