Diagnosis of pleural malignant mesothelioma by EUS-guided FNA (with video)

 CommentaryMesothelioma may affect the pleura, peritoneum, or pericardium and usually is caused by exposure to asbestos. The ancient Greeks and Romans already knew that asbestos caused lung disease in slaves that wove the material into cloth, and asbestos became one of the first accepted environmental causes of malignancy. As gastroenterologists, we are most familiar with the presentations of peritoneal mesothelioma, but as endosonographers increasingly working in parts of the body previously unexplored by us, we have much to learn. In this particular case, EUS with FNA was the only technique that made the diagnosis, and so we contributed a great deal of understanding about the nature of this unfortunate patient's illness. We, in turn, have yet to learn where this technique stands in relation to other current means of diagnosis. The terms sensitivity, specificity, positive predictive value, and negative predictive value come to mind but await an n >1. We also need to know the diagnostic yield and incidence of tumor seeding in the track of the FNA needle compared with that of image-guided core biopsies. As for calretinin, this is a calcium-binding protein that is a member of the family of so-called EF-hand proteins, an EF-hand unit having 2 helices approximately perpendicular to each other and connected by a loop. Calretinin is detected in most malignant mesothelioma but also may be seen in sex cord-stromal tumors and some adenocarcinomas, especially colon and pancreas. Asbestosis is named for the Greek word for inextinguishable, having to do with its inability to be consumed by a flame. Unfortunately, this patient's life soon will be extinguished by the tumor associated with this inextinguishable group of silicate minerals.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(08)01855-5

doi: 10.1016/j.gie.2008.05.034

© 2008 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.