Localized mesotheliomas of the pleura. The pathologic evaluation of 18 cases

Our plain-English summary of Localized mesotheliomas of the pleura. The pathologic evaluation of 18 cases, by E.A. Foster, L.V. Ackerman (American Journal of Clinical Pathology, 1960).

The study

• Authors: E.A. Foster, L.V. Ackerman
• Journal: American Journal of Clinical Pathology
• Published: 1960;34:349-64
• Cited by: 90 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a pathology case series from Washington University and Barnes Hospital in St. Louis. The authors re-examined the slides and records of 18 tumors classified as localized pleural mesotheliomas. The patients were 8 men and 10 women aged 24 to 65 when their tumors were removed. Nine tumors were entirely fibrous, 3 were papillary (epithelial) throughout, and 6 were mainly fibrous with some epithelial structures. Twelve were removed locally, five by lobectomy and one with a lung segment. No patient died from surgery. Of the 17 patients followed, two died. One developed X-ray evidence of multiple lung metastases four years after surgery and died a year later, without an autopsy. The other was reported to have died of a coronary thrombosis. A third was terminally ill with clinical evidence of kidney cancer. The other 14 were alive and well up to eight and a half years after surgery. The authors concluded that all the tumors were histologically benign, with no proved recurrences or metastases, but that malignancy was not entirely excluded. The article does not discuss asbestos.

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 pathologic case series (re-examination of slides and records of previously diagnosed cases, with follow-up)
• Who was studied: 18 patients with tumors classified as localized pleural mesotheliomas in the surgical pathology laboratory of Washington University School of Medicine and Barnes Hospital, St. Louis (15 removed at Barnes Hospital, 3 received in consultation). There were 8 men and 10 women, aged 24 to 65 at removal. Thirteen tumors were on the left and 5 on the right.
• Main results:
  • In the sections examined, 9 of the 18 tumors consisted entirely of fibrous tissue and 3 had a papillary epithelial structure in all regions.
  • Six tumors were predominantly fibrous with some epithelial elements: 5 had occasional papillary and/or tubular epithelial structures, and 1 had many small nests of epithelial cells.
  • The tumors ranged from 3 to 20 cm in greatest dimension; the largest weighed 2650 g.
  • Twelve tumors were locally resected, five were removed by lobectomy and one by resection of a lung segment. No patient died as a result of the operation.
  • Follow-up was obtained on 17 of the 18 patients. It lasted 5 years or longer for 11 patients and 3 years or more for 16 patients.
  • Two patients died. One (Case 2) developed X-ray evidence of multiple lung metastases four years after operation and died one year later. There was no clinical evidence of another primary tumor, and no autopsy was done.
  • The second death (Case 5) was reported as a coronary thrombosis 3 years after operation, with no return of symptoms from the pleural tumor.
  • One patient (Case 10) was reported terminally ill 5 years and 10 months after operation, with clinical evidence of kidney carcinoma and lung lesions interpreted as metastases.
  • The remaining 14 patients were alive and well for up to eight and a half years after operation. X-ray or fluoroscopic examination confirmed no recurrence in 11 of them.
• The authors' conclusion: The authors concluded that all the tumors were histologically benign, with no proved recurrences or metastases, although they did not entirely exclude malignancy. They considered that their findings supported the view that all three histologic types (epithelial or papillary, fibrous, and mixed) were derived from the pleural mesothelium and could properly be classified as mesotheliomas.
• Limitations the authors state:
  • The tumors containing epithelial elements were not verified by autopsy to rule out metastasis from an unrecognized carcinoma.
  • Epithelial elements may have been missed in some apparently purely fibrous tumors because of limited sampling.
  • None of the apparently intrapulmonary tumors was received intact, so attachment to the overlying pleura could not be properly evaluated.
  • The tumors may have been malignant in the 2 patients who died, even though neither tumor looked malignant under the microscope.

Topics

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

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

Related studies

• Benign localized fibrous tumor of the pleura: report of 25 new cases — S. Enon, D. Kilic, et al. (2012)
• Solitary fibrous tumour of the pleura: A case report — G. Rakovich, M. Laflamme, et al. (2010)
• Highlights of the 14th international mesothelioma interest group meeting: Pathologic separation of benign from malignant mesothelial proliferations and histologic/molecular analysis of malignant mesothelioma subtypes — A. Churg, K. Nabeshima, et al. (2018)
• CT findings in benign fibrous mesothelioma of the pleura: pathologic correlation in nine patients — K.S. Lee, J.G. Im, et al. (1992)
• Localized malignant mesothelioma, an unusual and poorly characterized neoplasm of serosal origin: best current evidence from the literature and the International Mesothelioma Panel — A.M. Marchevsky, A. Khoor, et al. (2020)
• Molecular characterization of localized pleural mesothelioma — Y.P. Hung, F. Dong, et al. (2020)

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