Pleural mesothelioma appears as a firm, grayish tumor that settles on the pleural surfaces that cover the lung and line the inner surface of the chest wall. It also develops hidden nodules and a buildup of fibrous tissue. It may completely blanket the lung with a rind of tumor that can be as thick as five centimeters even though the tumor has only slightly penetrated the bulk of the lung.
During the early stages, the tumor invades the chest wall, the fluid-filled sac surrounding the heart and the diaphragm. There can also be involvement of the lymph nodes in the area between the lungs.