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PubMed2004

[Pleuromesothelioma -- psychology and pathogenesis].

Investigations into the anatomical pathology are of crucial importance for the diagnosis and therapy of pleural tumours. The main objective is to differentiate reactive hyperplastic proliferations of the mesothelium from already manifest primary or secondary malignant pleural tumours. Given the absence of distinct morphological features displayed by pleural mesotheliomas, specific additional immunohistochemical and cytometric tests can provide valuable clues for the differential diagnosis of primary and secondary pleural neoplasms. Confirmation of the diagnosis during the initial stages of tumour development i. e. mesothelioma in-situ and early mesothelioma necessitates invasive diagnostic procedure as early as possible. This holds particularly true if surgery is aimed at cure. However, in order to firmly establish the diagnosis considering the afore mentioned problems, the tissue specimens to be examined by a pathologist must be of adequate size. 90 % of all pleural mesotheliomas are asbestos associated due to occupational exposure. Therefore, all cases of a suspected pleural mesothelioma must be reported to the appropriate professional association as a potential occupational disease. The Bochum based German Mesothelioma Registry, which is supported by the head office of the German Professional Associations, conducts research and acts as an advisory institution in difficult cases, where problems concerning the classification of tumours by their anatomical pathology arise.

Humans↗
PubMed2005

Pedunculated localized fibrous tumor of the pleura presenting as a moving chest mass.

Localized fibrous tumor of the pleura is a rare primary pleural neoplasm. The tumors are usually discovered incidentally on routine chest radiography. A change in the lesion's position with respiration and/or posture of the patient indicates a pedunculated pleural lesion. Computed tomography and magnetic resonance imaging reveal the relation of the lesions to adjacent structures. Magnetic resonance imaging is also useful for the characterization of the lesions on the basis of signal features. These tumors usually consist of mature fibrous tissue.

Female↗
PubMedDate not supplied

[Mortality and hospital discharges in the population of Biancavilla (Sicily) contaminated by natural fibres].

OBJECTIVE: The volcanic area of Biancavilla (Sicily Italy) has been included by the Italian national law among the areas of "environmental reclamation" due to the presence of amphibole fluoro-edenitic fibres in the environment. The aim of the study was to evaluate the health of residents in the area, through the analysis of the mortality registry and the hospital discharge records. DESIGN: Age, cause and gender specific indirect standardized mortality ratios SMR (1995-2000) and morbidity ratios SHR (2001-2003) were computed with 95% confidence intervals, using the population of surrounding municipalities as reference. RESULTS: statistically significant increases in mortality and morbidity were observed, both in men and women, for malignant pleural neoplasms (mortality: men SMR= 700, 6 observed; women SMR= 840, 3 observed; hospital admissions: women SHR= 1210, 5 observed), cardiovascular diseases (mortality: men SMR= 115, 267 observed, women SMR= 115, 278 observed; hospital admissions: men SHR= 109, 631 observed; women SHR= 114, 528 observed) and respiratory diseases (mortality: men SMR= 164, 68 observed; women: SMR= 215, 44 observed; hospital admissions: men SHR= 139, 558 observed, women SHR= 125, 374 observed). CONCLUSIONS: the excesses observed in this study are consistent with previous findings and suggest the need for further investigations aimed at improving the knowledge of the mineralogical aspects of the fibres, the assessment of human exposure and at estimating the prevalence of pleural plaques and lung fibrosis.

Asbestos, Amphibole↗
PubMed2004

Mortality from chronic obstructive pulmonary disease and pleural mesothelioma in an area contaminated by natural fiber (fluoro-edenite).

OBJECTIVES: The purpose of the present study was to investigate the association between mortality from chronic obstructive pulmonary disease (COPD) and exposure to fluoro-edenite, a newly discovered amphibolic fiber found in Biancavilla (Sicily), a municipality on the slope of the Etna volcano, where a high mortality from malignant mesothelioma had been previously observed. METHODS: Thirty-six municipalities located in the volcanic area of mount Etna were selected for study. An ecological regression model was applied with mortality from COPD as the dependent variable, mortality from mesothelioma as a proxy for exposure to fluoro-edenite, and lung cancer mortality, an urban-rural index, a deprivation index and an aging index as the predictors of COPD mortality. For each municipality, risk classes were determined for the continuous variables with the use of a finite mixture model. RESULTS: A significant association was found between COPD mortality and pleural neoplasm mortality among the women in this study. The association was less consistent for the men. CONCLUSIONS: Despite the limitations of this ecological study, the results cohere with the results of toxicologic and observational studies and suggest an etiologic role for fluoro-edenite in nonmalignant respiratory diseases.

Adult↗
PubMedDate not supplied

Clinical behavior of solitary fibrous tumors of the pleura. An immunohistochemical study.

