Malignant (Diffuse) Mesothelioma in Patients With Hematologic Malignancies: A Clinicopathologic Study of 45 Cases

Abstract

Context.-Ionizing radiation has a role in the development of malignant mesothelioma, in several epidemiologic studies, including patients with hematologic malignancies.Objective.-To study the clinicopathologic characteristics of patients with malignant mesothelioma and hematologic malignancies with and without a history of radiotherapy.Design.-From a database of approximately 3600 patients with malignant mesothelioma, we identified 45 patients (1%) who also had hematologic malignancies. We examined clinicopathologic features and noted whether the patient had received radiotherapy for malignancy, comparing those with and those without such exposure.Results.-Among the 45 cases, 18 (40%) had Hodgkin lymphoma, 15 (33%) had non-Hodgkin lymphoma, 10 (4%) had chronic lymphocytic leukemia, and 2 (22%) had chronic myelogenous leukemia; 20 patients (44%) had a history of radiotherapy, and 23 (51%) did not. Most patients with Hodgkin lymphoma (16 of 18; 90.0%) received radiation, whereas none of the patients with leukemia (0 of 12) and only 20% (3 of 15) of the patients with non-Hodgkin lymphoma did so. Patients without radiation were older than patients who received radiotherapy (median, 73 versus 54 years, respectively; P , .001), had a shorter interval from diagnosis of hematologic malignancy to that of mesothelioma (median, 2 versus 24 years, respectively; P , .001), and had a shorter survival period (median, 6.0 versus 14.0 months, respectively; P ¼ .02). Epithelial mesotheliomas were proportionately more common in patients with a history of radiotherapy.Conclusions.-Patients with mesothelioma and hematologic malignancies with a history of radiation tended to be younger, had a longer interval from diagnosis of hematologic malignancy to that of mesothelioma, had a longer survival period, and were more likely to have the epithelial variant compared with patients without radiotherapy.

Novel systemic therapy against malignant pleural mesothelioma

“…Risk factors for mesothelioma also include environmental, occupational, and para-occupational exposure to asbestos and other mineral fibers such as erionite (8). Prior chest radiation therapy or occupational radiation also increases the risk for developing mesothelioma (9)(10)(11)(12)(13)(14)(15). Familial variants of mesothelioma exist as well: for example, two families with strong family history of mesothelioma without an associated history of exposure to asbestos or other mineral fibers were found to have familial mutations in BRCA associated protein 1 (BAP1), a tumor suppressor gene, that either affects the gene's promoter or forms a premature stop codon (16).…”

Malignant Mesothelioma in Individuals With Nonmesothelial Neoplasms

“…Malignant mesothelioma has also been reported to arise following therapeutic radiation of an antecedent malignancy and is likely a contributing factor in at least some of the cases in our study population. 17,18 We observed an increased prevalence of various types of nonmesothelial malignancies typically treated with irradiation in individuals with MM. Details regarding some of these individuals have been previously published.…”

Non-hodgkin lymphoma and pleural mesothelioma in a person exposed to asbestos

“…In 1982 Ross et al (7) found an excess of lymphomas of the gastrointestinal tract and oral cavity among subjects exposed to asbestos in a case-control study. Moreover, numerous cases have been reported in which an asbestos-related mesothelioma or other asbestos-related conditions were associated with lymphomas or other lymphoproliferative lesions (1)(2)(3)(8)(9)(10)(11)(12)(13)(14)(15) It is in some way surprising that some accepted conclusions about the relationship between asbestos and non-Hodgkin lymphoma did not emerge in a field so largely and deeply explored in the 20th century such as asbestos and cancer. There are various possible explanations for these discrepancies.…”

“…It is difficult to attribute the mesothelioma-lymphoma association to fortuitous circumstances. Li et al (3) reported that BAP1 (BRCA1 associated protein 1), mutated in many mesotheliomas and has a role in the regulation of hematopoietic stem cell function. Various recent findings regarding the occurrence of familial mesotheliomas indicate that genetic factors play a role in the genesis of asbestos-related mesothelioma (22)(23)(24)(25).…”

“…Many cases in which non-Hodgkin lymphoma and pleural mesothelioma co-existed in the same patient have been reported (1)(2)(3). Such occurrence raises the question of whether common etiological factors might play a role in the genesis of the two malignancies.…”