recent concepts in pleural mesothelioma

malignant mesothelioma is one of the difficult diseases that doctors, patients, and families have to face. It is almost always caused by inhalation of asbestos fibres particularly crocidolite fibers.Simian virus 40 (SV40) has also been implicated in the etiology of some malignant mesothelioma. In the United States, at least 60% of human mesotheliomas express SV40 .Somatic genetic changes has been revealed in human malignant mesotheliomas. These changes implicate a multistep process of tumor genesis. Loss of a copy of chromosome 22 is one of the most frequent changes seen in human malignant pleural mesothelioma .Diffuse malignant pleural mesothelioma is classified into four histological types: pure epithelial (tubopapillary), pure mesenchymal (sarcomatous) or a mixture of the two (biphasic) and desmoplastic.In Egypt, the malignant pleural mesothelioma affects mainly middle aged patients. This may be referred to early childhood and adulthood heavy exposure to most dangerous type of asbestos like corcidolite .CT is the primary imaging modality used for the evaluation of MPM and to differentiate between malignant and benign pleural disease and determine criteria for unresectability. A tumor surrounding more than 50% of a mediastinal structure is suggestive of unresectability .The advantage of perfusion CT is its simple quantification and its wide availability. However, the disadvantages, such as high radiation exposure or side effects from iodinated contrast material, limit the use of perfusion CT in both research and clinical settings.