Localized fibrous tumors of the pleura are uncommon, generally asymptomatic and usually have a benign behavior even if in a few cases a malignant variant can be observed. We report 11 cases of localized pleural neoplasms submitted to surgical resection during the period 1987-1996. The differentiation between the localized fibrous as well as the less frequent localized malignant mesothelioma has been researched employing cyto-histopathologic and immunohistochemical assays. For the purpose of identifying solitary fibrous tumors of pleura that will behave in malignant manner, we applied the more recent criteria of specific immunohistochemical stains, microvessel density and proliferation mdex. All solitary fibrous tumors resulted positive for Vimentin and negative for Cytokeratin. Among these forms, high cellularity and microvessel density, high expression of Ki 67 and CD31 and negativity of CD34 prognostic factors for a poor prognosis.

Aged↗
PubMed2002

Synovial sarcoma of the pleura: a clinical and pathologic study of three cases.

Synovial sarcomas are rare soft tissue malignancies that most commonly affect the extremities in the vicinity of large joints. These malignancies typically occur in adolescents and young adults between the ages of 15 and 40 years.(1,2) Historically they are believed to originate from primitive pluripotent mesenchyme capable of synovial differentiation. This belief is consistent with the malignancy's origin from sites devoid of normal synovium, such as the pleural cavity. A variety of pleural cavity sarcomas have been described, including liposarcoma,(3) chondrosarcoma,(4) osteosarcoma,(5) and malignant schwannoma.(6) Pleural synovial sarcoma, however, is a much rarer entity. In fact, pleural synovial sarcoma was first described only 6 years ago(7) and has not yet been reported in the surgical literature. Because of its rarity, pleural synovial sarcoma is often mistaken for the histologically similar malignant mesothelioma, the most common of the pleural neoplasms. This is a critical distinction, because synovial sarcoma may be extremely aggressive. Studies in the last 10 years have shown it to be extremely sensitive to ifosfamide-based chemotherapy, and survival of patients with synovial sarcoma has recently increased with chemotherapy, with 5-year survivals now as high as 57%.(8-10) In this report, we describe 3 cases of synovial sarcoma of the pleura. Clinical findings are correlated with pathologic features, including immunohistochemical stains and fluorescence in situ hybridization (FISH) for the identification of the diagnostic chromosomal translocation, t(X;18)(p11.2;q11.2). This delineation of the clinical and pathologic aspects of this rare, newly recognized tumor should increase awareness among the surgical community.

Adult↗
PubMed2002

Synovial sarcoma arising from the pleura: a case report with ultrastructural and immunohistological studies.

Synovial sarcoma commonly occurs in the para-articular regions of the extremities, and rarely in the pleura. We report a 46-year-old woman with primary synovial sarcoma of the pleura. She was admitted with a complaint of left-sided chest pain and exertional dyspnea. She had previously undergone two operations for pleural neoplasm, at the ages of 33 and 36 years. A computed tomography scan revealed an expanded mass in the left thoracic cavity, involving the surrounding tissue. Macroscopic findings demonstrated a 25 x 25 x 15-cm grayish-white mass with hemorrhage beneath the pleura. Both epithelial and spindle cells were observed microscopically. Ultrastructural microscopy of the epithelioid cells demonstrated short, blunt microvilli on the luminal surface, and desmosomes between the neoplastic cells. Immunohistochemically, the tumor cells of the epithelial component were positive for embryonal membrane antigen (EMA), carcinoembryonic antigen (CEA), human mesothelial cells (HBME)-1, and cytokeratin, and the spindle cells were positive for vimentin. These findings led us to a diagnosis of primary synovial sarcoma of the pleura. She had no evidence of recurrence or metastasis after the third operation.

Diagnosis, Differential↗
PubMed1992

[Territorial distribution of mortality from malignant tumors of the pleura in Italy].

Mortality from malignant pleural neoplasms in Italy, 1980-87, was studied in order to detect areas at risk. The number of observed deaths occurring in each of the 8000 Italian municipalities was contrasted to the expected figure obtained from regional and/or national rates; whenever a significant increase, based on at least three observed cases, was detected, the municipality was included in the study. The main findings in Piedmont concern the city of Casale Monferrato, where an important asbestos cement factory is located, and some areas characterized by the presence of the textile industry. Genoa and other harbours of the northwestern coast, where important shipyards are located, were detected. In Lombardy an increased in risk concerning women was observed in several municipalities. Major increases in risk were seen in Venice. Trieste and Monfalcone, where important shipyards are located. In Tuscany, the highest risk was reported in Leghorn and surrounding areas; naval industry and chemical industries should be considered. In southern Italy, several cities with industrial harbours were shown to be at risk.

