Diffuse malignant mesothelioma of the pleura: a review of 37 cases

Our plain-English summary of Diffuse malignant mesothelioma of the pleura: a review of 37 cases, by H.C. Oels, E.G. Harrison, D.T. Carr, et al (Chest, 1971).

The study

• Authors: H.C. Oels, E.G. Harrison, D.T. Carr, P.E. Bernatz
• Journal: Chest
• Published: 1971;60(6):564-70
• Cited by: 128 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. 001371).

In plain English

This was a review of the records of 37 patients with diffuse malignant mesothelioma of the pleura seen at the Mayo Clinic over 22 years, through 1967. Thirty-two were men and five were women. Most lived in relatively small midwestern US communities, and none lived in major industrial or metropolitan areas. Three patients had definite occupational exposure to asbestos, seven had probable exposure, and 27 had no known exposure. Structures the authors called "asbestos bodies" were found in the lungs of all three definitely exposed patients, three of the seven probably exposed patients, and five of the 27 with no known exposure. The authors used that name for their appearance only, because their true nature was not proved by analysis. Slight lung fibrosis was seen in 17 of the 37 patients. Of the tumors, 25 were tubulopapillary, seven fibrous and five bimorphic. By the time of the review, 28 patients had died. The authors said asbestos exposure is difficult if not impossible to exclude, and they suggested the possibility of other, as yet unknown causes.

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 review of clinic records (case series)
• Who was studied: 37 patients with diffuse malignant mesothelioma of the pleura seen at the Mayo Clinic over 22 years through 1967. Thirty-two were men and five were women, aged 20 to 79. Most came from small midwestern US communities: 65 percent from areas of less than 50,000 population, and none from major industrial or metropolitan areas.
• Exposure: Asbestos exposure taken from patient histories. Three patients had definite occupational exposure (an asbestos worker in shipbuilding and an asbestos factory, an executive salesman for an asbestos-insulation company, and a pipecutter). Seven had probable exposure (a plumber, two chemists, a service station operator, a pipecutter, two boilermakers). Twenty-seven had no known exposure. One patient with no known asbestos exposure had exposure to beryllium. No fiber types were identified.
• Main results:
  • "Asbestos bodies" (a label based on appearance only) were found in the lungs of all 3 patients with definite exposure, 3 of 7 (43 percent) with probable exposure, and 5 of 27 (19 percent) with no known exposure.
  • Either "asbestos bodies" or "pseudo-asbestos bodies" were seen by light microscopy in 19 of the 37 patients: 11 with "asbestos bodies" and 8 with "pseudo-asbestos bodies". No single section showed more than three such bodies.
  • When burned (incinerated) lung sections were examined by polarizing microscopy, none contained particles resembling asbestos fibers.
  • Slight interstitial lung fibrosis was found in 17 of the 37 patients. None had nodular fibrosis.
  • By tumor type under the microscope, 25 were tubulopapillary, 7 fibrous and 5 bimorphic. In 13 patients the tumor involved both the pleura and the peritoneum.
  • At the time of review, 28 of the 37 patients had died: 17 of 25 with tubulopapillary tumors, all 7 with fibrous tumors, and 4 of 5 with bimorphic tumors.
  • Average survival from first symptoms was 29 months for the tubulopapillary group, 8 months for the fibrous group and 7 months for the bimorphic group. From diagnosis, the averages were 18, 4 and 5 months.
  • All patients received radiotherapy, nitrogen mustard, or both. The authors found no correlation between treatment and the course of the disease.
• The authors' conclusion: The authors said that, because asbestos is so widely used, exposure is difficult if not impossible to exclude. They also said that finding these tumors mostly in people from small midwestern communities, where asbestos exposure is probably minimal, suggests the possibility of other, as yet unknown causes. They noted that the disease had so far responded poorly to treatment.
• Limitations the authors state:
  • The "asbestos bodies" and "pseudo-asbestos bodies" were named by appearance only. Their true nature was not proved by physical or chemical analysis.
  • Asbestos exposure could not be ruled out, even in patients with no known exposure, because asbestos is so widely used.
  • No conclusions could be drawn about whether asbestos caused the lung fibrosis that was seen.
  • The staining tests were done on formalin-fixed tissue. Alcohol-fixed tissue would have given better results.

Topics

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

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

Related studies

• Asbestos-related lesions of the pleura: parietal plaques compared to diffuse thickening studied with chest roentgenography, computed tomography, lung function, and gas exchange — G. Hillerdal, P. Malmberg, et al. (1990)
• Trends in mortality of diffuse malignant mesothelioma of pleura — V.E. Archer, W.N. Rom (1983)
• Diffuse malignant mesothelioma of pleura. Diagnosis and survival in 92 cases — V.I. Adams, K.K. Unni, et al. (1986)
• Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients — P. Ruffie, R. Feld, et al. (1989)
• Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients — E.G. Butchart, T. Ashcroft, et al. (1976)
• Diffuse mesothelioma of the pleura and asbestos — P.C. Elmes, W.T. McCaughey, et al. (1965)

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