**2. Incidence**

The incidence of malignant pleural mesothelioma was increasing and reached a peak in the years 2000-2005 in the United States, because of the large number of individuals who were exposed to asbestos during the 1930s to 1960s in asbestos mines and asbestos-related indus‐ tries, before the causal relationship between asbestos and malignant pleural mesothelioma was

© 2013 Asteriou et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

recognized [7]. The recent decline in incidence is attributable to declining asbestos exposure, and this trend is expected to continue [2]. On the other hand, asbestos use in Western Europe remained high until 1980, and substantial quantities are still used in several European countries. Peto et al. suggested that for the period 1995–2029 the number of men dying from mesothelioma in Western Europe each year will almost double over the next 20 years, from 5,000 in 1998 to about 9,000 around 2018, and then decline, with a total of about a quarter of a million deaths over the next 35 years [8]. The highest risk will be suffered by men born around 1945–50, of whom about 1 in 150 will die of mesothelioma. These projections are based on the fit of a simple age and birth cohort model to male pleural cancer mortality from 1970 to 1989 for six countries (Britain, France, Germany, Italy, The Netherlands and Switzerland) which together account for three-quarters of the population of Western Europe [8]. According to Surveillance, Epidemiology and End Results (SEER) Program data, the incidence of malignant mesothelioma in the United States is estimated to be between 1-2/million in states with minimal exposure to mineral fibers and 10-15/million in states where large amounts of asbestos were used [9]. The latest data available show that malignant mesothelioma is responsible for approximately 3,000 deaths per year in the United States and an additional 5,000 deaths in Western Europe [10], [11]. The latency period, which is the interval between first exposure and the development of malignant mesothelioma, ranges from about 25 to 71 years and appears to be influenced by the amount of exposure, because workers in trades with higher amounts of exposure may experience shorter latencies compared to those exposed to lower amount of asbestos [11], [12]. It is of crucial importance for the Thoracic Surgeons to be fully informed about malignant pleural mesothelioma in order to reach the correct diagnosis and recommend the appropriate treatment when dealing with it.

asbestos production and has been mined principally in Russia, Canada (Quebec Province), South Africa, Italy, and Cyprus [17]. Chrysotile itself is not thought to cause malignant pleural mesothelioma but is often contaminated with amphibole fibers, such as tremolite or amosite [18], [19]. However, the issue of chrysotile as a cause of malignant mesothelioma remains still

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Individuals can be exposed to asbestos in many situations because of its widespread use [17], [20]. However, the areas of the world that have a high incidence of malignant pleural meso‐ thelioma are those with asbestos mines and countries that have shipyards, insulation, con‐ struction, and automobile industries that use large amounts of asbestos [17], [21–23].Regarding tobacco use, there is no evidence that smoking increases the risk of development of malignant mesothelioma [1], [24]. On the other hand, past radiotherapy is considered as a risk factor from

The right pleural cavity is more commonly involved than the left. In the early stages of the disease, the tumour often appears as multiple nodules on the surface of the visceral and parietal pleurae [1]. Occasionally, a localized pleural mass may develop but more often the nodules coalesce to form a sheet of tumour which surrounds the lung, extends along the fissures and may invade the underlying parenchyma [1]. Pericardial and diaphragmatic invasion are common. Bronchial invasion, usually by spread from the pleura near the hilum, is uncommon and may lead to diagnostic confusion if tumour is visible at bronchoscopy [26]. At post-mortem examination, distant metastases are common, occurring in about two-thirds of the cases with sarcomatoid type and one-third of the patients with the epithelioid and mixed types [26].

Diffuse malignant mesothelioma is divided into three main histological types: epithelioid which is most common, sarcomatoid and mixed or biphasic. The epithelial variety displays several patterns including tubulopapillary and glandular [1]. Histochemical and immunohis‐ tochemical stains assist in differentiating epithelioid mesothelioma from adenocarcinoma, the

A small number of localized serosal/subserosal neoplasms with histopathologic, histochemi‐ cal, immunohistochemical, and ultrastructural features identical to those of diffuse malignant mesothelioma have been described and given the designation ''localized malignant mesothe‐ lioma'' [28]. Crotty et al first described a series of 6 localized malignant mesotheliomas in 1994 [28]. Localized malignant mesotheliomas are extremely rare solitary circumscribed nodular tumors, attached either in a sessile or pedunculated manner to the surface of the pleura [29]. Most localized malignant mesotheliomas present as incidental findings or with nonspecific symptoms. Epithelial-type localized malignant mesotheliomas predominate, and very few tumors are purely sarcomatous [29]. However, as opposed to ordinary diffuse malignant mesotheliomas where epithelial forms have a better prognosis than sarcomatous forms and biphasic forms are intermediate, histologic subtype does not correlate with survival [29]. Tumor size also does not appear to affect the clinical course [28]. Because of the vastly different

most common and difficult differential diagnosis [27].

controversial [17–19].

case series [1], [25].

**4. Biological behavior**
