A case of malignant pleural mesothelioma following exposure to atomic radiation in Nagasaki

Our plain-English summary of A case of malignant pleural mesothelioma following exposure to atomic radiation in Nagasaki, by M. Mizuki, K. Yukishige, Y. Abe, et al (Respirology, 1997).

The study

• Authors: M. Mizuki, K. Yukishige, Y. Abe, T. Tsuda
• Journal: Respirology
• Published: 1997;2(3):201-5
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report the case of a 75-year-old Japanese man who developed malignant mesothelioma in the left hemithorax 50 years after the dropping of the atomic bomb on Nagasaki in 1945. This may be the first reported case of malignant mesothelioma following exposure to atomic radiation. Asbestos is the leading cause of malignant mesothelioma, but radiation therapy is the primary non-asbestos-related cause. In the case of radiation therapy, the interval between exposure and the occurrence of malignant mesothelioma tends to be many years. This patient was at a high risk of malignant mesothelioma as he had been exposed to radiation from the atomic bomb and may also have had a history of asbestos exposure at the munitions factory where he was employed as a shipbuilder for 2 years. It has been suggested that combined exposure to atomic radiation and asbestos is associated with an increased incidence of malignant mesothelioma. If thickening of the pleura or pleural effusion is found in atomic bomb survivors, malignant mesothelioma should be considered as one of the options in the differential diagnosis, even although the atomic bomb attacks occurred several decades ago.

In plain English

This case report describes a 75-year-old Japanese man admitted to Oita Medical University in September 1995 for fluid around his left lung (a pleural effusion). On 9 August 1945 he was exposed to radiation from the Nagasaki atomic bomb at a munitions factory 2.5 km from the explosion's centre. The authors' discussion also stated he had a history of asbestos exposure at that factory, where he was a shipbuilder for 2 years. Tests on the fluid and a pleural biopsy were consistent with malignant mesothelioma. The authors said iron-stained granules inside tumour cells suggested asbestos, but they found no characteristic asbestos bodies in the removed pleura and lung. His left lung and pleura were removed. The authors found no earlier reported mesothelioma case in an atomic bomb survivor. A Nagasaki survivor database recorded 40 deaths from primary malignant pleural tumours and 1217 lung cancer deaths in 1970 to 1994. From these data the authors could not tell whether survivors' mesothelioma death rate exceeded that of unexposed people. They concluded mesothelioma should be considered when survivors show pleural thickening or effusion.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient), with a brief look at cause-of-death records from a database of Nagasaki atomic bomb survivors
• Who was studied: one 75-year-old Japanese man admitted to Oita Medical University, Japan, in September 1995 with a left pleural effusion
• Exposure: radiation from the atomic bomb dropped on Nagasaki on 9 August 1945, received at a munitions factory 2.5 km from the central point of the explosion
• Main results:
  • In the discussion, the authors stated that the patient had a history of asbestos exposure at the munitions factory, where he worked as a shipbuilder for 2 years (no fiber type or other exposure details are given)
  • Draining the chest fluid produced a bloody pleural effusion with a markedly high hyaluronic acid level (144 000 U/mL)
  • The patient's tumour cells were positive for keratin, vimentin and epithelial membrane antigen and negative for carcinoembryonic antigen, which the authors said was consistent with malignant mesothelioma
  • Iron staining showed many haemosiderin granules inside the patient's tumour cells, which the authors said suggested the existence of asbestos
  • The authors could not identify characteristic asbestos bodies in the patient's resected pleura and lung
  • The patient underwent removal of the left lung and left pleura
  • The authors found no previously reported cases of malignant mesothelioma in atomic bomb survivors
  • In the Nagasaki atomic bomb survivor database, 40 people died from primary malignant tumour of the pleura (thought to be mostly mesothelioma) and 1217 died from lung cancer between 1970 and 1994
  • The authors suggested that the rate of malignant mesothelioma among atomic bomb survivors may be higher than among people not exposed to radiation
• The authors' conclusion: The authors concluded that malignant mesothelioma should be considered as one possible diagnosis when pleural thickening or pleural effusion is found in atomic bomb survivors
• Limitations the authors state:
  • From the database figures, the authors could not determine whether the mesothelioma mortality rate in atomic bomb survivors was higher than in people not exposed to the bomb
  • The database counted primary malignant tumours of the pleura, which the authors only thought were mostly mesothelioma

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Hemithorax, Asbestos Exposure, Pleura, Pleural Effusion, Differential Diagnosis.

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