Malignant mesothelioma arising after direct application of asbestos and fiber glass to the pericardium

Our plain-English summary of Malignant mesothelioma arising after direct application of asbestos and fiber glass to the pericardium, by A. Churg, M.L. Warnock, K.G. Bensch (The American Review of Respiratory Disease, 1978).

The study

• Authors: A. Churg, M.L. Warnock, K.G. Bensch
• Journal: The American Review of Respiratory Disease
• Published: 1978;118(2):419-24
• Type of article: Case report
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy.

Abstract

A case of mesothelioma, apparently arising in the pericardium, is reported in a patient who, 15 years previously, had been treated for angina pectoris by dusting of the pericardial cavity with a mixture of fibrous dusts. At autopsy, transparent fibers and ferruginous bodies were present within the pericardium. Electron diffraction and microprobe analysis indicated that approximately two thirds of the fibers were tremolite and anthophyllite asbestos, and the remainder, fiber glass. Development of mesothelioma in laboratory animals has been reported after intrapleural deposition of asbestos and other fibers, but in humans, the link between exposure to asbestos and mesothelioma has always been based on epidemiologic data and the retrospective finding of asbestos in tissues. To our knowledge, this is the first example of a malignant mesothelioma in a human associated with direct mesothelial contact with fibrous dusts.

In plain English

This case report described a 61-year-old man seen at Stanford University Medical Center in February 1972. In 1957, to treat angina pectoris, his pericardial sac had been opened, the heart surface scarified, and 0.3 g of "asbestos" dusted over it. He later worked as an engineer in a paint factory with lead dust exposure, and he never smoked. About 15 years after the operation he developed a right pleural effusion containing malignant cells. A biopsy was diagnosed as malignant mesothelioma, and he died in October 1973. At autopsy, fibers and rare ferruginous bodies were found in the thickened, scarred pericardium but not in the pleura. Of 50 fibers examined by electron diffraction, 33 were amphibole asbestos and 17 were amorphous. Microprobe analysis identified tremolite and anthophyllite asbestos and fiber glass. The authors labeled the tumor a pericardial mesothelioma but allowed that it might be of pleural origin. They concluded that, to their knowledge, this was the first human mesothelioma reported after direct contact between a mesothelial surface and fibrous dust.

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 report of a single patient, including autopsy and electron microscopic fiber analysis
• Who was studied: One 61-year-old man first seen at Stanford University Medical Center in February 1972. He had a history of angina pectoris and myocardial infarction, worked as an engineer in a paint factory with lead dust exposure, and never smoked. He died in October 1973 and was autopsied.
• Exposure: In 1957, during a pericardiopexy for angina, 0.3 g of material described as "asbestos" was dusted directly over the scarified epicardial surface. Fiber analysis showed a mixture of tremolite and anthophyllite asbestos and fiber glass. The authors could not determine the source of the material.
• Main results:
  • About 15 years after the operation, the patient developed dyspnea and a right pleural effusion containing many malignant cells. Biopsy of tumor nodules on the pleura and diaphragm was interpreted as malignant mesothelioma.
  • At autopsy, a large tumor mass bound together the heart, the bases of the right lung and the right diaphragm, and obliterated part of the pericardial sac over the right atrium and ventricle. Three small metastases were found in the left lower lobe and three periaortic nodes contained tumor.
  • The tumor had a biphasic (mixed glandular and spindle-cell) pattern, which the authors described as typical of the mixed pattern of mesothelioma.
  • Transparent fibers and rare ferruginous bodies were embedded in the thickened, fibrotic pericardium. Fibers were not obvious within the tumor nodules and were not seen in the pleura. Iron stains showed no ferruginous bodies in the pleura, lung or spleen.
  • By light microscopy, the uncoated pericardial fibers were 2 to 200 micrometers long, most less than 50 micrometers. Widths ranged from less than 1 to 5 micrometers, and 75 per cent were less than 1 micrometer wide.
  • Of 50 sequentially counted fibers examined by electron diffraction, 33 gave a pattern consistent with amphibole asbestos and 17 were amorphous.
  • Electron microprobe analysis was done on 15 fibers. Of the 11 amphibole fibers, 2 were consistent with anthophyllite asbestos and 9 with tremolite asbestos. The 4 amorphous fibers consisted largely of aluminum, silicon and calcium and appeared to be fiber glass.
• The authors' conclusion: The authors concluded that, whether the tumor began in the pericardium or the pleura, this case was, to their knowledge, the first malignant mesothelioma in a human arising after direct contact between a mesothelial surface and fibrous dust. They stated that it provides support for the epidemiologic and experimental evidence they cited.
• Limitations the authors state:
  • The authors could not determine the source of the "asbestos" used in the operation.
  • The authors could not examine the ferruginous bodies to determine whether any had formed on the fiber glass.
  • The authors noted that the patient's clinical presentation was unusual for pericardial mesothelioma, and they left open whether the tumor was of pericardial or pleural origin.

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, Pericardium, Mesothelioma, Pericardial, Autopsy, Ferruginous Bodies, Tremolite, Anthophyllite.

Related studies

• Primary tumors and cysts of the heart and pericardium — H.A. McAllister (1979)
• Primary malignant mesothelioma of the pericardium. Case report and literature review — R. Thomason, W. Schlegel, et al. (1994)
• Primary malignant mesothelioma of the pericardium — J. Patel, M.N. Sheppard (2011)
• Malignancies involving the pericardium — W.H. Warren (2000)
• Extrapericardial solitary fibrous tumour of the pericardium — S.M. Andreani, L. Tavecchio, et al. (1998)
• Letter: Mesothelioma of the pericardium with cholesterol pericarditis — E. Argianas, K. Melissinos, et al. (1974)

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