Mesothelioma in an agricultural community of India: a clinicopathological study

Our plain-English summary of Mesothelioma in an agricultural community of India: a clinicopathological study, by P.B. Das, A.G. Fletcher, S.G. Deodhare (The Australian and New Zealand Journal of Surgery, 1976).

The study

• Authors: P.B. Das, A.G. Fletcher, S.G. Deodhare
• Journal: The Australian and New Zealand Journal of Surgery
• Published: 1976;46(3):218-26
• Type of article: Case report
• Cited by: 28 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. 002267).

Abstract

Mesothelioma is an uncommon neoplastic condition. Its association with asbestos exposure is well established, but it occurs even in non-industrial workers, and naturally there must be some other factors in its aetiology than asbestos exposure. In this report, five patients with primary mesothelioma, all belonging to a rural agricultural community with no chance of any asbestos exposure, have been documented. There was one common interesting observation, in that all five patients were associated with sugar-cane farming or an allied trade. Whether this observation is coincidental or has any aetiological bearing on mesothelioma needs further investigation. Its histopathological features, symptomatology, diagnosis, and treatment are discussed, with a brief review of the literature.

In plain English

This article reported five patients with primary mesothelioma treated at Wanless Hospital, Miraj, Maharashtra, India, from January 1974 to March 1976, with a brief literature review. The authors stated that none had any chance of occupational asbestos exposure and that all were associated with sugar-cane farming or an allied trade. Four came from the sugar-cane farming community (one was a housewife in a sugar-cane farming family); the fifth was a chemist in a local sugar factory. Four tumours arose from the pleura and one from the pericardium. Four were diffuse malignant mesotheliomas and one was benign, though the authors noted it was not localized. In the three patients whose lung tissue was removed, apparently no asbestos or asbestos-like bodies were found. Two were symptom-free 26 and 24 months after surgery. Two were doing well ten and eight months after diagnosis, following radiotherapy and chemotherapy. One did not respond and developed scalp metastases. The authors wrote that some farming-related rural factor must induce mesothelioma as asbestos does. They added that whether the sugar-cane link was coincidental needed further investigation.

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 series (clinicopathological study) of five patients, with a brief review of the literature
• Who was studied: Five patients from non-industrial rural communities of India treated at Wanless Hospital, Miraj Medical College, Miraj, Maharashtra, between January 1974 and March 1976. Case 1 was a 35-year-old agriculturist, Case 2 a 35-year-old housewife in a sugar-cane farming family, Case 3 a 27-year-old sugar-cane farmer, Case 4 a 54-year-old sugar-cane farmer, and Case 5 a male chemist in a sugar factory (his age is unreadable in the scan).
• Exposure: The authors stated there was no chance of occupational asbestos exposure in any of the five. All were associated with sugar-cane farming or an allied trade. Four belonged to the farming community, which the authors described as engaged in sugar-cane farming and making jaggery and molasses (Case 2 was a housewife in a family engaged in sugar-cane farming), and one was a chemist in a local sugar factory. The authors raised, as an open question, irritating fumes from dried and crushed sugar-cane burned as fuel.
• Main results:
  • The tumour was of pleural origin in four patients and of pericardial origin in one (Case 1).
  • Four of the five were diffuse malignant mesotheliomas and one (Case 2) was a benign mesothelioma. The authors noted that the benign tumour was not localized.
  • By tissue type, two were tubulopapillary (Cases 1 and 3), two were fibrous (Cases 2 and 4), and one was bimorphic or mixed (Case 5).
  • In the three cases where lung tissue was resected, the tissue was examined for asbestos or asbestos-like bodies, and the authors wrote that apparently none was found.
  • In Case 4 a tumour deposit was found on the chest wall at the site of an earlier needle drainage of fluid. The only distant metastasis was in Case 5, as nodules in the scalp.
  • Cases 1 and 2, whose tumours were removed surgically, remained without symptoms 26 and 24 months after surgery, with no evidence of recurrence.
  • Cases 3 and 4, treated with radiotherapy and cyclophosphamide chemotherapy, were still doing well ten and eight months after diagnosis. Case 5 did not respond to radiotherapy and chemotherapy and left hospital at his relatives' request as his condition worsened.
  • The authors reviewed ten previously reported Indian cases (seven autopsy cases and three case reports) and found that all came from non-industrial rural communities. Three of these came from Maharashtra, but it was not clear whether any were associated with sugar-cane farming.
• The authors' conclusion: The authors wrote that their five cases, together with earlier Indian reports, indicated that there must be a factor in non-industrial rural areas connected with farming that induces mesothelioma in the same way as asbestos does. They added that further investigations, possibly including animal experiments, are required to prove this.
• Limitations the authors state:
  • The authors stated that whether the sugar-cane association is coincidental or has any causal bearing needs further investigation.
  • The authors stated that it is difficult to say at this stage whether fumes from burning sugar-cane could irritate the pleura.
  • For the earlier Indian cases they reviewed, the authors stated it was not clear whether any patient was associated with sugar-cane farming.

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, Asbestos Exposure.

Related studies

• Increased risk of lung cancer in pesticide-exposed male agricultural workers — E. Barthel (1981)
• Medically reported work-related ill-health in the UK agricultural sector — S.J. Stocks, S. Turner, et al. (2010)
• A principal factor analysis to characterize agricultural exposures among Nebraska veterans — L. Weissenburger-Moser, J. Meza, et al. (2017)
• Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India — P.A.M. Paul, N. Calton, et al. (2021)
• Translocation and bioaccumulation of metals in Oryza sativa and Zea mays growing in chromite-asbestos contaminated agricultural fields, Jharkhand, India — A. Kumar, S.K. Maiti (2014)
• Malignant mesothelioma arising after direct application of asbestos and fiber glass to the pericardium — A. Churg, M.L. Warnock, et al. (1978)

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