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Abstract
Malignant mesothelioma is an aggressive tumor that arises from the mesothelial surfaces of the pleural and the peritoneal cavities, and less commonly from the pericardium and the tunica vaginalis. Malignant pleural mesothelioma (MPM) is a highly aggressive tumor with a poor survival rate. Previously, it was considered as a rare tumor, but in the last few years, its incidence showed a considerable increase, thus it has become a very important public health issue(Bendayan and Kramer, 2006 and Scherpereel et al., 2006 ) .
Asbestos exposure is the main factor involved in the pathogenesis of MPM. The screening and the diagnosis of MPM in the subjects exposed to asbestos are difficult because the disease may occur up to 30 to 40 years after exposure. The use of pleural biopsies for the differentiation between MPM, pleural benign diseases and pleural metastasis of adenocarcinoma may be difficult in some cases even with the use of immunohistochemistery . Thus it’s thought that diagnosis and management of MPM would be improved if guided by reliable markers (Scherpereel et al., 2006 ) .
A potentially reliable marker in mesothelioma diagnosis is mesothelin – also called soluble mesothelin related protein (SMRP)–which is a glycosyl phosphatidyl inositol (GPI) linked membrane protein of 40 KDa. Mesothelin is expressed by normal mesothelial cells, however, it’s highly over-expressed in malignant mesothelioma. It can be detected in the blood and the pleural fluid ( Hassan et al., 2007 ) . Elevated amounts of SMRP have already been reported in sera and pleural effusions from mesothelioma patients providing a useful diagnostic marker for MPM. Serum level of SMRP is elevated in 84% of patients with mesothelioma and fewer than 2% of patients with other lung diseases. Effusion levels have a sensitivity of 67% and a specificity of 98% for distinguishing mesothelioma from non malignant effusions. Its diagnostic value was similar in both types of samples, but pleural fluid SMRP may better discriminate primary mesothelioma from pleural metastasis (Bendayan and Kramer, 2006, Creaney et al, 2007 and Sapede et al., 2008. SMRP level parallels the progression and the resection of the tumor, therefor it could be used in monitoring therapy and diagnosing mesothelioma earlier than conventional methods. Early diagnosis could reduce the costs of subsequent hospitalizations and investigations and provide the opportunity for early treatment by using new treatment regimens which have been proved to be of some value (Bendayan and Kramer, 2006 and Creaney et al, 2007 ) .