The Journal of Thoracic and Cardiovascular Surgery, Vol 71, 621-627, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Malignant pleural mesothelioma. Report of 19 cases
JC Shearin Jr and D Jackson
Malignant pleural mesothelioma may be composed of sarcomatous,
epitheliomatous or mixed cell types. They can be differentiated from
localized, benign mesothelioma. Malignant pleural mesothelioma is a rapidly
fatal tumor that poses serious diagnostic and therapeutic problems. A
series of 19 cases was compiled at the North Carolina Baptist Hospital, and
data from these cases were compared to those of other series. The average
survival time was 10 months. The most common symptoms were dyspnea, chest
pain, pleural effusion, and weight loss. Three patients had a definite
history of exposure to asbestos; in 6 more there was a questionable
exposure. The most helpful investigative screening tool was the chest
roentgenogram, in that it demonstrated an intrathoracic abnormality;
however, mesothelioma could not be differentiated from inflammatory
reaction or bronchogenic carcinoma with pleural effusion. Sputum cytology
as well as pleural effusion cytology was only suggestive of malignancy.
Bronchoscopy was not helpful. Needle biopsy yielded malignant cells in 3 of
8 patients. Exploratory thoracotomy was the most accurate means of
diagnosis but was frequently followed by seeding into the incision and
severe, intractable incisional pain. Therapy proved to be palliative at
best. Thoracotomy did not alter the course of the disease; in fact, the
production of severe incisional pain was deleterious to the patient's
well-being. Cordotomy done in 3 patients brought no relief. Neither
radiation therapy nor chemotherapy had a significant effect on survival
time or palliation.
