Malignant pleural mesothelioma at St Mary's Hospital, Portsmouth--a review of 29 fatal cases

Our plain-English summary of Malignant pleural mesothelioma at St Mary's Hospital, Portsmouth--a review of 29 fatal cases, by R.N. Harrison, S.C. Hibberd, J.H. Dadds (Postgraduate Medical Journal, 1983).

The study

• Authors: R.N. Harrison, S.C. Hibberd, J.H. Dadds
• Journal: Postgraduate Medical Journal
• Published: 1983;59(697):712-6
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001738).

Abstract

The clinical details are presented of 29 fatal cases of pleural mesothelioma in the majority of which there was a history of exposure to asbestos during dockyard work in Portsmouth. Chest pain, breathlessness and weight loss dominated the clinical picture. Analgesia and repeated pleural aspirations provided temporary relief but symptoms invariably progressed. The mean survival time was 39 weeks. Only one patient survived longer than 2 years from hospital presentation. At autopsy, extensive local spread was usual but a high proportion of patients also had metastases at distant sites.

In plain English

This was a retrospective review of hospital records for 29 patients (28 men, 1 woman) at St Mary's Hospital, Portsmouth, who died of malignant pleural mesothelioma over a 6.5-year period ending in June 1982. Ages at death ranged from 41 to 91 years. Twenty-two patients reported past asbestos exposure, 27 had worked in jobs with a recognized exposure risk, and 20 had worked at H.M. Dockyard, Portsmouth. The case notes recorded the timing of exposure too poorly for it to be analysed. Chest pain and breathlessness were the most common complaints. Average survival from first hospital visit was 39 weeks (median 28 weeks), and six patients lived more than a year. Patients with fluid around the lung survived longer after their first visit but had also come to hospital sooner. Tru-Cut needle biopsy gave a diagnosis in 5 of 7 attempts, and Abrams needle biopsy in 1 of 17. Among patients examined at autopsy, the tumour was confined to the chest in only 11. The authors concluded that pleural fluid appeared not to influence survival, and suggested Tru-Cut biopsy as an alternative to open biopsy.

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 review (case series) of fatal cases at one hospital
• Who was studied: 29 patients (28 male, 1 female) seen at St Mary's Hospital, Portsmouth, who died of histologically proven malignant pleural mesothelioma over a 6.5-year period ending June 1982. In all cases the diagnosis was accepted by the Pneumoconiosis Medical Panel. Age at death ranged from 41 to 91 years, mean 63 years.
• Exposure: Occupational asbestos exposure, mainly dockyard work. 22 patients admitted previous asbestos exposure. 27 had been in occupations with a recognized exposure risk, 20 of them at H.M. Dockyard, Portsmouth (jobs included boiler maker, lagger, shipwright, builder, electrician, naval engineer and plumber). The remaining 2 patients, a waitress and a local government officer, had no history of exposure. Fiber type and dose were not reported.
• Main results:
  • At first hospital attendance the patients' complaints were chest pain (79%), breathlessness (71%), cough (50%), weight loss (39%) and malaise (11%).
  • For all 29 patients, the average time from hospital presentation to death was 39 weeks, with a range of 4 to 128 weeks. The median survival from presentation was 28 weeks.
  • Six patients survived more than 1 year and one survived for 2 years.
  • Patients with pleural effusions survived significantly longer after hospital presentation than those without fluid (48 vs 23 weeks, P less than 0.025). They also presented earlier after symptom onset (15 vs 48 weeks, P less than 0.005). Survival from symptom onset was similar in the two groups (63.2 vs 69 weeks, not significant).
  • In patients with no history of asbestos dust exposure, mean survival from symptom onset was 53 weeks (range 44 to 64 weeks).
  • Diagnostic yield by biopsy method: Abrams needle biopsy was positive in 1 of 17 attempts, Tru-Cut needle in 5 of 7, and thoracotomy in 12 of 13. Pleural fluid cytology was diagnostic in only one case.
  • Detailed autopsy reports were available for all but 2 cases. Tumour was confined to the thoracic cavity in only 11 patients. Local spread involved the underlying lung (16 cases), diaphragm (14), chest wall (6) and pericardium (5). Extrathoracic spread was most common to the liver and peritoneum.
  • Of the 23 patients with serial plasma electrolytes, 9 had plasma sodium fall below 135 mmol/litre as the disease progressed.
  • Treatment was conservative and symptomatic in all cases. Attempts to prevent fluid reaccumulation with mepacrine, bleomycin or Corynebacterium parvum were unsuccessful.
• The authors' conclusion: The authors concluded that their results did not support the view that patients denying asbestos exposure fare better, and that pleural fluid appeared not to influence survival, though it may have led to earlier presentation. They suggested the Tru-Cut needle should be considered as an alternative to open pleural biopsy.
• Limitations the authors state:
  • The timing (chronological details) of asbestos exposure was poorly recorded in the case sheets and was not analysed.
  • Accurate estimates of the nature or degree of exposure could not be obtained from the records.
  • The poor yield of Abrams biopsy may simply reflect operator inexperience.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Autopsy.

Related studies

• Case-control study of lung cancer in civilian employees at the Portsmouth Naval Shipyard, Kittery, Maine — R.A. Rinsky, J.M. Melius, et al. (1988)
• The Portsmouth thoracoscopy experience, an evaluation of service by retrospective case note analysis — S.V. Fletcher, R.J. Clark (2007)
• The significance of asbestos exposure in the diagnosis of mesothelioma: a 28-year experience from a major urban hospital — F.M. Hasan, G. Nash, et al. (1977)
• Diffuse malignant pleural mesothelioma in an urban hospital: clinical spectrum and trend in incidence over time — K.E. Shepherd, L.C. Oliver, et al. (1989)
• Fatal pleural mesothelioma in Japan (2003-2008): evaluation of computed tomography findings — K. Kato, K. Gemba, et al. (2016)
• Sister Mary Joseph's nodule as primary localized malignant mesothelioma. Report of a case — A. Papalambros, F. Sigala, et al. (2011)

Browse more research in Postgraduate Medical Journal, or return to medical research.