Pathology of pleural mesothelioma

Our plain-English summary of Pathology of pleural mesothelioma, by H. Otto (The Thoracic and Cardiovascular Surgeon, 1985).

The study

• Author: H. Otto
• Journal: The Thoracic and Cardiovascular Surgeon
• Published: 1985;33(6):332-4
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Macroscopic and microscopic details of benign and malignant mesotheliomas are discussed in connection with indications for localization and frequency. Of special significance are malignant mesotheliomas of the pleura and the peritoneum resulting from exposure to asbestos which had often taken place several decades earlier. It is especially important to objectify the exposure to asbestos by means of histological and pulmonary dust investigations in those cases where the occupational anamnesis is vague or questionable.

In plain English

This article was a lecture by a pathologist, read at a 1985 meeting of the German Society for Thoracic and Cardiovascular Surgery. It was an overview of benign and malignant mesothelioma, not a formal study with stated methods. It drew on the mesothelioma register at the Pathological Institute in Dortmund, Federal Republic of Germany. The author described the tumors' appearance and their epithelial, bivalent and sarcomatous forms, and how they can be confused with other cancers. Of 500 malignant mesotheliomas in the register, 3 were in the pericardium. The author reported that mesothelioma frequency showed no relation to the severity of asbestosis. In 300 consecutive autopsies, lung tissue was dissolved and filtered through millipore filters and the asbestos bodies were counted. Indications of occupational asbestos exposure were found frequently only at 30 or more asbestos bodies per cubic centimeter of lung, and were the rule above 50. The lower (basal) parts of the lungs held 5 to 7 times more asbestos than the upper (apical) parts. Searching the tumor itself nearly always failed. The author concluded that non-tumor lung tissue should also be taken for testing.

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 overview (lecture) by a pathologist, drawing on the Dortmund mesothelioma register and the author's institute's autopsy work; no formal methods section
• Who was studied: Malignant mesothelioma cases in the Dortmund register (500 malignant mesotheliomas mentioned), held at the Pathological Institute, Municipal Clinic, Dortmund, Federal Republic of Germany, set up in 1976; plus 300 consecutive autopsies evaluated for lung asbestos load
• Exposure: Asbestos exposure, mainly occupational, with no fiber type specified for the author's own data (crocidolite is mentioned only in the historical background on Kimberley, South Africa). Exposure was measured as asbestos bodies per cubic centimeter of lung tissue, after the tissue was dissolved and filtered through millipore filters.
• Main results:
  • Of 500 malignant mesotheliomas in the Dortmund register, only 3 were located in the pericardium
  • The author stated that malignant mesotheliomas of the pleura are 10 to 20 times more frequent than those of the peritoneum
  • The frequency of mesotheliomas showed no relation to the severity of asbestosis; only a small proportion of mesothelioma cases had clinically or radiologically recognizable asbestosis
  • Limited asbestos exposure led to a minimal asbestosis that was not visible to the eye or on X-ray. It was found only after many tissue slides were prepared, as minimal fibrosis around the small airways with individual asbestos bodies.
  • In the 300 consecutive autopsies, indications of occupational asbestos exposure were found frequently only in cases with 30 or more asbestos bodies per cubic centimeter of lung
  • In the same autopsy series, an indication of occupational exposure was the rule in cases with over 50 asbestos bodies per cubic centimeter of lung
  • Asbestos was unevenly distributed in the lungs: the basal parts contained 5 to 7 times more asbestos than the apical sections
  • The asbestos content of one-centimeter cubes of lung varied between regions by a factor of 6 to 8
  • The search for asbestos was nearly always unsuccessful in the tumor tissue itself
  • The pure epithelial type of mesothelioma was now identified noticeably more often than before, when many such cases were diagnosed as peripheral bronchial carcinoma. The author stated that insurance-liability considerations had some influence on these diagnoses.
• The authors' conclusion: The author concluded that, to establish asbestos exposure in mesothelioma cases, other lung tissue besides tumor tissue should be taken as a specimen, at least one centimeter on each edge, for the millipore procedure. The author considered this especially relevant when the occupational history appears 'empty'.
• Limitations the authors state:
  • Only a small percentage of mesothelioma cases had definite histories of work involving asbestos contact. For many, judging the relevance of the exposure was a matter of opinion and estimation.
  • Because asbestos is unevenly distributed in the lung, the asbestos content of a tissue block used for a slide is very inhomogeneous
  • The author questioned whether electron microscopy, which uses thinner and smaller sections, necessarily helps in finding asbestos

Topics

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

Medical terms in this study, explained in our Lexicon: Pathology, Pleural Mesothelioma, Malignant Mesothelioma, Pleura, Peritoneum.

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Browse more research in The Thoracic and Cardiovascular Surgeon, or return to medical research.