Diffuse malignant mesothelioma and synchronous lung cancer: A clinicopathological study of 18 cases

Our plain-English summary of Diffuse malignant mesothelioma and synchronous lung cancer: A clinicopathological study of 18 cases, by K.J. Butnor, N.A. Brownlee, A. Mahar, et al (Lung Cancer, 2016).

The study

• Authors: K.J. Butnor, N.A. Brownlee, A. Mahar, E.N. Pavlisko, T.A. Sporn, V.L. Roggli
• Journal: Lung Cancer
• Published: 2016;95:1-7
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: To examine the clinicopathologic characteristics of individuals with diffuse malignant mesothelioma (DMM) occurring concurrently with lung cancer (LC).

Materials And Methods: A database of approximately 3800 patients with DMM was reviewed, from which 18 patients (0.5%) who had synchronous LC were identified. The clinicopathologic features, as well as the occupational exposure history and fiber burden analysis data were examined.

Results: The patient median age was 68 years (range 58-84 years). Of the 18 patients (14 male, 4 female), 11 (61%) had epithelial, 5 (28%) had biphasic, and 2 (11%) had sarcomatoid DMM, with the majority (16 cases; 89%) originating in the pleura and only 2 were peritoneal. Among the histologic types of LC, adenocarcinoma was most frequent (12 cases; 67%), while 5 cases of squamous cell carcinoma, and 1 case of small cell carcinoma were observed. Three patients also had a history of prior malignancy (1 with testicular seminoma and bladder carcinoma and 2 with prostate carcinoma). Fifteen patients had a positive smoking history. All but 3 had documented asbestos exposure. Three had histologic features of asbestosis. Mineral analysis performed in 8 showed an elevated asbestos fiber burden in 4 (22%). Amosite was detected in 4 patients, crocidolite in 3, and non-commercial amphiboles in 5.

Conclusion: The finding of simultaneous carcinoma of the lung and DMM is distinctly unusual. The majority of patients are male smokers with pleural epithelial DMM and lung adenocarcinoma. This study represents the largest cohort of patients reported to date with synchronous malignant mesothelioma and lung cancer, and we propose guidelines for making a diagnosis of synchronous malignant mesothelioma and primary lung cancer.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

In plain English

This study reviewed cases from a pathology consultation database held by one of the authors. The database contained about 3800 diffuse malignant mesothelioma cases from 1982 to 2015. The authors found 18 patients (0.5%) who had mesothelioma and lung cancer at the same time. Fourteen were men and 4 were women, with a median age of 68 years. The mesothelioma was in the pleura in 16 patients and in the peritoneum in 2, and 11 were epithelial. The lung cancer was adenocarcinoma in 12 patients. Fifteen of the 18 were smokers or ex-smokers, and 15 had a documented history of asbestos exposure. Three had asbestosis on tissue examination. Lung fiber analysis was done in 8 patients. Four had asbestos levels within the background range and 4 had elevated levels. Amosite, crocidolite, tremolite and actinolite were found. The authors judged the mesothelioma attributable to asbestos in 8 patients and the lung cancer in 3. The authors concluded that this combination is extremely rare, and they proposed diagnostic criteria. Survival information was not available for most patients.

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: Retrospective case series: review of mesothelioma cases in one author's pathology consultation database, with clinical, pathologic, occupational and lung fiber analysis data
• Who was studied: 18 patients with diffuse malignant mesothelioma and lung cancer at the same time, found among about 3800 mesothelioma cases (professional and medicolegal consultation cases, 1982 to 2015) in the database of one author (VLR)
• Exposure: Occupational asbestos exposure, documented in 15 of the 18 patients (jobs included U.S. Navy or merchant marine, construction, insulator, pipefitter, shipyard and asbestos manufacturing). Exposure duration was known in 13 patients: mean 24 years, range 3 to 45 years. In 8 patients, lung tissue was analyzed for amosite, crocidolite, tremolite, anthophyllite, actinolite and chrysotile.
• Main results:
  • 18 patients with both cancers at once were found among about 3800 mesothelioma cases in the database (0.5%)
  • Of the 18 patients, 14 were male (78%) and 4 were female (22%)
  • Median age at diagnosis was 68 years, range 58 to 84 years
  • Mesothelioma was pleural in 16 of 18 patients (89%) and peritoneal in 2 (11%)
  • Mesothelioma type: epithelial in 11 of 18 (61%), biphasic in 5 (28%), sarcomatoid in 2 (11%)
  • Lung cancer type: adenocarcinoma in 12 patients (67%)
  • Lung cancer type: squamous cell carcinoma in 5 patients (28%) and small cell lung cancer in 1 patient (6%)
  • 15 of the 18 patients (83%) were smokers or ex-smokers
  • Asbestos exposure was documented in 15 patients (83%)
  • Histologic asbestosis was confirmed in 3 patients (17%) and absent in 9 (50%)
  • Pleural plaques were seen in 5 patients (28%)
  • Of the 8 patients whose lung tissue was analyzed, 4 had asbestos fiber burdens within the background population range and 4 had elevated burdens (the article gives the percentages as 22% of all 18 patients)
  • Amosite fibers were found in 4 patients
  • Tremolite fibers were found in 5 patients, crocidolite in 3 and actinolite in 1
  • The authors judged the mesothelioma conclusively attributable to asbestos in 8 of the 18 patients (44%)
  • The authors judged the lung cancer attributable to asbestos in 3 patients (17%), based on histologic asbestosis. In 6 other cases, fiber analysis did not support an asbestos cause for the lung cancer.
  • The authors proposed criteria for diagnosing mesothelioma and primary lung cancer occurring together, based on imaging, distinct histological appearance and different immunohistochemical profiles
• The authors' conclusion: The authors concluded that mesothelioma and lung cancer occurring at the same time is extremely rare, even in highly selected patient populations
• Limitations the authors state:
  • Survival after diagnosis was not available for most patients
  • Which side of the body the disease was on was not available in some cases
  • Records for 12 cases did not show whether pleural plaques were present

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Lung Cancer, Occupational Exposure History, Fiber Burden Analysis, Biphasic Mesothelioma, Sarcomatoid, Pleura, Adenocarcinoma.

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