Pleural mesothelioma

Our plain-English summary of Pleural mesothelioma, by W.N. Campbell (The American Journal of Pathology, 1950).

The study

• Author: W.N. Campbell
• Journal: The American Journal of Pathology
• Published: 1950;26(3):473-87
• Read it: PubMed · Free full text

In plain English

This article described 4 cases of pleural mesothelioma confirmed among 3533 consecutive autopsies over 8 years at Temple University Hospital in Philadelphia. It compared them with 10 recently published autopsied cases. The article does not mention asbestos, work or exposures. The four patients were white men aged 35, 57 and 64 and a white woman aged 36. Among the 14 tumors, 10 showed epithelial and mesenchymal (sarcoma-like) patterns in different areas, 4 were only epithelial, and 1 was purely mesenchymal. Added together, these printed counts come to more than the 14 cases the article says were studied. The diaphragm was invaded in 10 cases (2 further reports did not say) and the peritoneum was studded with tumor in 9. None of the 14 had proved widespread metastasis into organ tissue itself, as opposed to organ surfaces. Proved cases made up 0.11 per cent of autopsies. The author concluded that the tumor characteristically spreads by direct extension and by seeding along body linings. The author called for early diagnosis, hoping radical surgery may cure it. The author noted that only autopsied cases were used and that lymph node involvement often lacked microscopic confirmation.

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 of 4 autopsy-confirmed cases from one hospital, combined with a review of 10 recently reported autopsied cases from the English-language literature
• Who was studied: 4 patients with pleural mesothelioma found among 3533 consecutive autopsies at Temple University Hospital, Philadelphia, over 8 years (patients admitted 1939 to 1949): white males aged 35, 64 and 57 and a white female aged 36. Also 10 published autopsied cases from other authors, out of 18 reported since 1943 (8 were excluded).
• Exposure: Not reported. The article does not mention asbestos, fiber types, occupations or any other exposure for any patient.
• Main results:
  • Of the 14 cases studied, only one (Temple case 4) showed a purely mesenchymal pattern.
  • Four of the tumors showed only an epithelial component.
  • Of the 14 tumors, 10 showed an epithelial component in some areas and a mesenchymal pattern in others. (Added to the 4 epithelial-only tumors and the 1 purely mesenchymal tumor, the printed counts come to more than the 14 cases studied.)
  • Among the 14 cases, the diaphragm was invaded in 10 (not mentioned in 2 further reports) and the peritoneum was studded with tumor nodules in 9.
  • None of the 14 cases had proved widespread metastasis to parenchymatous organs, meaning the substance of the organs rather than tumor on their surface linings. Liver nodules, which the author called presumptive evidence of spread by the blood, were seen in only 2 cases.
  • The author judged that the characteristic and usual method of spread was by contiguity (direct extension) and serosal seeding.
  • Hilar lymph nodes were reported as involved by tumor in 8 cases, but microscopic verification was affirmed for only 3 of these.
  • In the Temple series, proved diagnoses made up 0.11 per cent of autopsies, about one case per 900 autopsies (printed by OCR as 'O.II' and 'goo'; consistent with 4 of 3533).
  • Over the same 8 years, 6 additional surgical pleural specimens had findings compatible with pleural mesothelioma but were not confirmed at autopsy and were not included.
• The authors' conclusion: The author concluded that pleural mesothelioma can usually be diagnosed on microscopic (cytologic) grounds when both epithelial and mesenchymal elements are present, and that it characteristically spreads by contiguity and serosal seeding, which may help tell it apart from bronchogenic carcinoma. Because these tumors grow rapidly, the author made a plea for early diagnosis in the hope that early radical surgery may result in cure.
• Limitations the authors state:
  • Only autopsied cases were used.
  • In Temple case 4 most of the tumor was necrotic, presumably from alcohol injection, so an epithelial component may have been destroyed.
  • Lymph node involvement was often not microscopically verified, so the frequency of lymphatic spread is uncertain and further work is needed.
  • Because surgical cases not confirmed at autopsy were excluded, the true incidence may be somewhat higher than reported.

Topics

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

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

Related studies

• Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province — J.C. Wagner, C.A. Sleggs, et al. (1960)
• Histochemical demonstration of hyaluronic acid in pleural mesotheliomas — J.C. Wagner, D.E. Munday, et al. (1962)
• Diffuse mesothelioma of the pleura and asbestos — P.C. Elmes, W.T. McCaughey, et al. (1965)
• Localized mesotheliomas of the pleura. The pathologic evaluation of 18 cases — E.A. Foster, L.V. Ackerman (1960)
• Exposure to asbestos and mesothelioma of the pleura — P.B. Fowler, J.C. Sloper, et al. (1964)
• Roentgen aspects of pleural mesothelioma — N. Finby, I. Steinberg (1955)

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