Malignant mesothelioma secondary to chronic inflammation and old scars. Two new cases and review of the literature

Our plain-English summary of Malignant mesothelioma secondary to chronic inflammation and old scars. Two new cases and review of the literature, by G. Hillerdal, J. Berg (Cancer, 1985).

The study

• Authors: G. Hillerdal, J. Berg
• Journal: Cancer
• Published: 1985;55(9):1968-72
• Type of article: Case report
• Cited by: 55 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. 000480).

Abstract

Old scars of the pleura, for example from chronic empyema or therapeutic pneumothorax, can cause a malignant mesothelioma appearing some decades later. The authors describe two cases of primary pleural tumors, which probably had such an etiology. A literature review revealed 20 further cases, the majority of which were squamous cell carcinomas. Whether these tumors developed from metaplastic mesothelium or inplanted cells from the skin is not clear.

In plain English

This article reported two cases from Uppsala, Sweden, and reviewed the published literature. Both patients were women, aged 53 and 72, who had been treated 27 and 37 years earlier with intrapleural pneumothorax for active tuberculosis on the same side of the chest where the tumor later grew. In the first woman, the autopsy diagnosis was a poorly differentiated tumor consistent with malignant mesothelioma of the sarcomatous type. She died 20 months after her first symptoms. In the second, the tumor cells were compatible with a sarcoma or a mesothelioma of the sarcomatous type. She died 6 months after decortication, a surgical procedure on the thickened pleura. Neither autopsy showed signs of asbestosis. The authors found 20 further published cases, and their tally of tumor types listed 12 squamous cell tumors. Among the 22 patients, the mean time from pneumothorax treatment or signs of empyema to tumor symptoms was 16 years. The authors concluded that their two cases probably arose from old pleural scars. They described their material as limited and noted that diagnosis was difficult in some cases.

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: two case reports with a review of published cases
• Who was studied: two women (aged 53 and 72) seen at University Hospital, Uppsala, Sweden, plus 20 further cases found in the literature
• Exposure: old pleural scars after intrapleural pneumothorax treatment for active tuberculosis, 27 and 37 years earlier; the reviewed cases also included chronic empyema, extrapleural pneumothorax and pneumonectomy
• Main results:
  • Case 1: at autopsy, a poorly differentiated tumor consistent with malignant mesothelioma of the sarcomatous type, with metastases
  • Case 1 died 20 months after first symptoms despite radiotherapy
  • Case 2: malignant cells compatible with a sarcoma or a mesothelioma of the sarcomatous type
  • Case 2 died 6 months after decortication; no metastases were seen at autopsy
  • No signs of asbestosis were found in the lungs at autopsy (stated for both cases)
  • The authors' tally of tumor types: 3 sarcomatous, 6 mixed (most typical for mesothelioma), 12 squamous cell tumors, 1 not defined histologically
  • Of the squamous cell tumors, 7 arose in remnants of extrapleural pneumothorax, 1 in intrapleural pneumothorax complicated by pyopleuritis, 3 in chronic empyemas and 1 after pneumonectomy
  • Among the 22 patients, the mean latency from first pneumothorax treatment or signs of empyema to tumor symptoms was 16 years (range 4 to 43 years)
• The authors' conclusion: The authors concluded that old pleural scars can cause malignant mesothelioma decades later and that their two cases probably had this cause; whether such tumors come from metaplastic mesothelium or implanted skin cells was not clear to them
• Limitations the authors state:
  • The authors described the reviewed material as limited when drawing conclusions about tumor types
  • Establishing the diagnosis was considerably difficult in some cases, even after thoracotomy

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, Chronic Inflammation, Pleura, Empyema, Pneumothorax, Etiology, Squamous Cell Carcinoma, Mesothelium.

Related studies

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• Asbestos-induced cellular and molecular alteration of immunocompetent cells and their relationship with chronic inflammation and carcinogenesis — H. Matsuzaki, M. Maeda, et al. (2012)
• Chronic inflammation in tumor stroma is an independent predictor of prolonged survival in epithelioid malignant pleural mesothelioma patients — K. Suzuki, K. Kadota, et al. (2011)
• Chronic Inflammation, Oxidative Stress and Metabolic Plasticity: Three Players Driving the Pro-Tumorigenic Microenvironment in Malignant Mesothelioma — I. Fiorilla, S. Martinotti, et al. (2023)
• Apoptosis Resistance in Fibroblasts Precedes Progressive Scarring in Pulmonary Fibrosis and Is Partially Mediated by Toll-Like Receptor 4 Activation — K.M. Hanson, E.B. Hernady, et al. (2019)

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