Biomarkers for Predicting Malignant Pleural Mesothelioma in a Mexican Population

Background: Diagnosis of malignant pleural mesothelioma (MPM) remains a challenge, especially when resources in pathology are limited. The study aimed to evaluate cost-effective tumor markers to predict the probability of MPM in plasma samples in order to accelerate the diagnostic workup of the tissue of potential cases. Methods: We conducted a case-control study stratified by gender, which included 75 incident cases with MPM from three Mexican hospitals and 240 controls frequency-matched by age and year of blood drawing. Plasma samples were obtained to determine mesothelin, calretinin, and thrombomodulin using enzyme-linked immunosorbent assays (ELISAs). We estimated the performance of the markers based on the area under the curve (AUC) and predicted the probability of an MPM diagnosis of a potential case based on the marker concentrations. Results: Mesothelin and calretinin, but not thrombomodulin were significant predictors of a diagnosis of MPM with AUCs of 0.90 (95% CI: 0.85-0.95), 0.88 (95% CI: 0.82-0.94), and 0.51 (95% CI: 0.41-0.61) in males, respectively. For MPM diagnosis in men we estimated a true positive rate of 0.79 and a false positive rate of 0.11 for mesothelin. The corresponding figures for calretinin were 0.81 and 0.18, and for both markers combined 0.84 and 0.11, respectively. Conclusions: We developed prediction models based on plasma concentrations of mesothelin and calretinin to estimate the probability of an MPM diagnosis. Both markers showed a good performance and could be used to accelerate the diagnostic workup of tissue samples in Mexico.

[Tracheal stenosis as a initial manifestation of relapsing polychondritis. Case report]

Relapsing polychondritis is a rare multisystemic disease, of unknown origin, characterized by recurrent swelling, destruction of cartilages and connective tissue mainly of the ear and nose cartilages. Complications of the airways (laryngeal and tracheal stenosis) occur late in the disease. We present a case of a male with relapsing polychondritis which appeared initially as a tracheal stenosis (laryngeal stridor, exertional dyspnea) followed by cutaneous lesions, swelling of the ear and nose cartilage (deformity of nose septum in the shape of a saddle). Computerized tomography of the neck showed a decrease in diameter of the trachea about 50%, bronchoscopy revealed a concentric diminution of the tracheal lumen about 50% that involved the right and left main bronchi. A biopsy of the ear cartilage showed signs of chondritis. The patient responded satisfactorily to steroids and dilatation of stenosis; however, one year later he died of respiratory insufficiency. Tracheal stenosis is a sign of ominous prognosis in relapsing polychondritis.