Primary Malignant Mesothelioma Of The Pleura

Our plain-English summary of Primary Malignant Mesothelioma Of The Pleura, by H.B. Eisenstadt, F.W. Wilson (1960).

The study

• Authors: H.B. Eisenstadt, F.W. Wilson
• Published: Lancet 80:511-514, November (1960)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 001597. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article described two patients with malignant mesothelioma of the pleura, the lining of the lungs. Both were oil refinery foremen; the authors practiced in Port Arthur, Texas. The first, a 57-year-old man reported before, had chest pain and a collapsed lung, and surgery found only scar tissue. He was diagnosed only when a stomach X-ray, described as post-mortem, showed destroyed ribs and a biopsy there showed pleural mesothelioma. The second, a 58-year-old man who had worked with asbestos insulating material, had bloody fluid around the lung in January 1959. A first tissue sample was called a granuloma of unknown origin. Rib destruction appeared in December 1959, and he died in May 1960. Damaged text reports asbestos bodies in his lung biopsy. The autopsy pathologist considered a link to asbestos "very unlikely" because the fibers were in the bronchi, not the pleura; the authors noted that asbestos could have reached the pleura unseen under the microscope. The authors concluded that both men reached an advanced stage, with destroyed chest bones, before diagnosis, despite care by several specialists.

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 of two patients (the first previously reported, the second new)
• Who was studied: Two oil refinery foremen, aged 57 (case 1) and 58 (case 2). The authors were with St. Mary's Hospital and Park Place Hospital, Port Arthur, Texas. Case 2 had an exploratory thoracotomy at an unnamed large medical center and was followed from January 1959 until his death in May 1960.
• Exposure: Case 2 worked with asbestos insulating material and, according to the scanned discussion, had a history of long-time asbestos exposure. No asbestos exposure is described for case 1.
• Main results:
  • Case 1: chest surgery showed only dense fibrosis and adhesions. No diagnosis was made until a stomach X-ray, described in the text as post-mortem, unexpectedly showed several destroyed ribs. A biopsy of that region showed pleural mesothelioma.
  • Case 2: in January 1959 a bloody pleural effusion contained large mesothelial cells that one pathologist suspected were malignant. Other pathologists consulted did not share this suspicion.
  • Case 2: exploratory thoracotomy at a large medical center found multiple hard plaques and extensive adhesions. A pleural specimen was reported as granuloma of unknown origin, and the patient was given antituberculous treatment.
  • Case 2: in December 1959 X-rays showed several ribs destroyed, and a biopsy of the bone was interpreted as fibrous sarcoma
  • Case 2: the disease went on to destroy the lower dorsal vertebrae and upper sternum, causing spinal cord compression. The patient died in May 1960.
  • Case 2 autopsy: massive destruction of the left pleura involving the mediastinum, ribs, scapula, liver, spleen and lungs
  • Case 2: asbestos bodies were found in the lung biopsy specimen (badly scanned passage)
  • Case 2: on the basis of the autopsy, the pathologist considered it very unlikely that the tumor was related to the asbestos fibers, because they were located in the bronchi and not in the pleura (badly scanned passage)
  • The authors noted that asbestos material could have reached the pleural tissue without being demonstrable microscopically (badly scanned passage)
  • Case 2: a calcium deposit along the diaphragmatic surface of the pleural space was found at autopsy and could be seen on the initial X-rays (badly scanned passage)
• The authors' conclusion: The authors concluded that, despite continuous care by various specialists, both patients progressed to an advanced stage with destruction of the bony thorax before the correct diagnosis was established (reconstructed from a badly scanned summary)

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleura, Pneumothorax, Biopsy, Pleural Mesothelioma, Granuloma, Asbestos Bodies, Autopsy.

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