Synchronous diffuse malignant mesothelioma and carcinomas in asbestos-exposed individuals

Our plain-English summary of Synchronous diffuse malignant mesothelioma and carcinomas in asbestos-exposed individuals, by R.L. Attanoos, D.H. Thomas, A.R. Gibbs (Histopathology, 2003).

The study

• Authors: R.L. Attanoos, D.H. Thomas, A.R. Gibbs
• Journal: Histopathology
• Published: 2003;43(4):387-92
• Cited by: 39 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: The development of synchronous diffuse malignant mesothelioma and carcinoma in individuals exposed to asbestos is rare. We report nine cases and discuss the medico-legal implications.

Methods And Results: Five hundred patients seeking compensation for asbestos-related diffuse malignant mesothelioma were reviewed with access to post-mortem data. The study group comprised cases in which a second (non-mesothelial) neoplasm was identified. The study group comprised eight males, one female, mean age 68 years (range 60-75). All individuals gave a history of asbestos exposure. Synchronous malignant mesothelioma with carcinoma was identified in 9/500 (1.8%). Eight malignant mesotheliomas were pleural, one was primary peritoneal in origin. By morphological subtyping there were four epithelioid, three biphasic and two sarcomatoid mesotheliomas. In 6/9 (67%) the second tumour was a primary bronchogenic carcinoma (three adenocarcinomas, two squamous cell carcinomas and one small-cell carcinoma). In 3/9 (33%) the second tumour was a non-bronchogenic carcinoma (colonic, pancreatic and breast ductal adenocarcinoma). No other neoplasms were identified in the cohort of malignant mesotheliomas studied. Five persons had pathological evidence of asbestosis (four had bronchogenic carcinomas, one colorectal adenocarcinoma). Two persons with non-bronchogenic carcinomas had identifiable asbestos bodies but no interstitial fibrosis. In two cases the second neoplasms (primary bronchogenic squamous cell and small-cell carcinomas) were associated with diffuse interstitial fibrosis but no asbestos bodies were seen on light microscopy. In each case transmission electron microscopic mineral analysis revealed an asbestos fibre burden within the background population range for control subjects and well below that seen in cases of established asbestosis. These cases were considered to represent cryptogenic fibrosing alveolitis in subjects with a history of asbestos exposure.

Conclusions: Synchronous malignant mesothelioma with carcinomas in asbestos-exposed workers is rare and identified in 1.8% of 500 malignant mesotheliomas in this series. In most cases the carcinoma represents a primary bronchogenic neoplasm. Primary lung carcinomas are recognized to be asbestos related only when occurring in association with asbestosis. In this series this combination (bronchogenic carcinoma and asbestosis) was seen in four (0.8%) cases. In post-mortem cases for possible malignant mesothelioma it is important to identify any other neoplasia and determine whether it is related to asbestos. Their presence impact upon anticipated life expectancy and in the presence of malignant mesothelioma will affect the compensation settlement.

In plain English

This study reviewed post-mortem findings for 500 people with malignant mesothelioma. They were seeking compensation for asbestos-related mesothelioma, and their cases were referred to the Environmental Lung Disease Research Group in Cardiff, Wales, over a 5-year period. The authors looked for people who also had a second, different cancer. Nine of 500 (1.8%) did: eight men and one woman, aged 60 to 75. All reported past asbestos exposure, in jobs such as pipe lagger, plumber, ammunition worker, boiler stripper and asbestos factory worker, plus one housewife with exposure at home. Eight mesotheliomas were pleural and one was peritoneal. In six people the second cancer was a primary lung cancer. In three it was an adenocarcinoma of the pancreas, colon or breast. Five of the nine had asbestosis. Two people with lung cancer had lung scarring that the authors judged to be cryptogenic fibrosing alveolitis, not asbestosis, because their asbestos fibre counts were not above background levels. The authors concluded that the combination is rare. They said only four cases (0.8%), lung cancer with asbestosis, would count as asbestos-related lung cancers for compensation.

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 drawn from a review of post-mortem examinations in medico-legal (compensation) referral cases of malignant mesothelioma. Cases with a second cancer identified at post mortem formed the study group.
• Who was studied: 500 patients seeking compensation for asbestos-related diffuse malignant mesothelioma. Their cases were referred to the Environmental Lung Disease Research Group, Cardiff, Wales, UK, over a 5-year period (calendar years not stated). The study group was the 9 of these with a second cancer.
• Exposure: All nine study cases alleged prior asbestos exposure. Occupations listed were lagger (three cases), ammunition worker, plumber, boiler stripper, asbestos factory worker and housewife with domestic exposure; one occupation was not known. Fibre types and doses were not reported.
• Main results:
  • Of the 500 malignant mesothelioma cases, 9 (1.8%) also had another cancer found at post-mortem examination. Eight of these mesotheliomas were pleural and one was peritoneal.
  • The study group of 9 was eight males and one female, aged 60 to 75 years (mean 68 years).
  • Among the 9 mesotheliomas, four were epithelioid, three biphasic and two sarcomatoid.
  • In 6 of the 9 cases the second cancer was a primary bronchogenic (lung) carcinoma: three adenocarcinomas, two squamous carcinomas and one small-cell carcinoma.
  • In 3 of the 9 cases the second cancer was a primary adenocarcinoma outside the chest, in the pancreas, colon or breast.
  • Asbestosis was present in 5 of the 9 cases: cases 1 to 4 (all with lung carcinoma) and case 8 (colorectal adenocarcinoma).
  • In cases 5 and 6 (both lung carcinomas), the lung showed diffuse interstitial fibrosis but no asbestos bodies. Electron microscopic fibre analysis found asbestos fibre burdens not elevated above background levels. The authors considered these to be cryptogenic fibrosing alveolitis in people with prior asbestos exposure.
  • In cases 7 (asbestos factory worker) and 9 (housewife with domestic exposure), lung sections showed asbestos bodies but no interstitial fibrosis.
  • For compensation purposes, the authors stated that cases 1 to 4 (lung carcinoma with asbestosis) would be regarded as asbestos-related lung carcinomas. Cases 5 to 9 would not.
  • The combination of lung carcinoma with asbestosis was seen in four (0.8%) of the 500 mesothelioma cases.
• The authors' conclusion: The authors concluded that synchronous malignant mesothelioma with carcinoma in asbestos-exposed workers is rare, found in 1.8% of 500 malignant mesotheliomas in this series. In most cases the second cancer was a primary lung carcinoma. They stated that identifying any second cancer at post mortem, and whether it is asbestos related, matters for estimating life expectancy and the compensation settlement.
• Limitations the authors state:
  • The precise latent periods (time from first asbestos exposure to death) were not known. The authors stated that first exposure in each case preceded the minimum latent period of 15 years.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Carcinoma, Neoplasm, Asbestos Exposure, Epithelioid, Biphasic Mesothelioma, Sarcomatoid, Mesothelioma.

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