Diffuse malignant mesothelioma of pleura. Diagnosis and survival in 92 cases

Our plain-English summary of Diffuse malignant mesothelioma of pleura. Diagnosis and survival in 92 cases, by V.I. Adams, K.K. Unni, J.R. Muhm, et al (Cancer, 1986).

The study

• Authors: V.I. Adams, K.K. Unni, J.R. Muhm, J.R. Jett, D.M. Ilstrup, P.E. Bernatz
• Journal: Cancer
• Published: 1986;58(7):1540-51
• Cited by: 120 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. 000368).

Abstract

Clinical, radiographic, surgical, and pathologic findings and survival in 92 patients with diffuse malignant mesothelioma (DMM) of the pleura who were examined at the Mayo Clinic between 1950 and 1980, were studied retrospectively. With the use of defined criteria and ordinary tissue stains, the 92 cases were classified into the following histologic subtypes: purely epithelial, 42 cases; mixed, 29 cases; and sarcomatous, 21 cases. Eight of the sarcomatous cases were desmoplastic. Median survivals were 12, 5, and 3 months for the patients in the epithelial, mixed, and sarcomatous groups, respectively. Survival was significantly longer for patients with epithelial DMM. Women survived longer than men but more often had epithelial DMM. Early disease manifested as multiple discrete pleural nodules, predominantly on the parietal pleura. However, nine patients had a dominant mass. Radiographic signs especially suggestive of DMM were nodular pleural thickening, irregular thickening of interlobar fissures, a dominant mass, or decreased volume of the affected hemithorax.

In plain English

This retrospective study reviewed 92 patients with diffuse malignant mesothelioma of the pleura examined at the Mayo Clinic from 1950 to 1980. The authors selected them after re-examining tissue slides from 164 candidate cases found in a search of the clinic's tissue registry. Of the 92 patients, 71 were men and 21 were women. Asbestos exposure was documented in 24 patients (26%), but the authors noted that half the records showed no inquiry about exposure. Using ordinary tissue stains, the authors classed 42 tumors as purely epithelial, 29 as mixed and 21 as sarcomatous. Median survival for all 92 patients was 242 days. Median survival was 1.1 years for the epithelial group, 0.7 year for the mixed group and 0.3 year for the sarcomatous group, and survival was significantly longer in the epithelial group. Women survived longer than men. However, 76% of women and 37% of men had the epithelial type, and the authors attributed the difference to this. Of 42 patients with chest radiographs available, 20 had findings suggesting mesothelioma. The authors concluded that their results confirmed the generally short survival of these 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: clinical, radiographic, surgical, pathologic and survival review of tissue registry cases at one institution
• Who was studied: 92 patients with diffuse malignant mesothelioma of the pleura examined at the Mayo Clinic (Rochester, Minnesota), 1950 to 1980. A tissue registry search found 212 candidate cases. Slides from 164 of them were reviewed, and the 92 were identified among these. The other cases included metastatic carcinoma, localized fibrous mesothelioma, other tumors, benign effusions, and 5 inadequate biopsy specimens. There were 71 men (ages 28 to 77) and 21 women (ages 32 to 80).
• Exposure: Asbestos exposure as recorded in patient histories. No fiber types or doses are given. Exposure was documented in 24 of 92 patients (26%), and in 16 of the 53 cases from 1971 to 1980. Fifty-two patients smoked cigarettes.
• Main results:
  • Histologic subtypes among the 92 tumors: 42 purely epithelial, 29 mixed, 21 sarcomatous. The body text says 9 of the sarcomatous tumors were desmoplastic (low grade).
  • Median survival for all 92 patients was 242 days. Of the 92 patients, 88 had died, 2 were alive at 5 and 7 years, and 2 were lost to follow-up.
  • Median survival was 1.1 years in the epithelial group, 0.7 year in the mixed group and 0.3 year in the sarcomatous group.
  • Two-year survival probability was 32% in the epithelial group, 8% in the mixed group and 5% in the sarcomatous group.
  • Survival differences between the epithelial group and each other group were statistically significant (P < 0.05). The difference between the mixed and sarcomatous groups was not significant.
  • Women survived longer than men (P < 0.03).
  • 76% of the women but only 37% of the men had the epithelial type. Among patients with epithelial tumors, survival of women and men did not differ significantly (P = 0.38).
  • Of the 42 patients with chest radiographs available, findings in 20 suggested diffuse malignant mesothelioma and in 22 were indeterminate. Two patients had uncalcified pleural plaques, and one of these also had calcified pleural plaques.
  • An unequivocal diagnosis of mesothelioma had been made in only 10% of the 50 evaluable needle biopsies. At open pleural biopsy, done in 75 patients, it had been made in 77%.
  • Nine patients survived 3 years or more, and seven of them had purely epithelial tumors. There was no obvious correlation with treatment method.
• The authors' conclusion: The authors concluded that their results confirm previous reports of overall short survival in patients with diffuse malignant mesothelioma, and that survival is better with the purely epithelial type. They attributed women's longer survival to the higher proportion of epithelial tumors among women.
• Limitations the authors state:
  • The true number of patients exposed to asbestos was probably higher than recorded, because half the records showed no inquiry about exposure and some cases predate knowledge of the asbestos link.
  • Documentation of spread of disease after diagnosis was incomplete, because many patients were not followed at the Mayo Clinic.
  • Original radiographs were available only for cases from 1974 to 1980.
  • Numbers treated with pleural pneumonectomy were too small for valid conclusions.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleura, Histological Subtype, Desmoplastic Mesothelioma, Median Survival, Parietal Pleura, Pleural Thickening, Hemithorax.

Related studies

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• The role of closed pleural needle biopsy in the diagnosis of malignant mesothelioma of the pleura — H.D. Beauchamp, N.K. Kundra, et al. (1992)
• "Signet-ring" cells--a caveat in the diagnosis of a diffuse peritoneal mesothelioma occurring in a lady presenting with recurrent ascites: an unusual case report — B. Rekhi, S. Pathuthara, et al. (2010)
• Diffuse malignant mesothelioma of the pleura: a review of 37 cases — H.C. Oels, E.G. Harrison, et al. (1971)
• Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients — E.G. Butchart, T. Ashcroft, et al. (1976)
• Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients — P. Ruffie, R. Feld, et al. (1989)

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