Malignant pleural and peritoneal mesothelioma consequential to brief indirect asbestos exposure

Our plain-English summary of Malignant pleural and peritoneal mesothelioma consequential to brief indirect asbestos exposure, by B. Singhal, S. Kohli, A. Singhal, et al (Journal of Clinical Imaging Science, 2014).

The study

• Authors: B. Singhal, S. Kohli, A. Singhal, V. Kumar
• Journal: Journal of Clinical Imaging Science
• Published: 2014;4:35
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This report highlights that pleural and peritoneal mesothelioma can occur without direct asbestos exposure as was seen in our young patient. The patient had indirect exposure for as short as 3 months as a child, 15 years earlier, when she was residing with her miner father in the district of Jharia, Jharkhand, which is an asbestos-rich mining area in eastern India. The patient presented with chest pain and breathlessness. Chest X-ray showed opaque right hemithorax. Typical contrast- computed tomography (CECT) enhanced radiological features included nodular, soft-tissue attenuation and homogenously enhancing rind-like mass causing scalloping of the underlying lung and liver. Similar lesions were also found involving the pelvis. Diagnosis of malignant mesothelioma was confirmed on lung biopsy. Under-reporting of exposure is usual because it is unrecognized by both patients and investigators.

In plain English

This case report described one patient: a 26-year-old nonsmoking housewife from Bihar, India, with four months of worsening chest pain and breathlessness. She reported no dust or fume exposure, but as a child had lived in Jharia, where her father worked in the mines. The authors described this as indirect exposure lasting as little as 3 months, about 15 years earlier, in what they called an asbestos-rich mining area; the article names no fiber type and gives no exposure measurements. A chest X-ray showed an opaque right chest. CT scans showed a rind-like mass encasing the right lung and crossing the diaphragm onto the liver surface, possible liver metastases, a pelvic mass and abdominal fluid. A lung biopsy with special stains led to a diagnosis of malignant mesothelioma. She was prescribed cisplatin and pemetrexed but did not follow treatment or return. The authors concluded that even small, indirect exposure through an asbestos-exposed family member can be associated with malignant mesothelioma, and that such exposures often go unrecognized and unreported.

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 (one patient)
• Who was studied: One 26-year-old woman from Bihar, India, a nonsmoker and housewife, with a 4-month history of chest pain and breathlessness
• Exposure: Indirect (non-occupational) exposure in childhood. The patient reported no dust or fume exposure herself, but had lived with her father, who worked in the mines in Jharia. The authors called Jharia an asbestos-rich mining area and gave the exposure as lasting as little as 3 months, about 15 years earlier. No fiber type, product or exposure measurement is given.
• Main results:
  • The patient had no history of dust or fume exposure and was a nonsmoker; the childhood residence in a mining area with her father was the reported exposure history.
  • The chest X-ray showed an opaque right side of the chest (right hemithorax).
  • Contrast-enhanced CT showed a pleural-based mass completely encasing the right lung (a rind-like appearance), with collapse of the right lung.
  • The mass crossed the diaphragm and scalloped the liver surface. Multiple areas in the liver were suggestive of metastasis.
  • CT of the pelvis showed a separate enhancing mass abutting the bowel without obstruction, and ascites (abdominal fluid) was noted.
  • Malignant mesothelioma was diagnosed from the lung biopsy and immunohistochemistry. The tissue was positive for calretinin and WT1 and negative for CEA, CD15, EMA and TTF1.
  • The patient was prescribed cisplatin and pemetrexed but did not comply with treatment or return for follow-up, so no outcome is reported.
• The authors' conclusion: The authors concluded that, as in this case, even a small amount of exposure, and indirect exposure through asbestos-exposed family members, can be associated with malignant mesothelioma. They considered the case unusual because of the patient's young age and limited indirect exposure. They noted that short childhood exposures are often ignored or unknown, which leads to under-reporting.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure, Chest X-Ray, Hemithorax, Mesothelioma, Biopsy.

Related studies

• Indirect corrections for confounding under multiplicative and additive risk models — M.H. Gail, S. Wacholder, et al. (1988)
• Indirect exposures: the significance of bystanders at work and at home — P. Grandjean, E. Bach (1986)
• Comparison of direct and indirect methods of measuring airborne chrysotile fibre concentration — C. Eypert-Blaison, S. Veissiere, et al. (2010)
• Use of direct versus indirect preparation data for assessing risk associated with airborne exposures at asbestos-contaminated sites — M.P. Goldade, W.P. O'Brien (2014)
• Progressive lung cell reactions and extracellular matrix production after a brief exposure to asbestos — L.Y. Chang, L.H. Overby, et al. (1988)
• Reactive mesothelial hyperplasia vs mesothelioma, including mesothelioma in situ: a brief review — D.W. Henderson, K.B. Shilkin, et al. (1998)

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