Resection Of Primary Pulmonary Sarcoma: Review Of Literature And Report Of A Case Associated With Pulmonary Asbestosis

Our plain-English summary of Resection Of Primary Pulmonary Sarcoma: Review Of Literature And Report Of A Case Associated With Pulmonary Asbestosis, by B.C. Dyson, A.E. Trentalance (1964).

The study

• Authors: B.C. Dyson, A.E. Trentalance
• Published: Journal Of Thoracic And Cardiovascular Surgery 47(5):577-589, May (1964)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 002736. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article combined a literature review with one new case report. The authors gathered 66 published, surgically treated cases of primary lung sarcoma and added one from Cooper Hospital, Camden, New Jersey. In that case, a man's left upper lung lobe, containing a 3 cm tumor, was removed. Asbestos bodies were found in the tumor and nearby lung tissue. A work history taken afterwards revealed 6 years as a fitter of insulation on pipes. Pathologists gave differing diagnoses, including mesothelioma, but the authors classed it a primary pulmonary sarcoma. A later addendum reported recurrent sarcoma in the surgical scar and the patient's death. The authors reported 63 per cent of 45 patients with bronchial sarcoma were alive and apparently tumor-free after 3 months to 21 years, as were 39 per cent of 22 with outer-lung sarcoma, a group including the new case, after 1 to 14 years. These do not match the article's detailed counts, such as 7 of 22 living and well. The authors concluded this was the first reported case associating pulmonary asbestosis with primary pulmonary sarcoma.

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: Literature review of published surgically treated cases of primary pulmonary sarcoma, plus a single case report
• Who was studied: 66 previously published cases of primary pulmonary sarcoma treated surgically, plus one new male patient seen at Cooper Hospital, Camden, New Jersey. In total, 67 patients: 45 with sarcoma of bronchial origin and 22 of peripheral origin, the 22 including the new case.
• Exposure: In the new case: a work history, obtained after asbestos bodies were found, of 6 years as a fitter of insulation on pipes, followed by one year in a newspaper press room before the operation. No fiber type is named. The literature review did not study asbestos exposure.
• Main results:
  • New case: left upper lobectomy was performed.
  • New case: the tumor was a single mass measuring 3 cm.
  • New case: asbestos bodies were present within the tumor and in adjacent lung tissue.
  • New case: consulting pathologists gave differing labels, including fibrosarcoma, leiomyosarcoma, mesothelioma, sarcoma of the lung, and inflammatory pseudotumor with asbestosis. The authors did not consider it a mesothelioma, but a primary pulmonary sarcoma.
  • New case, addendum: biopsy of the thoracotomy scar showed recurrent sarcoma similar to the tumor removed 18 months earlier by lobectomy.
  • New case, addendum: the patient died, and no autopsy was performed.
  • Review, authors' summary figure: of 45 patients with sarcoma primary in the bronchus, 63 per cent were alive and apparently free of tumor after 3 months to 21 years (average 4 years). This is not a survival rate measured at one common time.
  • Review, detailed bronchial counts: 3 of 4 patients treated by bronchoscopic removal were living apparently free of tumor, and 22 of 41 recognized at thoracotomy survived apparently free of tumor. These counts do not reproduce the 63 per cent figure.
  • Review, authors' summary figure: of 22 cases of primary pulmonary sarcoma of peripheral origin, which include the new case, 39 per cent were alive and apparently free of tumor after 1 to 14 years (average 6 years 8 months).
  • Review, detailed peripheral count: 7 of the 22 peripheral-origin patients were last observed living and well after 1 to 14 years. This does not reproduce the 39 per cent figure.
  • Review: of the 67 patients who came to thoracotomy, over 90 per cent were considered operable, and operative mortality was less than 10 per cent.
  • Review: bronchoscopy gave a positive biopsy diagnosis in 26 of 44 cases of bronchial sarcoma in which it was done.
  • Review: the sarcoma cell type had little correlation with survival after surgery.
• The authors' conclusion: The authors concluded that asbestos bodies in the excised tumor and adjacent lung, together with a history of occupational asbestos dust exposure, made this the first reported case in which pulmonary asbestosis was associated with primary pulmonary sarcoma. They also concluded that even large primary lung sarcomas have been removed surgically with many years of survival.
• Limitations the authors state:
  • Without complete autopsy or long recurrence-free survival, a supposed primary lung tumor may in fact have been a metastasis from elsewhere.
  • Histological classification of sarcoma subtypes is difficult, so apparent survival differences between subtypes are probably not significant.

Topics

Medical terms in this study, explained in our Lexicon: Sarcoma, Asbestosis, Asbestos Bodies, Occupational History, Mesothelioma.

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