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Mesotheliomas are uncommon tumours arising from the mesothelial surface (pleura, peritoneum, and rarely from sites such as the pericardium and tunica vaginalis testis). Diffuse mesotheliomas are invariably malignant. At the time of presentation, pleural mesothelioma usually is often confined to the thorax, however, disease typically contaminates the entire pleural cavity and pleural effusion is common. Later, there is extension to the chest wall, mediastinum and encasement of the lung with a thick rind of tumour. Regional lymph nodes may become involved. Extension through the diaphragm may cause peritoneal involvement and ascites. Hematogenous metastases are uncommon but may be seen particularly in patients surviving longer than average.

Patients may present with chest pain, dyspnea and cough. The referring clinical problem may be pleural effusion of unknown etiology. Advancing disease causes respiratory insufficiency, chest wall pain, cardiovascular complications from invasion of the heart and general constitutional deterioration.

(Revised May 2001)