Mesothelioma: Update on diagnostic strategies

Malignant pleural mesothelioma (MPM) is a rare, highly aggressive malignancy involving the serosa of the pleura and peritoneum. The relationship between asbestos and mesothelioma was established in the 1960s; nearly a century after industrial production of asbestos began in the 1850s. Given the protean clinical manifestations and poor prognosis of MPM, a prompt, accurate diagnosis challenges clinicians in distinguishing MPM from benign asbestos pleural effusions and metastatic carcinomas. In this review, we present a patient with MPM and then review the emerging epidemiologic trends and clinical manifestations. Our primary focus is to review the accumulating evidence supporting an important role for cytopathologic immunostains and serum biomarkers in the diagnosis and management of MPM.