Malignant pleural mesothelioma: two cases in first degree relatives

Our plain-English summary of Malignant pleural mesothelioma: two cases in first degree relatives, by A. Wilkins, S. Popat, S. Hughes, et al (Lung Cancer, 2007).

The study

• Authors: A. Wilkins, S. Popat, S. Hughes, M. O'Brien
• Journal: Lung Cancer
• Published: 2007;57(3):407-9
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report two cases of malignant pleural mesothelioma in first degree relatives arising within weeks of each other. The patients had a shared exposure to asbestos and age difference of over 20 years at time of presentation. In both cases, the anatomical pattern was similar and unusual for mesothelioma and initial histology was reported for both as non-small cell lung cancer. Both patients were treated with platinum-based combination chemotherapy.

In plain English

This case report, from the Royal Marsden Hospital in the United Kingdom, described malignant pleural mesothelioma in a father and son diagnosed around the same time. The father, aged 60 and a 45 pack-year smoker, first had fluid around the left lung in January 2004. Early tests were negative, but in August 2005 a biopsy of a tumour at the top of the left lung was reported as adenocarcinoma, a type of lung cancer. The case description stated that he denied asbestos exposure, but the discussion stated that he worked in construction and was exposed. He received three cycles of platinum-based chemotherapy and partly responded, with considerable side effects. The son, aged 39 and a 20 pack-year smoker, had gone with him to building sites about 20 years earlier, with confirmed asbestos exposure. The son's biopsy was also reported as adenocarcinoma, but a review confirmed mesothelioma. The father's diagnosis was then changed to malignant mesothelioma. Both tumours started at the tops of the lungs, a pattern the authors called unusual for mesothelioma. The authors said the cases raise the question of whether shared genetic factors are involved.

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 (two cases)
• Who was studied: Two male first degree relatives treated at the Department of Medical Oncology, Royal Marsden Hospital, Sutton, United Kingdom: a 60-year-old man who first presented in January 2004, and his 39-year-old son
• Exposure: Asbestos; the fiber type is not named. The son went with his father to building sites about 20 years earlier and had confirmed asbestos exposure. The father's exposure is described inconsistently: the case history says he denied any asbestos exposure, while the discussion says he worked for several years in construction and was exposed. Both were also smokers (father 45 pack-years, son 20 pack-years), and the son habitually used cannabis.
• Main results:
  • Father: when he first presented with a large left pleural effusion, the pleural fluid cytology and pleural biopsy were both negative.
  • Father: a repeat CT in August 2005 showed progressive disease with an apical lung tumour. A percutaneous biopsy was reported as adenocarcinoma.
  • Father: staged as stage IV. He was given three cycles of palliative platinum-based combination chemotherapy and had a partial response, with considerable toxicity (fatigue, thrombosis, vomiting, myelosuppression).
  • Son: he presented with a 6-week history of intermittent left upper chest pain and weight loss. CT showed extensive pleurally based tumour at the left apex with mediastinal invasion (stage IIIb), and a CT-guided biopsy was reported as adenocarcinoma.
  • Son: his histopathology was reviewed for possible clinical trial entry and the review confirmed mesothelioma. The father's histopathology result was then also changed to malignant mesothelioma.
  • In both patients the tumour arose from the lung apices, with pleural disease clumped around the apical domes. The authors described this distribution as unusual in malignant mesothelioma and said it explains why the initial histology was accepted.
• The authors' conclusion: The authors concluded that the cases raise the question of whether common genetic factors are involved in the development of malignant mesothelioma, and that they highlight the potential for familial clustering.

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, Mesothelioma, Histology, Non-Small Cell Lung Cancer, Chemotherapy.

Related studies

• Familial mesothelioma in first degree relatives — A.M. Kalogeraki, D.J. Tamiolakis, et al. (2013)
• Cancer diagnosis in first-degree relatives and non-small cell lung cancer risk: results from a multi-centre case-control study in Europe — A. Cassidy, J. Balsan, et al. (2009)
• Quality of life and personality traits in patients with malignant pleural mesothelioma and their first-degree caregivers — A. Granieri, S. Tamburello, et al. (2013)
• Correlation between TS, MTHFR, and ERCC1 gene polymorphisms and the efficacy of platinum in combination with pemetrexed first-line chemotherapy in mesothelioma patients — T. Powrózek, D.M. Kowalski, et al. (2014)
• Pemetrexed re-challenge in pleural malignant mesothelioma: an option for a subset of patients initially treated with pemetrexed-platinum doublets in the first-line setting? — G. Zalcman, E. Bergot, et al. (2011)
• Home interviews with relatives of deceased persons: a means of obtaining histories of exposure to a hazardous substance — A. Finlayson, J. McEwen, et al. (1971)

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