Malignant mesothelioma of the pleura and other malignancies in the same patient

Our plain-English summary of Malignant mesothelioma of the pleura and other malignancies in the same patient, by C. Bianchi, T. Bianchi, L. Ramani (Tumori, 2007).

The study

• Authors: C. Bianchi, T. Bianchi, L. Ramani
• Journal: Tumori
• Published: 2007;93(1):19-22
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims And Background: The co-existence of mesothelioma, mostly asbestos-related, and other primary malignancies has repeatedly been reported. The present study evaluated the frequency of such an occurrence.

Methods: In the period October 1979-June 2002, 215 cases of malignant pleural mesothelioma were diagnosed at the Hospital of Monfalcone, Italy. All the cases of the above series, examined at necropsy (169), were included in the study. Occupational histories had been obtained from the patients or from their relatives by personal or telephone interviews. In 132 cases, asbestos bodies were isolated after chemical digestion of lung samples. The thoracic cavities were examined for pleural plaques.

Results: Additional malignancies were observed in 32 cases (18.9%). Multiple tumors were synchronous in 22 cases, metachronous in 8 cases, and synchronous and metachronous in 2. Four different tumors were found in 2 cases, 3 malignancies were detected in 6 patients, and 2 malignancies in the remaining 24. The most frequent additional malignancies were prostate adenocarcinoma (7 cases), non-Hodgkin lymphoma or chronic lymphocytic leukaemia (5 cases), bladder carcinoma (4 cases), kidney carcinoma (4 cases), large bowel carcinoma (4 cases), and liver cell carcinoma (4 cases). All the patients had histories of exposure to asbestos, mostly in shipbuilding. Lung asbestos body burdens ranged between 60 and 230,000 per gram of dried tissue. Pleural plaques were found in 26 cases.

Conclusions: In contrast with other series of the literature, in the present cases the co-existence of mesothelioma and other malignancies appeared as a relatively frequent event. The lack of a control group does not allow definite conclusions about the meaning of the occurrence. However, the co-existence of certain tumors with asbestos-related mesothelioma suggests that mesothelioma and associated malignancies might share some etiologic factors (asbestos and others).

In plain English

This study reviewed 169 cases of malignant pleural mesothelioma examined at necropsy (autopsy). They came from 215 cases diagnosed at the Hospital of Monfalcone, Italy, between October 1979 and June 2002. All cases in the series had been classed as asbestos-related, and the authors looked for other primary cancers in the same patients. Other cancers were found in 32 of the 169 patients (18.9%), totalling 42 tumors. In 22 patients these were found at the same time as the mesothelioma, in 8 at a different time, and in 2 both. The most frequent were prostate adenocarcinoma (7 patients), non-Hodgkin lymphoma or chronic lymphocytic leukaemia (5), and bladder, kidney, large bowel and liver cell carcinoma (4 each). All 32 had been exposed to asbestos: 23 in shipyards, 3 in construction, and 6 women at home from cleaning asbestos-polluted work clothes. The authors concluded that these combinations appeared relatively frequent in this series and might share causes, asbestos and others. They stated that, without a control group, no definite conclusions were possible.

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 necropsy (autopsy) cases of malignant pleural mesothelioma from one general hospital, with no control group
• Who was studied: 169 malignant pleural mesothelioma cases examined at necropsy (139 men, 30 women). They came from 215 cases diagnosed at the Hospital of Monfalcone, Italy, from October 1979 to June 2002, among residents of the Gorizia Province. Necropsy was done at Monfalcone in 160 cases and at other hospitals of the Friuli Venezia Giulia Region in the rest. The 32 patients with additional cancers were 24 men and 8 women aged 56 to 91 years.
• Exposure: Asbestos exposure, reconstructed from interviews and work booklets, plus lung asbestos body counts and pleural plaques found at necropsy. The article does not name fiber types. Among the 32 patients with additional cancers, exposure was occupational in 26 (shipyards 23, construction industry 3) and domestic in 6 women who had cleaned asbestos-polluted work clothes.
• Main results:
  • Additional primary malignancies were found in 32 of the 169 mesothelioma cases (18.9%), for a total of 42 tumors.
  • The additional tumors were synchronous (found at the same time as the mesothelioma) in 22 cases, metachronous (found at a different time) in 8 cases, and both in 2 cases.
  • Counting only synchronous cancers, the prevalence in this series was 14.2%.
  • The most frequent additional malignancies were prostate adenocarcinoma (7 cases), non-Hodgkin lymphoma or chronic lymphocytic leukaemia (5 cases), bladder carcinoma (4 cases), kidney carcinoma (4 cases), large bowel carcinoma (4 cases) and liver cell carcinoma (4 cases). Lung carcinoma was found in 2 cases.
  • The 32 patients with multiple tumors were 24 men and 8 women, aged 56 to 91 years (mean 73.1, median 75.0).
  • In the 32 patients with multiple tumors:
• lung asbestos body burdens ranged from 60 to 230,000 bodies per gram of dried tissue;
• pleural plaques were found in 26 cases;
• latency periods (from first exposure to mesothelioma diagnosis) ranged from 32 to 64 years (mean 52.6, median 53.0).
  • Pleural plaques were found in:
• 21 of 23 former shipyard workers;
• 2 of 3 construction industry workers;
• 3 of 6 women with domestic exposure.
  Plaques were generally larger, and asbestos body burden substantially higher, among shipyard workers.
  • No mesothelioma following radiation treatment (post-irradiation mesothelioma) was noted in the series.
• The authors' conclusion: The authors concluded that, in contrast with other published series, the co-existence of mesothelioma and other malignancies appeared relatively frequent in these cases. They stated that the lack of a control group does not allow definite conclusions about what this means. They added that the co-existence of certain tumors with asbestos-related mesothelioma suggests that mesothelioma and the associated malignancies might share some causes (asbestos and others).
• Limitations the authors state:
  • No control group was available.
  • The series is a collection of cases diagnosed in a single general hospital.
  • Cancer registration in the Friuli Venezia Giulia Region started only in recent years.
  • The authors stated that whether asbestos causes the co-existing tumors cannot be resolved on the basis of these findings.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleura, Pleural Mesothelioma, Autopsy, Asbestos Bodies, Pleural Plaques, Adenocarcinoma, Carcinoma.

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