Extent Of Local Tumour Spread

Border: pushing/infiltrative.

Lymphocytic reaction: prominent/sparse.

The TNM classification applies to pleural mesothelioma only.

pTis carcinoma in situ pT1 tumour involves ipsilateral parietal (mediastinal, diaphragmatic) pleura a. no involvement of visceral pleura b. focal involvement of visceral pleura pT2 tumour involves ipsilateral pleural surfaces with also any of: confluent visceral pleural tumour, invasion of the diaphragmatic muscle or lung parenchyma pT3* tumour involves ipsilateral pleural surfaces with also any of: invasion of endothoracic fascia, mediastinal fat, solitary chest wall soft tissue focus, non-transmural pericardial involvement pT4t tumour involves ipsilateral pleural surfaces with also any of: contralateral pleura, peritoneum, rib, extensive chest wall or medi-astinal invasion, myocardium, brachial plexus, spine, transmural pericardium, malignant pericardial effusion.

Spread is typically pleural, encasing the lung with extension along fissures and septa and into subpleural lung parenchyma. Nodal spread and distant metastases (up to 30% of cases) occur late in the disease course.

Contiguous spread through the diaphragm with involvement of abdominal organs is not infrequent.

*Locally advanced but potentially resectable tumour. fLocally advanced but technically unresectable tumour.

Tumour involves ipsilateral parietal pleura with or without focal involvement of visceral pleura a. Tumour involves ipsilateral partietal (mediastinal, diaphragmatic) pleura. No involvement of visceral pleura b. Tumour involves ipsilateral parietal (mediastinal, diaphragmatic) pleura, with focal involvement of visceral pleura

Figure 18.1. Pleural malignant mesothelioma. |W

Figure 18.2. Pleural malignant mesothelioma. |W

Tumour involves any of the ipsilateral pleural surfaces, with at least one of the above:

Figure 18.3. Pleural malignant mesothelioma. |W

Tumour involves any of the ipsilateral pleural surfaces, with at least one of the above:

Figure 18.3. Pleural malignant mesothelioma. |W

Peritoneal disease is usually secondary to pleural tumour but can also be primary and asbestos related. Pericardial disease usually represents spread from pleural tumour.

Flat or granular pleura adjacent to tumour nodules may show cyto-logical atypia constituting "mesothelioma in situ" and, although unusual in pleural biopsies, this can be a useful indicator of potential for progression to invasion or concurrent tumour.

5. LYMPHOVASCULAR INVASION

Present/absent. Intra-/extratumoral.

6. LYMPH NODES

Site/number/size/number involved/limit node/extracapsular spread. Regional nodes: intrathoracic, internal mammary, scalene, supraclavicular.

pN0 no regional lymph node metastasis pN1 metastasis in ipsilateral bronchopulmonary and/or hilar lymph node(s), including involvement by direct extension pN2 metastasis in subcarinal lymph node(s) and/or ipsilateral internal mammary or mediastinal lymph node(s) pN3 metastasis in contralateral mediastinal, internal mammary, hilar node(s), and/or ipsilateral or contralateral scalene or supraclav-icular lymph node(s).

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