Current pathogenetic concepts of diffuse malignant mesothelioma

Our plain-English summary of Current pathogenetic concepts of diffuse malignant mesothelioma, by J.E. Craighead (Human Pathology, 1987).

The study

• Author: J.E. Craighead
• Journal: Human Pathology
• Published: 1987;18(6):544-57
• Type of article: Review
• Cited by: 81 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. 000305).

In plain English

This article was a review, not a new study. The author drew on published research to discuss how diffuse malignant mesothelioma arises. The review cited an estimate of one to two cases per million people each year in the occupationally unexposed North American population, and noted that this figure may be in error by several orders of magnitude. The author described the amphiboles crocidolite and amosite as the probable cause of most mesotheliomas in industrialized countries. The author also noted that several studies had failed to demonstrate convincingly an increased risk among chrysotile miners and manufacturing workers. The author concluded that pleural plaques are not a premalignant lesion in the great majority of cases, and stated that there is no epidemiologic evidence linking benign solitary pleural tumors to asbestos. In the rat experiments reviewed, fiber dimensions rather than chemical composition were critical, and long, thin fibers tended to cause more tumors. Drawing on separate animal, tissue and staining observations, the author proposed that these tumors arise from multipotential cells beneath the pleural and peritoneal lining, while acknowledging that proof is lacking. The author suggested foreign body carcinogenesis as a working model.

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 review of published epidemiologic, pathologic and experimental studies (no new data collected)
• Who was studied: No study population of its own; the review drew on published human epidemiologic and pathologic studies and animal experiments (mainly rats and mice)
• Exposure: Asbestos fiber types: commercial amphiboles (crocidolite, amosite), chrysotile, and the contaminating amphiboles tremolite, actinolite and anthophyllite; experimental fibers such as fiberglass were also discussed
• Main results:
  • The review cited an estimated background incidence of one to two cases per million people each year in the occupationally unexposed population of North America
  • In case series from the United States and Great Britain cited by the review, no causative factor was identified in 20 to 40 per cent of patients
  • The author stated that the amphiboles crocidolite and amosite are the probable cause of most mesotheliomas in industrialized countries
  • The review reported that several recent epidemiologic studies had failed to demonstrate convincingly an increased risk of diffuse malignant mesothelioma among chrysotile miners and workers in manufacturing trades
  • Epidemiologic studies cited in the review indicated that peritoneal mesotheliomas occur almost exclusively in workers heavily exposed to amphibole asbestos for prolonged periods
  • The author concluded that pleural plaques are not a premalignant lesion, at least in the great majority of cases of mesothelioma
  • The author stated that there is no epidemiologic evidence of a causal relationship between benign solitary pleural tumors and asbestos
  • In the rat experiments reviewed, fiber dimensions rather than chemical composition were critical, and long, thin fibers tended to cause more tumors than short fibers
  • Evidence the review offered for a subserosal cell of origin included an electron microscopy study reporting cellular transformation in the subserosal tissue of chrysotile-inoculated animals before mesotheliomas developed, and immunohistochemical studies of human tissue
  • The author proposed that a common multipotential progenitor cell beneath the pleural and peritoneal lining gives rise to these tumors, and suggested foreign body carcinogenesis as a working model
• The authors' conclusion: The author concluded that amphibole asbestos is the most common cause of diffuse malignant mesothelioma in the Western world, that the cause of a substantial proportion of cases cannot be defined, and that the tumor's pathogenesis remains an enigma, with fibers of a critical length and breadth near the serosal lining appearing to be a key factor
• Limitations the authors state:
  • The author noted that the background incidence figures may be in error by several orders of magnitude
  • The author acknowledged that proof is lacking for the hypothesis that mesotheliomas arise from multipotential subserosal cells
  • The author stated that experimental evidence suggests, but does not prove, that the physical properties of asbestos types influence their capacity to cause disease

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma.

Related studies

• Current concepts in the evaluation and treatment of patients with diffuse malignant peritoneal mesothelioma — K. Turner, S. Varghese, et al. (2012)
• Current concepts about the pathogenesis of silicosis and asbestosis — R.D. deShazo (1982)
• Malignant pleural mesothelioma: current concepts in treatment — A. Tsiouris, R.K. Walesby (2007)
• Current concepts in malignant pleural mesothelioma — A.J. Kaufman, H.I. Pass (2008)
• The epidemiology of pleural mesothelioma: current concepts and controversies — M. Huncharek (1989)
• Clinical features and current treatment of diffuse malignant pleural mesothelioma — V.W. Rusch (1995)

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