Diffuse malignant pleural mesothelioma in an urban hospital: Clinical spectrum and trend in incidence over time

Abstract

This retrospective analysis reviews the clinical experience of a major urban referral hospital with diffuse malignant pleural mesothelioma during the 14-year period from 1973 through 1986. Seventy-five cases of definite or equivocal mesothelioma were identified. There were four cases of primary malignant peritoneal mesothelioma, seven cases of benign fibrous mesothelioma, and 64 cases of diffuse malignant pleural mesothelioma. In 43 cases (67%) of diffuse malignant pleural mesothelioma, there was historic evidence of asbestos exposure. In 21 cases (33%), there was no known history of asbestos exposure. An increase in annual incidence of diffuse malignant pleural mesothelioma was observed over the study period, from three cases in 1973 to ten cases in 1986. Despite greater awareness of this disease, the diagnosis remains a difficult one to establish given the nonspecific symptoms, signs and radiographic appearance, variable histologic appearance, and poor diagnostic sensitivity and specificity of thoracentesis and closed pleural biopsy. Thoracotomy, thoracoscopy, and CT-guided needle biopsies gave higher yields and are the diagnostic measures of choice when diffuse malignant pleural mesothelioma is suspected.

Diagnosis and Prognostic Factors in Malignant Pleural Mesothelioma: A Retrospective Analysis of Sixty-Five Patients

“…These data could not therefore be used for multivariate analyses on survival. Most centers now use computerized axial tomography for routine staging, and as one of several diagnostic tools [18,19,20].…”

“…4 patients with stage-1 disease were treated surgically without any other therapy. Their median survival time was 14 months (range [7][8][9][10][11][12][13][14][15][16][17][18][19][20] (table 2) were clinical stage I, maxi mum tumor diameter <5 cm, performance status WHO ¿1, and diagnostic delay from first symptom to histologi cal diagnosis > 6 months, or asymptomatic. Gender (p = 0.943), age (p = 0.64), histological subtype (p = 0.424), smoking history (p = 0.225), asbestos exposure (p = 0.780), dyspnea (p = 0.809), cough (p = 0.129) and pain (p = 0.891) were not prognostically significant.…”

Non-occupational malignant pleural mesothelioma due to asbestos and non-asbestos fibres

“…The incidence of malignant pleural mesothelioma (MPM), one of the most aggressive and yet incurable human malignancy that was virtually unknown until the second half of the 20 th century, has rapidly increased due to the widespread mining and industrial use of asbestos in many western countries [1,2]. The causal relationship between asbestos exposure and MPM has been proven by a number of epidemiologic surveys, case reports, and experimental studies [3][4][5][6][7][8][9][10][11][12]. Despite the International Agency for Research on Cancer having acknowledged the carcinogenic effect of asbestos on the basis of previous studies [13][14][15], in Italy the use of this mineral was definitively prohibited from 1992, whereas other European countries have adopted measures to drastically decrease the use asbestos throughout Europe [16].…”