Features of asbestos-exposed and unexposed mesothelioma

Our plain-English summary of Features of asbestos-exposed and unexposed mesothelioma, by A. Hirsch, P. Brochard, H. De Cremoux, et al (American Journal of Industrial Medicine, 1982).

The study

• Authors: A. Hirsch, P. Brochard, H. De Cremoux, L. Erkan, P. Sebastien, L. Di Menza, J. Bignon
• Journal: American Journal of Industrial Medicine
• Published: 1982;3(4):413-22
• Cited by: 42 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. 000678).

Abstract

Thirty-six histologically confirmed cases of pleural and peritoneal mesothelioma have been observed in a chest unit over a period of 53 months. The past asbestos exposure was assessed by a standardized questionnaire in all cases and the asbestos lung burden was determined by means of mineralogical analysis of lung-related biological specimens (sputum, bronchoalveolar lavage fluid, lung tissues) in 28 cases. The results of these two methods were found in good agreement. Past asbestos exposure has been definitely implicated in 17 cases and definitely eliminated in 10 cases. The results were inconclusive in other cases. The group with definite past asbestos exposure was different from the nonasbestos-exposed group by clinical, biological, pathological, and prognosis features that were analyzed. In cases without past asbestos exposure there were no other possible causative agents. Younger age and similar incidence in men and women suggest an environmental or natural disease.

In plain English

This French study described 36 consecutive mesothelioma cases (34 pleural, 2 peritoneal) seen in a Val de Marne chest unit between October 1976 and February 1981. All were confirmed from tissue samples. Past asbestos exposure was assessed in every case by standardized questionnaire. In 28 cases, coated fibers were also counted in sputum, bronchoalveolar lavage (lung-wash) fluid or lung tissue. The questionnaire placed 7 cases in heavy and 10 in moderate definite exposure, 10 without definite exposure, and 9 as inconclusive. Adding fiber counts identified 6 more exposed cases among the 9 inconclusive and 3 among the 10 questionnaire-negative cases. The authors compared the 17 questionnaire-exposed cases with the 10 questionnaire-negative cases. The exposed group had shorter mean survival (11.9 versus 31 months). It also more often had asbestos-related X-ray changes on the opposite side of the chest (76% versus 10%). Differences in age, proportion of men and tumor type were not statistically significant. The authors found no other cause in the cases without asbestos exposure. They suggested such cases could reflect an environmental exposure or a natural disease.

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: Case series of consecutive mesothelioma cases in one hospital chest unit, comparing cases with and without past asbestos exposure
• Who was studied: 36 histologically confirmed mesotheliomas (34 pleural, 2 peritoneal) referred to a chest hospital unit in Val de Marne, France, October 1976 to February 1981 (53 months)
• Exposure: Past asbestos exposure (occupational, para-occupational, environmental and domestic) assessed by standardized questionnaire in all 36 cases. Coated fibers were counted in sputum, bronchoalveolar lavage fluid and/or lung tissue in 28 cases. Fiber types were not specified. Work histories were also reviewed for other hazards.
• Main results:
  • By questionnaire: 7 cases with heavy definite past asbestos exposure, 10 with moderate definite exposure, 10 without definite exposure, and 9 inconclusive
  • Using fiber measurement together with the questionnaire, 6 additional exposed cases were found among the 9 inconclusive cases and 3 among the 10 questionnaire-negative cases
  • Among questionnaire-negative cases, 3 of 6 investigated had asbestos bodies at a very low level, except case 27 (a leather goods maker), with 6,903 coated fibers per gram of dried lung tissue
  • Table V compared 17 questionnaire-positive cases with 10 questionnaire-negative cases, 3 of which the authors later judged exposed. Mean survival time was 11.9 months in the 17 questionnaire-positive cases versus 31 months in the 10 questionnaire-negative cases (p less than 0.01).
  • Asbestos-related X-ray signs on the side of the chest opposite the tumor were present in 13 of the 17 questionnaire-positive cases (76%). They were absent in 9 of the 10 questionnaire-negative cases (10% present). The difference was p less than 0.001.
  • Mean age was 64.1 years in questionnaire-positive cases and 56.8 years in questionnaire-negative cases. Table V marks this difference as not significant.
  • The male-to-female ratio was 1.5 in unexposed cases and 7 in exposed cases. Males were 88% of questionnaire-positive and 60% of questionnaire-negative cases, a difference marked not significant.
  • All 10 questionnaire-negative cases were epithelial type. Among the 17 questionnaire-positive cases, 12 were epithelial, 3 mixed and 2 fusiform. This difference was marked not significant.
  • The tuberculin (PPD) skin test reaction measured 5.3 mm in questionnaire-positive cases and 12.2 mm in questionnaire-negative cases (p less than 0.05)
  • Length of asbestos exposure was significantly greater in the moderate exposure group (30.3 years) than in the heavy exposure group (11.4 years), p less than 0.001
  • Work histories of unexposed cases pointed to hypothetical factors: glass dust (cases 32 and 33), repeated chest X-rays (case 28, cumulative 9.5 rads over 26 years), and melted paraffin (case 29)
• The authors' conclusion: The authors concluded that cases with definite asbestos exposure differed from unexposed cases in clinical, biological, pathological and prognostic features. No other causative agent was found in the unexposed cases. They suggested the younger age and similar numbers of men and women in that group point to an environmental exposure or a natural disease.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Peritoneal Mesothelioma, Asbestos Exposure, Sputum, Bronchoalveolar Lavage (BAL), Prognosis.

Related studies

• French mesothelioma register — J. Bignon, P. Sebastien, et al. (1979)
• Asbestos risk among full-time workers in an electricity-generating power station — A. Hirsch, L. Di Menza, et al. (1979)
• From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation — A.D. Levy, J. Arnáiz, et al. (2008)
• Malignant mesothelioma in situ: morphologic features and clinical outcome — A. Churg, F. Galateau-Salle, et al. (2020)
• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)
• Mesothelioma with clear cell features: an ultrastructural and immunohistochemical study of 20 cases — N.G. Ordóñez (2005)

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