Palliation of malignant pleural mucous-secreting mesothelioma: a possible role for phenol irrigation

Our plain-English summary of Palliation of malignant pleural mucous-secreting mesothelioma: a possible role for phenol irrigation, by A. Marath, A. Manche, E.J. Weaver (Journal of the Royal Society of Medicine, 1989).

The study

• Authors: A. Marath, A. Manche, E.J. Weaver
• Journal: Journal of the Royal Society of Medicine
• Published: 1989;82(11):685-7
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

In plain English

This case report, from the Cardiothoracic Unit of the London Hospital, described one 56-year-old woman with a mucous-secreting malignant mesothelioma of the pleura (the membrane lining the chest). The article does not mention asbestos or any other exposure. Her large right-sided pleural effusion (fluid around the lung) was too thick to drain with needles or chest tubes. Injections of Corynebacterium parvum and tetracycline had no effect. At operation, 2.123 kg of greasy mucous fluid was removed, the pleura was surgically removed, and radiotherapy followed. Tissue tests supported epithelial mesothelioma rather than the adenocarcinoma first suggested. The tumour recurred after two and a half months of marked improvement. The team then repeatedly rinsed the chest with 1% phenol solution through a chest tube. They observed less pain and, judged by chest X-rays, less fluid production, with relief lasting several days between rinses. She died 17 months after first presentation. The authors concluded that phenol irrigation may possibly play a useful role in reducing morbidity (illness and suffering), while noting that their experience was limited.

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)
• Who was studied: One 56-year-old woman with a large right pleural effusion caused by mucous-secreting malignant pleural mesothelioma. The authors were at the Cardiothoracic Unit, London Hospital, Whitechapel, London. No dates of treatment are given.
• Exposure: Not reported: the article does not mention asbestos or any occupational or other exposure. The treatment examined was irrigation of the pleural cavity with 1% phenol solution.
• Main results:
  • Repeated needle drainage (pleural taps) and chest drains failed to reduce the effusion because the fluid was so viscous.
  • Injections of Corynebacterium parvum and tetracycline into the pleural space had no effect.
  • At thoracotomy, 2.123 kg of tacky mucous fluid was removed. A right parietal and visceral pleurectomy was performed, followed by radiotherapy (4000 rad).
  • Tissue examination showed a tumour suggesting epithelial mesothelioma. Sialomucin was present, epithelial mucin was absent and the test for CEA was negative, which supported malignant mesothelioma rather than adenocarcinoma.
  • After two and a half months of marked improvement, the tumour recurred and involved the thoracotomy scar.
  • The fluid's measured viscosity was greater than 100 kPa-S.
  • After 1% phenol irrigation through a chest tube, the authors observed reduced pain and discomfort and a decrease in daily fluid production, estimated by serial chest X-rays.
  • Relief lasted several days between irrigations until the patient's death, nine months after thoracotomy and 17 months after first presentation.
  • The chest tube was not troublesome and did not appear to cause infection (sepsis).
• The authors' conclusion: The authors concluded that it is possible that phenol irrigation may play a useful role in reducing morbidity in this situation.
• Limitations the authors state:
  • The authors stated that their experience with this type of presentation is limited.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

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

Related studies

• Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery — O. Soysal, N. Karaoğlanoğlu, et al. (1997)
• Prognostic factors for survival after surgical palliation of malignant pleural effusion — J.E. Pilling, M.E. Dusmet, et al. (2010)
• Radiotherapy in the treatment of malignant mesothelioma of the pleura, with special reference to its use in palliation — S.R. Davis, L. Tan, et al. (1994)
• Mesothelioma--VATS biopsy and lung mobilization improves diagnosis and palliation — M.W. Grossebner, A.A. Arifi, et al. (1999)
• Palliation of malignant ascites with a Tenckhoff catheter — D.A. Lomas, P.J. Wallis, et al. (1989)
• Palliation of male genital cancers — C.J. Shukla, M. Shabbir, et al. (2010)

Browse more research in Journal of the Royal Society of Medicine, or return to medical research.