Malignant mesothelioma of the pleura

Our plain-English summary of Malignant mesothelioma of the pleura, by R.J. Pisani, T.V. Colby, D.E. Williams (Mayo Clinic Proceedings, 1988).

The study

• Authors: R.J. Pisani, T.V. Colby, D.E. Williams
• Journal: Mayo Clinic Proceedings
• Published: 1988;63(12):1234-44
• Type of article: Review
• Cited by: 72 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. 000260).

Abstract

Malignant mesothelioma of the pleura most commonly occurs in persons with a heavy occupational exposure to asbestos. Some patients, however, have no such history of exposure. Clinical features include initial complaints of nonpleuritic chest pain and dyspnea. The most frequent roentgenographic finding is a unilateral pleural effusion. Thrombocytosis and elevated erythrocyte sedimentation rates are common. Pleural effusions are typically exudates, are often hemorrhagic, and are usually insufficient for diagnosing mesothelioma based on cytology alone. Even pleural biopsy may not produce enough tissue to enable the pathologist to make a firm diagnosis. Thoracotomy and open biopsy will confirm the diagnosis in most cases. Pathologic distinction from metastatic adenocarcinoma may be difficult even after the use of special stains and electron microscopy. Clinical deterioration is primarily attributable to local spread of tumor. Several factors seem to predict prolonged survival: (1) epithelial histologic subtype, (2) performance score, (3) age of the patient at the time of diagnosis, and (4) absence of chest pain. Surgical treatment, chemotherapy, and irradiation, alone or in combination, have been used for malignant mesothelioma. Except for the palliative effect of irradiation, most treatment protocols have not altered the dismal median survival of approximately 11 months seen in untreated patients with malignant mesothelioma.

In plain English

This article was a review of published research on malignant mesothelioma of the pleura, the lining around the lungs. The authors did not study a group of patients of their own. Drawing on earlier studies, they wrote that the evidence linking crocidolite and amosite to mesothelioma is widely accepted. They described chrysotile as less carcinogenic, with increased risk seeming limited to people directly exposed to chrysotile mine dust. They also noted that no case had been reported among Finnish miners exposed to anthophyllite. In most of the patient series reviewed, gradual chest pain was the most common first symptom (60%). One cited study reported a median survival of 13 months for the epithelial type, compared with 3.6 months for the sarcomatous type and 8.4 months for the mixed type. Untreated patients had a median survival of approximately 11 months, and no treatment had extended median survival beyond 24 months. The authors noted that most treatment claims rested on small, retrospective, unrandomized studies. They concluded that it remains questionable whether any treatment substantially alters the grave prognosis.

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: Review of published literature (subject review); no new patient data
• Who was studied: Published studies and patient series on malignant pleural mesothelioma, including 14 previously published treatment studies summarized in a survival table
• Exposure: Asbestos exposure of different fiber types: crocidolite, amosite, tremolite, chrysotile and anthophyllite, mainly occupational exposure (for example miners, insulators, factory workers, shipyard workers)
• Main results:
  • From the literature reviewed: the evidence linking crocidolite and amosite to increased mesothelioma is widely accepted. Chrysotile's carcinogenicity is not as great, and increased risk seems limited to those directly exposed to chrysotile mine dust.
  • From a cited study: no case of mesothelioma had been reported among Finnish miners exposed to anthophyllite asbestos
  • Across most published series of patients with diffuse malignant mesothelioma, gradual onset of chest pain was the most common initial symptom (60%)
  • In one cited study, patients with the epithelial subtype had a median survival of 13 months, compared with 3.6 months for the sarcomatous subtype and 8.4 months for the mixed subtype
  • Untreated patients with malignant mesothelioma had a median survival of approximately 11 months
  • Based on the published treatment studies reviewed, none of the treatments used for malignant mesothelioma had extended median survival beyond 24 months
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma is increasing in the United States and is being seen more often in people without clear occupational asbestos exposure. They wrote that open pleural biopsy is needed for diagnosis in most cases and that the usual course is rapid progression to death within 2 years. They concluded that it remains questionable whether any treatment substantially alters the grave prognosis.
• Limitations the authors state:
  • The authors stated that most claims of treatment effectiveness in the literature came from small, single-center, retrospective, unrandomized studies that used survival time as the endpoint, which makes sound conclusions difficult
  • The authors stated that the pooled survival data give only a crude estimate of each treatment's influence, because the underlying studies have inherent limitations

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, Pleura, Occupational Exposure, Dyspnea, Pleural Effusion, Exudate, Mesothelioma, Cytology.

Related studies

• Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura — P.M. Cury, D.N. Butcher, et al. (2000)
• 'Pseudomesotheliomatous' carcinomas of the pleura: a 10-year analysis of cases from the Environmental Lung Disease Research Group, Cardiff — R.L. Attanoos, A.R. Gibbs (2003)
• Combined use of novel epithelial (MOC-31) and mesothelial (HBME-1) immunohistochemical markers for optimal first line diagnostic distinction between mesothelioma and metastatic carcinoma in pleura — C. González-Lois, C. Ballestín, et al. (2001)
• Localized benign mesothelioma of the pleura: case report and review of the literature — H. Seggewiss, K. Minami, et al. (1986)
• Black spots concentrate oncogenic asbestos fibers in the parietal pleura. Thoracoscopic and mineralogic study — C. Boutin, P. Dumortier, et al. (1996)
• Immunohistological study of malignant diffuse mesotheliomas of the pleura — H. Loosli, J. Hurlimann (1984)

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