Pneumothorax and malignant mesothelioma in patients over the age of 40

Our plain-English summary of Pneumothorax and malignant mesothelioma in patients over the age of 40, by J.D. Sheard, W. Taylor, A. Soorae, et al (Thorax, 1991).

The study

• Authors: J.D. Sheard, W. Taylor, A. Soorae, M.G. Pearson
• Journal: Thorax
• Published: 1991;46(8):584-5
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Five patients over the age of 40 with malignant mesothelioma of the pleura presented with a spontaneous pneumothorax in the course of five years. The diagnosis of malignant mesothelioma was not suspected at surgery but was made by histological examination of the pleurectomy specimens. During this time 91 pleurectomies for recurrent pneumothorax were performed, 45 in patients over the age of 40; malignant mesothelioma therefore accounted for 11% of spontaneous pneumothorax requiring pleurectomy in this age group. The association of spontaneous pneumothorax and malignant mesothelioma is not emphasised in current publications. These five cases highlight the need for all pleurectomy specimens in cases of spontaneous pneumothorax to be sent for histological examination and for a full occupational history to be taken, especially in older patients.

In plain English

This article reported a series of five patients over the age of 40 who had surgery to remove pleura (pleurectomy) at one Liverpool hospital for a spontaneous pneumothorax (collapsed lung), and whose removed tissue showed malignant mesothelioma of the pleura. Over five years the pathology department received 91 pleurectomy specimens from operations for recurrent or persistent spontaneous pneumothorax, 45 of them from patients over 40. Only one of the hospital's two thoracic surgeons sent specimens for examination at that time. The five cases made up 11% of specimens from patients over 40. All five were men aged 43 to 87. Mesothelioma was not suspected during surgery in any case. In one case the tissue was first reported as florid hyperplasia (overgrowth) of mesothelial cells, and mesothelioma was found at necropsy a year later. Three patients (two laggers and a docker) had a definite history of asbestos exposure, obtained afterwards. A shipyard worker's exposure was not known, and a teacher had none. The authors concluded that all pleurectomy specimens should be examined, especially from patients over 40, and that a thorough occupational history should be taken.

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 (five cases from one hospital's pleurectomy specimens over five years)
• Who was studied: Five men over 40 with malignant mesothelioma of the pleura, drawn from 91 pleurectomy specimens (45 from patients over 40) received over five years for recurrent or persistent spontaneous pneumothorax at Fazakerley Hospital, Liverpool. Only one of the hospital's two thoracic surgeons sent pleurectomy specimens for examination at that time.
• Exposure: Occupational asbestos exposure, recorded per patient: lagger (exposed), docker (exposed), shipyard worker (exposure not known), lagger (exposed), teacher (not exposed). Lung asbestos fibre counts were reported for the four patients who died. The article does not name the asbestos fibre types.
• Main results:
  • The five mesothelioma cases accounted for 11% of all pleurectomy specimens received from patients over 40 during the five-year period (5 of 45).
  • Mesothelioma was not suspected during surgery in any of the five cases. Malignancy was suspected before the operation in only one (case 3), who also had chest pain and weight loss.
  • In all five cases the chest radiograph showed no abnormality before the operation other than the pneumothorax.
  • In case 3 the pleurectomy specimen was first reported as florid hyperplasia of mesothelial cells. Necropsy a year later found an extensive right pleural malignant mesothelioma (epithelial type).
  • In four of the five cases the diagnosis was confirmed at postmortem examination. In the fifth patient, who was still alive, clinical and radiological findings supported the diagnosis.
  • All five patients were men. The oldest was 87 (patient 1) and the youngest 43 (patient 5).
• The authors' conclusion: The authors concluded that all pleurectomy specimens should be sent for histological examination, especially from patients over 40, and that a thorough occupational history should be taken from patients with spontaneous pneumothorax.

Topics

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

Medical terms in this study, explained in our Lexicon: Pneumothorax, Mesothelioma, Pleura, Occupational History.

Related studies

• Surgically treated pneumothorax. Radiologic and pathologic findings — K.G. Jordan, J.S. Kwong, et al. (1997)
• Recurrent pneumothorax: an unusual presentation of malignant mesothelioma — S.I. Handa, A.G. Wilkinson (1989)
• Intrapleural talc for the prevention of recurrent pneumothorax — J.R. Milanez, F.S. Vargas, et al. (1994)
• Recurrent pneumothorax following abdominal paracentesis — P.J. Stafford (1990)
• Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review — S. Alkhuja, A. Miller, et al. (2000)
• Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage — P. Lange, J. Mortensen, et al. (1988)

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