Primary Neoplasms of the Pleura

Our plain-English summary of Primary Neoplasms of the Pleura, by P. Klemperer, C.B. Rabin (1931).

The study

• Authors: P. Klemperer, C.B. Rabin
• Published: Archives of Pathology 11:385-412 (1931)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This pathology paper from Mount Sinai Hospital in New York reported five patients with primary tumors of the pleura, the lining around the lungs. It also reviewed earlier published cases. The article does not mention asbestos, and it reports no occupational or environmental exposure for any of the five patients. The authors divided these tumors into localized and diffuse forms. Four cases were localized giant tumors arising beneath the visceral pleura. Two were diagnosed as fibrosarcoma. One was described as an overgrowth of embryonic connective tissue. One was a lipoma, a fatty tumor, measuring 25 by 19 by 12 cm, in a man aged 41 who died of cardiac failure. The fifth case, a woman aged 26, had a diffuse tumor that completely ensheathed the left lung and measured 4 to 15 cm thick. Under the microscope it showed cells of epithelial appearance separated by collagen fibers. The authors concluded that diffuse pleural tumors arise from the surface lining cells, the mesothelium, and should be called mesothelioma, whether they look like epithelium, connective tissue, or both. They noted that this patient's autopsy was limited.

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 (report of five cases) combined with a review of previously published cases of primary pleural tumors
• Who was studied: Five patients at Mount Sinai Hospital, New York: four with localized giant tumors of the visceral pleura (including a man aged 53 and a man aged 41) and one woman aged 26 with a diffuse pleural tumor; the published literature on primary pleural tumors was also reviewed
• Exposure: Not addressed: the article does not mention asbestos, and it reports no occupational or environmental exposure for any of the patients. Radiation treatment given to some patients is recorded as therapy, not studied as a cause.
• Main results:
  • Literature review: the authors counted sixteen previously described cases of giant tumors of the visceral pleura. In the literature these tumors did not metastasize or infiltrate, even though they looked like sarcoma under the microscope.
  • Case 1 (localized tumor): tumor cells infiltrated the capsule in a few places, so the tumor was designated a fibrosarcoma
  • Case 2 (man aged 53): a fibrosarcoma with a low degree of malignancy was diagnosed
  • Case 3 (localized tumor, autopsy): the authors judged the tumor to be a neoplastic overgrowth of embryonic connective tissue
  • Case 4 (man aged 41): the tumor mass in the right chest measured 25 by 19 by 12 cm and had the typical structure of a lipoma. The patient died of cardiac failure two days after admission.
  • Case 5 (woman aged 26): at autopsy the left lung was completely ensheathed by tumor tissue measuring 4 to 15 cm in thickness
  • Case 5: under the microscope the tumor was made of cells of epithelial appearance that were almost everywhere separated from each other by collagen fibers
• The authors' conclusion: The authors concluded that diffuse neoplasms of the pleura arise from the surface lining cells (the mesothelium), should be designated mesothelioma, and may show the characteristics of epithelium, of connective tissue, or of both. In their view, localized tumors are different: they are of mesenchymal structure, originate from the subpleural areolar tissue, progress very slowly, and offer an opportunity for surgical removal.
• Limitations the authors state:
  • In case 5 the autopsy was limited by the terms of the autopsy permission
  • In case 4 the thoracic organs were removed through an abdominal incision, so no direct inspection of the chest organs in place was possible

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Pleura, Pathology, Environmental Exposure, Visceral Pleura, Collagen, Mesothelium, Mesothelioma.

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