Asbestos and neoplasia: diffuse mesothelial tumors. Criteria for diagnosis of diffuse mesothelial tumors

Our plain-English summary of Asbestos and neoplasia: diffuse mesothelial tumors. Criteria for diagnosis of diffuse mesothelial tumors, by W.T. McCaughey (Annals of the New York Academy of Sciences, 1965).

The study

• Author: W.T. McCaughey
• Journal: Annals of the New York Academy of Sciences
• Published: 1965;132(1):603-13
• Cited by: 101 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002506).

Summary of the article

The author, a pathologist at Queen's University, Belfast, set out criteria for diagnosing diffuse mesothelial tumors (diffuse mesothelioma) and distinguishing them from metastatic tumors of the serosal membranes. He drew on a review, with colleagues from other United Kingdom centers, of their combined experience of 124 autopsied cases and many surgical specimens. Grossly, the tumors infiltrated the serosa extensively, often encasing the lung, but this appearance alone did not exclude metastatic tumor, and diagnosis at autopsy rested largely on excluding other primary sites. Histologically, structure varied greatly within and between tumors. More specific patterns included tubulopapillary structures lined by uniform cubical or flattened cells, sheets of spheroidal cells with a pericellular reticulin network, and distinctive patterns of hyaline collagen. A mixed structure was noted in close on half of the author's autopsied cases, so he stressed sampling many areas. The periodic acid-Schiff reaction was nearly always negative. A colleague found hyaluronidase-removable acid mucopolysaccharide in all 17 mesotheliomas examined and in none of 20 adenocarcinomas. However, the author had seen an identical reaction in pleural metastases from pancreatic adenocarcinoma. He considered effusion cytology and hyaluronic acid only a guide. He concluded that the diagnosis should be reserved for growths with an unequivocal predilection to spread along a serosal membrane and a certain serosal origin.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This paper was a pathologist's discussion of how to diagnose diffuse mesothelial tumors (diffuse mesothelioma). It was based on accumulated case experience, not a formal study with stated methods. The author drew on a joint review with United Kingdom colleagues of 124 autopsied cases and many surgical specimens. The author wrote that the tumor's naked-eye appearance could not distinguish it from tumor spread from elsewhere, so autopsy diagnosis rested largely on excluding other tumor sources. Microscopic patterns varied greatly. Some were described as highly specific and others as common to many tumors. A mixed structure was noted in close on half of the autopsied cases the author had seen; in many it would have been missed with only one or two tissue blocks. The author cautioned that finding acid mucopolysaccharide or hyaluronic acid was not decisive, having seen pleural spread from a pancreatic adenocarcinoma give an identical reaction. The author concluded that the diagnosis should be reserved for growths clearly spreading along a serosal membrane with certain serosal origin, and that often a final decision must await autopsy.

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: Narrative discussion of diagnostic criteria by a pathologist, based on the author's accumulated case experience and a joint review of cases with colleagues; no formal methods or comparative design described
• Who was studied: 124 autopsied cases of diffuse mesothelioma plus many surgical specimens, from the combined experience of the author and colleagues at centers in the United Kingdom (J. C. Wagner, W. Glyn Owen, O'B. Hourihane); author based at Queen's University, Belfast
• Exposure: Asbestos exposure was not measured and no fiber types are named. The author noted only that there was no evidence at the time that serosal tumors other than diffuse mesotheliomas were related to asbestos exposure.
• Main results:
  • The gross (naked-eye) appearance of diffuse mesothelioma did not allow it to be distinguished from metastatic tumor
  • On the dozen or so occasions the author found metastatic tumor in the pleura mimicking late-stage diffuse pleural mesothelioma, the primary tumor was usually a lung adenocarcinoma
  • In the peritoneal cavity the tumor was often less confluent than in the pleura, sometimes appearing mainly as isolated plaques and nodules
  • A mixed microscopic structure was noted in close on half of the autopsied cases of diffuse mesothelioma the author had seen; in many it would not have been detected with only one or two blocks
  • The periodic acid-Schiff reaction was nearly always negative in these tumors
  • The author had seen pleural metastases from an adenocarcinoma of the pancreas give an identical acid mucopolysaccharide reaction, with hyaluronic acid in the effusion
• The authors' conclusion: The author concluded that the diagnosis of diffuse mesothelioma should only be applied to growths with an unequivocal predilection to spread along a serosal membrane and a certain serosal origin. A generous biopsy can sometimes establish the diagnosis, particularly with a mixed histologic structure, but often a final decision must await exclusion of other tumor sources at autopsy. Hyaluronic acid in an effusion and certain acid mucopolysaccharides in the tumor provide strong support for the diagnosis.
• Limitations the authors state:
  • The author's group had relatively limited experience with the cytology of these tumors and found false positive or negative diagnoses all too easy, so they used cytology and hyaluronic acid only as a guide to likely cases
  • The author warned that more cases like the pancreatic adenocarcinoma giving a positive reaction may emerge

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Autopsy, Tubulopapillary, Collagen, Adenocarcinoma, Cytology, Hyaluronic Acid.

Related studies

• Cytopathology of serous neoplasia of the ovary and the peritoneum: differential diagnosis from mesothelial proliferations — L.R. Pisharodi, C.W. Bedrossian (1996)
• Milky spots (Taches laiteuses) as structures which trap asbestos in mesothelial layers and their significance in the pathogenesis of mesothelial neoplasia — K. Kanazawa, F.J. Roe, et al. (1979)
• Asbestos-related pleural diseases: dimensional criteria are not appropriate to differentiate diffuse pleural thickening from pleural plaques — J. Ameille, M. Matrat, et al. (2004)
• Use of intermediate filament antibodies in the differential diagnosis of gynecological neoplasia — F.C. Ramaekers, J.J. Puts, et al. (1985)
• Mesothelial tumors and exposure to asbestos dust — W.G. Owen (1965)
• Asbestos, asbestosis, and cancer: The Helsinki criteria for diagnosis and attribution. Critical need for revision of the 2014 update — X. Baur, H.J. Woitowitz, et al. (2017)

Browse more research in Annals of the New York Academy of Sciences, or return to medical research.