Anatomo-Clincal Study of 10 diffuse Pleural Mesotheliomata

Our plain-English summary of Anatomo-Clincal Study of 10 diffuse Pleural Mesotheliomata, by G. Miech, P. Stoebner, J.P. Witz, et al (1970).

The study

• Authors: G. Miech, P. Stoebner, J.P. Witz, G. Morand, E. Roegel, P. Oudet
• Published: Journal Français de Medicine et Chirurgie Thoraciques, XXIV(2):105-118, 1970
• 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 French article was a case series from university thoracic surgery and pathology services in Strasbourg. The authors reviewed surgically biopsied pleural tumors from the previous ten years, excluded obvious metastatic tumors, and studied 10 diffuse malignant pleural mesotheliomas: 9 typical and 1 atypical, pseudo-sarcomatous case. All patients were men. Pain was the dominant symptom. Pleural fluid was bloody in 5 of 8 cases. Biopsy with an Abrams needle found tumor cells in 1 of 5 attempts. Samples from four typical cases were examined under the electron microscope, and those tumors were made of characteristic mesothelial cells. The atypical case was a 30-year-old man whose ordinary microscope slides suggested a sarcoma. Under the electron microscope, that tumor was also made of typical mesothelial cells. Only one patient (case 3) had been exposed to asbestos. No asbestos bodies were found in that patient's tissue slides, and the chest X-rays showed no suggestive signs. The authors called the role of asbestos as a predisposing factor still controversial. They concluded that electron microscopy appeared to be an indispensable means of diagnosing pleural tumors in the future.

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: Retrospective case series: review of surgically biopsied pleural tumors, with clinical, X-ray, histological and electron-microscopic (ultrastructural) comparison
• Who was studied: 10 male patients with diffuse malignant pleural mesothelioma (9 typical, 1 atypical pseudo-sarcomatous) whose tumors were surgically biopsied over ten years at the thoracic surgery services of the Strasbourg university hospital; obvious metastatic pleural tumors were excluded
• Exposure: Asbestos exposure was reported for only one patient (case 3); no fiber type, job or dose was given
• Main results:
  • In the patient exposed to asbestos (case 3), no asbestos bodies were found in the histological preparations
  • In the same patient, detailed X-ray analysis showed no suggestive images
  • Pain was the dominant symptom in the typical cases
  • Pleural fluid was bloody in 5 of 8 cases and clear yellow (citrine) in 3 of 8
  • Abrams needle biopsy was done five times: four samples showed only pleural thickening, and one showed tumor cells. The authors noted that the Menghini needle may give a better result in cases without effusion (case 7).
  • Among the 9 typical cases, all three tissue patterns (fibroblastic, endo-epithelial and adenoid) were present in seven, and two were mainly fibrous and epithelial
  • Samples were taken for electron microscopy four times among the typical cases; these tumors were made of characteristic mesothelial cells
  • In the atypical pseudo-sarcomatous case (case 10), electron microscopy showed the growth was consistently made of typical mesothelial cells
  • Hyaluronic acid testing of pleural fluid was positive in primary pleural tumors (cases 7 and 10) and also in metastatic effusions and non-tumor pleurisies, so the results were disparate
  • Of the 10 patients, 6 had died and only two were autopsied. One autopsy showed widespread peritoneal cancer. The other showed spread to the opposite pleura, liver, spleen, lymph nodes and peritoneum, with no other primary cancer found.
• The authors' conclusion: The authors concluded that electron microscopy appeared to be an indispensable means of diagnosing pleural tumors in the future. They also said that the role of asbestos as a predisposing factor was still controversial.
• Limitations the authors state:
  • Neither of the two autopsied cases was examined by electron microscopy

Topics

Medical terms in this study, explained in our Lexicon: Thoracic Surgery, Pathology, Pleural Mesothelioma, Biopsy, Mesothelial Cells, Sarcoma, Asbestos Bodies, Chest X-Ray.

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