Pathological recognition of diffuse malignant mesothelioma of the pleura: the significance of the historical perspective as regards this signal tumor

Our plain-English summary of Pathological recognition of diffuse malignant mesothelioma of the pleura: the significance of the historical perspective as regards this signal tumor, by E.J. Mark, R.L. Kradin (Seminars in Diagnostic Pathology, 2006).

The study

• Authors: E.J. Mark, R.L. Kradin
• Journal: Seminars in Diagnostic Pathology
• Published: 2006;23(1):25-34
• Type of article: Historical article, Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Diffuse malignant mesothelioma (DMM) is a distinctive tumor which provides an uncommon opportunity to observe the gradual appreciation and increasing incidence of a new disease. DMM is a new disease. One cannot comment intelligently about the pathology of sporadic cases that might have occurred before the beginnings of anatomic pathology, but we do know that there were so few cases before 1930 that the very existence of the disease was not accepted in general before 1930 and not accepted by all pathologists even up until 1960. Because DMM is increasing on a worldwide basis and is making its appearance in the developing world, where it has not previously been diagnosed, appreciation of how the disease came to be noticed sheds light on its causation. As a signal tumor for exposure to asbestos, and knowing that all special exposures contribute to the development of the disease, knowledge of its continuing escalation underscores the importance of recognition of previously unimplicated or occult exposures for reasons of public health in both developed and developing countries.

In plain English

This article was a historical review, not a new study of patients. The authors, Massachusetts General Hospital pathologists, traced how pleural diffuse malignant mesothelioma (DMM) came to be recognized. They excluded experimentally induced mesotheliomas in animals and mesotheliomas in infants and children, and discussed peritoneal and pericardial DMM only briefly, as the same serosal tumor. They described older literature doubting that primary pleural tumors existed: a 1931 German handbook held that such tumors were usually spread from lung cancer, and not all pathologists accepted the disease even up until 1960. They recounted their hospital's first DMM diagnosis, in 1946, in a 37-year-old Swedish asbestos worker. They set out five 'acts' of exposure, from miners and millers to occult exposure. Using published data from Great Britain (males only), Australia and Japan, they reported that rising DMM incidence extrapolated back to effectively zero before 1960. The authors concluded that DMM is a new disease, that virtually no cases are unrelated to asbestos, and that calling cases 'spontaneous' or 'idiopathic' is mistaken. They acknowledged that sporadic undocumented cases probably occurred earlier.

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: Narrative historical review of the medical and pathology literature on diffuse malignant mesothelioma (DMM) of the pleura
• Who was studied: No new patient group. The review covered published descriptions of DMM of the pleura in humans, from 19th-century pathology literature to incidence data into the 21st century. It excluded experimentally induced mesotheliomas in animals and mesotheliomas in infants and children. It addressed DMM of the peritoneum and pericardium only to say it is the same serosal tumor, noting that the link of peritoneal DMM to asbestos parallels that of pleural DMM.
• Exposure: Asbestos in general: the amphiboles (crocidolite, amosite, tremolite, actinolite, anthophyllite) and the serpentine chrysotile. The authors stated that all forms cause DMM, with crocidolite the most oncogenic and chrysotile the least. They also discussed the asbestiform minerals erionite and balangerite, and radiotherapy.
• Main results:
  • The authors described DMM as a new disease.
  • A 1931 German pathology handbook, as quoted by the authors, concluded that so-called primary pleural tumors were in most cases metastases or extensions of primary lung cancer.
  • According to the authors, the existence of DMM was not accepted by all pathologists up until 1960.
  • The first DMM case at Massachusetts General Hospital, diagnosed in 1946, was in a 37-year-old Swedish asbestos worker.
  • The authors described the history of asbestos disease in five 'acts': miners and millers; tradesmen; bystanders; family members exposed at home; and occult exposure.
  • In the authors' composite graph of published data from Great Britain, Australia and Japan, rising DMM incidence extrapolated back to an effective incidence of zero before 1960.
  • In that composite graph, the Great Britain data covered males only.
  • Citing published reports from Great Britain, Australia, Japan and the United States, the authors stated that DMM had increased multifold over periods as short as two decades.
  • Early reports had few DMM cases compared with localized fibrous tumors of the pleura. In the authors' own experience, this ratio is now reversed.
• The authors' conclusion: The authors concluded that, because incidence trends mirror asbestos use with a delay matching the latency of DMM, there are virtually no DMM cases unrelated to asbestos, and that calling cases 'spontaneous' or 'idiopathic' is a mistaken concept.
• Limitations the authors state:
  • The authors acknowledged that sporadic, undocumented DMM cases probably occurred before commercial asbestos use.
  • The authors noted that how often a history of asbestos exposure is found depends on how and by whom the history is taken.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleura, Signal Tumor, Pathology, Causation.

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• Historical perspective on asbestos: policies and protective measures in World War II shipbuilding — J.K. Corn, J. Starr (1987)
• An update on pleuro-pulmonary cytopathology: Part i: Cytological diagnosis of mesothelioma and molecular cytology of lung cancer with an historical perspective — C.W. Bedrossian (2015)
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