Near Missed Case of Occupational Pleural Malignant Mesothelioma, a Case Report and Latest Therapeutic Options

Our plain-English summary of Near Missed Case of Occupational Pleural Malignant Mesothelioma, a Case Report and Latest Therapeutic Options, by C.M. Handra, M. Chirila, R.A. Smarandescu, et al (International Journal of Environmental Research and Public Health, 2022).

The study

• Authors: C.M. Handra, M. Chirila, R.A. Smarandescu, I. Ghita
• Journal: International Journal of Environmental Research and Public Health
• Published: 2022;19(22)
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos use started to be gradually banned in Europe from 1991 onwards, and there are currently strict occupational exposure limits for asbestos. However, malignant mesothelioma has a long latency time (in some cases up to 50-60 years), so the risks related to asbestos exposure should not be forgotten. Considering the increased risk of lung cancer following the inhalation of asbestos fibers, lifetime health monitoring should be considered in people occupationally exposed to asbestos, with an emphasis on the respiratory system. An assessment of their occupational history should be performed rigorously, especially in the areas with a history of asbestos production/use, as this is a key element for an early diagnosis and appropriate treatment. This case report presents a near-missed case of occupational pleural malignant mesothelioma. The latency time between the first asbestos exposure and the diagnosis of occupational pleural malignant mesothelioma was 49 years. The accurate diagnosis was made two years after the first symptoms appeared.

In plain English

This case report from Romania described a 68-year-old non-smoking woman with pleural malignant mesothelioma. In 2019 she had fluid around the left lung and was diagnosed with pleurisy of unspecified cause. A pleural biopsy in September 2021 showed malignant mesothelioma. Tissue removed at surgery in October 2021 showed diffuse biphasic mesothelioma (60% sarcomatous and 40% epithelioid elements) invading the lung. She received radiotherapy and chemotherapy with cisplatin and pemetrexed. After the third course of chemotherapy, fluid appeared around the other lung and her general condition worsened. A detailed work history, taken only in February 2022, found 1 year and 10 months of exposure between 1973 and 1975. She worked as a quality control specialist in a factory making asbestos-cement plates with chrysotile. The time from first exposure to diagnosis was 49 years, and the accurate diagnosis came 2 years after symptoms began. No fiber measurements were made at that workplace. The authors concluded that short-term occupational exposure may be overlooked, and that lifetime monitoring of exposed people should be recommended. The discussion also reviewed treatment options described in other studies.

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 (single patient), with a discussion reviewing diagnosis and treatment options from other literature
• Who was studied: one 68-year-old non-smoking female patient with essential hypertension, dyslipidemia and hypothyroidism, admitted in February 2022 to the Colentina Occupational Medicine Clinic in Romania
• Exposure: 1 year and 10 months of occupational exposure (1973 to 1975) as a quality control specialist checking board thickness in a Romanian factory producing asbestos-cement plates with chrysotile. Respiratory protection was not ensured and no fiber measurements were made. She then worked 34 years as a middle school teacher.
• Main results:
  • In 2019 the patient had a left pleural effusion and was diagnosed with pleurisy of unspecified etiology; the fluid was reabsorbed after treatment
  • After pleural decortication in October 2021, histopathology showed diffuse biphasic mesothelioma (60% sarcomatous, 40% epithelioid elements) with pulmonary invasion
  • Immunohistochemistry was positive for calretinin, Wilms tumor 1 and D2-40, supporting the diagnosis of mesothelioma
  • PET-CT showed thickening of the left pleura from top to base, with no metastases or invasion of the chest wall, mediastinum or diaphragm
  • Treatment with radiotherapy and cisplatin plus pemetrexed was followed by worsening: after the third course of chemotherapy, pleurisy appeared on the opposite side and the general condition worsened
  • The latency from first asbestos exposure to diagnosis was 49 years
  • The accurate diagnosis was made 2 years after the first symptoms; a detailed occupational history was taken only on admission to the Occupational Medicine Clinic in February 2022
• The authors' conclusion: The authors concluded that occupational asbestos exposure may be overlooked, especially with short-term exposure and long latency. They called for more awareness of asbestos risks among current and former workers and for lifetime monitoring with screening of exposed people. They also noted that, with current treatments, screening would not assure better survival rates.
• Limitations the authors state:
  • No asbestos fiber measurements were made at the workplace during the exposure period
  • No data were available on post-exposure medical follow-up of the workers from this factory

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, Occupational Exposure, Latency, Asbestos Exposure, Lung Cancer, Occupational History.

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