Environmental malignant mesothelioma in southern Anatolia: a study of fifty cases

Our plain-English summary of Environmental malignant mesothelioma in southern Anatolia: a study of fifty cases, by E.H. Zeren, D. Gümürdülü, V.L. Roggli, et al (Environmental Health Perspectives, 2000).

The study

• Authors: E.H. Zeren, D. Gümürdülü, V.L. Roggli, S. Zorludemir, M. Erkişi, I. Tuncer
• Journal: Environmental Health Perspectives
• Published: 2000;108(11):1047-50
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a highly aggressive tumor of the serous membranes, which in humans results from exposure to asbestos and asbestiform fibers. Although occupational malignant mesothelioma is still the most common form of this lesion, naturally contaminated soil can play an important role in the development of environmental malignant mesothelioma in some parts of the world. Fifty cases of malignant mesothelioma (MM) from southern Turkey with no occupational history of asbestos exposure were reviewed regarding pathologic and clinical features. A case of hyaline fibrous plaque of the pleura was also included in this series. Histologically the cases were classified as epithelial (36 cases); sarcomatous (7 cases); and biphasic (7 cases). One of the sarcomatous cases was desmoplastic. Ultrastructural examination of the tumor tissue in three cases revealed long-surface microvilli in epithelial cells. Interstitial cells of the lung in one case showed electron-dense asbestos fibers in the cytoplasm. Mineralogical analyses of the lung tissue in three cases of MM and the case of pleural plaque showed high amounts of asbestos fibers most consistent with tremolite and actinolite. The clinical and pathologic features of our cases support that the environmental inhalation of asbestos is still a major health problem in some parts of Turkey.

In plain English

This was a case series from southern Turkey. The authors reviewed pathology files from hospitals and a private laboratory in Adana. They found 50 cases of malignant mesothelioma reported over the previous 10 years, in people from small villages around Adana and the nearby cities of Diyarbakir, Sanliurfa, Malatya and Adiyaman. One case of pleural fibrous plaque was also included. None of the 50 patients (36 men, 14 women) had an occupational history of asbestos exposure, and all had lived in small villages for at least 10 years. Under the microscope, 36 tumors were epithelial, 7 sarcomatous (one of them desmoplastic) and 7 biphasic. The authors analyzed lung tissue for fibers in three mesothelioma cases and the plaque case. All four showed high fiber levels, mostly consistent with tremolite and actinolite. Two fibers indicating erionite were found in the plaque case, but none were found in the three mesothelioma cases. Of 10 patients with follow-up, eight died 4 to 14 months after diagnosis. The authors concluded that the analyses implicated tremolite/actinolite, not erionite, in this region, probably from environmental sources.

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 pathology files, with tumor pathology, electron microscopy and lung fiber analysis in a few cases
• Who was studied: 50 malignant mesothelioma cases (36 male, 14 female) from the files of Çukurova University Hospital, Adana SSK Hospital, Adana State Hospital and a private pathology laboratory, covering the previous 10 years. Patients came from small villages around Adana and the neighboring cities Diyarbakir, Sanliurfa, Malatya and Adiyaman. One case of fibrous pleuritis with hyaline plaque was also included.
• Exposure: Environmental (non-occupational) exposure. No patient had an occupational history of asbestos exposure. All had lived in small villages of the region for at least 10 years, and most had lived in white stucco-painted houses in childhood and early adult life. Fibers found in lung tissue were mostly tremolite and actinolite.
• Main results:
  • Tumor types among the 50 cases: 36 epithelial, 7 sarcomatous (one desmoplastic) and 7 biphasic.
  • All patients presented with pleural effusion, and imaging showed diffuse pleural thickening. In two cases the tumor invaded both the pleura and the pericardium.
  • Lung tissue from three mesothelioma cases and one pleural fibrous plaque case all showed high fiber burdens. The fibers were mostly consistent with tremolite and actinolite. By light microscopy, asbestos bodies per gram of wet lung were 36, 1,400 and 8,160 in the three mesothelioma cases and 21,900 in the plaque case, against a stated normal range of 0 to 20.
  • Two fibers indicating erionite were found in the pleural plaque case. No erionite fibers were found in the lung tissue of the three mesothelioma cases.
  • In one case, electron microscopy showed electron-dense fibers consistent with asbestos inside interstitial cells of the lung.
  • Follow-up was available for 10 mesothelioma cases. Eight patients died of disease 4 to 14 months after diagnosis, and two were alive 30 and 12 months after diagnosis.
  • The authors saw no link between particular tumor subtypes and particular geographical areas, and found no prognostic significance of subtype in their series.
• The authors' conclusion: The authors concluded that the mineral analyses implicated tremolite/actinolite, not erionite, in this region, probably from environmental sources. They called for future studies of the environmental sources of these fibers.
• Limitations the authors state:
  • The authors had difficulty obtaining patient follow-up because cases were poorly recorded. Some patients were treated in other cities and lost to follow-up.
  • The patient with the pleural plaque had lived in several different places in the country, so the exposure may have come from other parts of Anatolia.

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, Southern Anatolia, Asbestiform, Occupational History, Asbestos Exposure, Pleura, Biphasic Mesothelioma, Desmoplastic Mesothelioma.

Related studies

• Lung cancer and mesothelioma in towns with environmental exposure to asbestos in Eastern Anatolia — H.C. Hasanoglu, Z. Yildirim, et al. (2006)
• Environmental asbestos exposure and mesothelioma cases in Bari, Apulia region, southern Italy: a national interest site for land reclamation — L. Vimercati, D. Cavone, et al. (2018)
• Evaluation of malignant mesothelioma in central Anatolia: a study of 67 cases — I. Gulmez, L. Kart, et al. (2004)
• Asbestos knowledge and awareness level in central part of Anatolia — S. Metintas, G. Ak, et al. (2017)
• Trouble in Anatolia — N.R. Anthonisen (2004)
• An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgüp in Anatolia — Y.I. Baris, A.A. Sahin, et al. (1978)

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