Cause of Death↗
PubMed2003

Mortality among former shipbreaking workers--a 13-year retrospective follow-up study in Taiwan.

This study examined the mortality among shipbreaking workers from 1985 to 1997, after the shipbreaking industry was banned in 1985-1986. The study cohort consisted of men including 2,850 flame cutters, 871 lifters, 240 odd-jobbers and 225 other workers registered in 1985 at Kaohsiung Shipbreaking Workers Union. Mortality (n=336) data examined were obtained from the Vital Statistics Registry from January 1985 to December 1997. The standardized mortality ratio (SMR) and logistic regression were used to estimate the risk of mortality from neoplasms, injuries and other causes. Compared to the local reference population, the deaths that were significantly higher than the expected numbers among all workers included deaths from all cumulative causes (SMR=1.11, 95% confidence interval (CI)=1.00-1.23), and deaths from external causes of injury and poisoning (SMR=1.75, 95% CI =1.47-2.09). Flame cutters in the youngest group, on the other hand, had very significant excess deaths from nasopharynx neoplasm (SMR=5.2, 95% CI=1.7-16.2) and pleural neoplasm (SMR=104.1, 95% CI=14.0-739.0). Based on logistic regression analysis controlling for age, lifters was about 5.1 more likely times than flame cutters to die from accidental falls. This study suggests that former shipbreaking workers are more likely to be at higher risk of injuries and the young flame cutters are at higher risk from neoplasms.

Accidents, Occupational↗
PubMed2002

[Small-cell mesothelioma of the pleura: description of a case].

A case of mesothelioma with a small cell component in a 53-year-old, non-smoker woman. The patient had a history of asbestos exposure, and presented with thoracic pain. A total body computed tomogram showed a left pleural effusion and a 7.5-cm pleural mass. Thoracoscopy revealed a diffuse nodular thickening of the left parietal pleura, and a biopsy was performed. The patient died of the disease 4 months after diagnosis. Microscopically, the pleural neoplasm was composed of three different components: 40% of the tumor showed the classic histology of a malignant epithelial mesothelioma, 40% was composed of small- to medium-sized cells with open nuclear chromatin, evident nucleoli and high mitotic activity, and 20% of the neoplasm was indistinguishable from a small cell carcinoma. Immunohistochemically, the first component was diffusely and strongly positive for cytokeratin AE1/AE3, cytokeratin CAM 5.2 and EMA, focally positive for BER-EP4, and negative for CD15, B 72.3, CEA, LCA, chromogranin, synaptophysin, TTF-1 and CD99. The cells of the second component were positive only for cytokeratin AE1/AE3 and cytokeratin CAM 5.2, and the elements of the third component were negative for all the antibodies tested. Pleural mesothelioma with a small cell component is rare. The most useful parameters to distinguish it from other small cell malignancies that may involve the pleura, particularly small cell carcinoma of pulmonary origin, are discussed.

Asbestos↗
PubMed2003

[Solitary fibrous tumor (SFT) of the nasal mucosa].

PATIENT: A case of a 76-year-old-man is reported who was referred to the department because of an increasing tumor of the right nasal cavity. After surgical treatment of the neoplasm histological examination revealed a solitary fibrous tumor (SFT) of the nasal mucosa. DISCUSSION: Solitary fibrous tumors mostly occur as pleural neoplasms. Extrapleural locations of this mesenchymal tumor species are rarely found in the head and neck region. These extrapleural tumors are sometimes difficult to diagnose because of their histologic variability. Solitary fibrous tumors typically show intense staining for CD 34, vimentin, bcl-2 and sometimes for desmin. These immunohistochemical features have made differentiation from other lesions in the head and neck region much easier. Most pleural and extrapleural solitary fibrous tumors behave in a benign fashion with good prognosis, though aggressive lesions with local invasion or distant metastases have been reported. Definitive surgical treatment with complete tumor removal is recommended in literature. Encouraging chemotherapy or radiotherapy results have not been reported so far.

Aged↗
PubMed2004

Pulmonary fibre burden in sheep living in the Biancavilla area (Sicily): preliminary results.

In a national survey on mortality from malignant pleural neoplasms in Italy, aimed at detecting geographic clusters of cases of the disease, the town of Biancavilla, located in a volcanic area of Eastern Sicily, showed high risk of pleural mesothelioma in the absence of occupational asbestos exposure. An environmental survey suggested the stone quarries located in 'Monte Calvario', south-east of the town of Biancavilla, as a possible source of asbestiform fibre exposure. A subsequent crystal-chemistry investigation of the 'Monte Calvario' amphiboles identified the mineral asbestiform fibres as 'fluoro-edenite', a new end-member of the edenite ==> fluoro-edenite series. A collaborative epidemiological and environmental study was initiated to investigate the characteristics of the outbreak of malignant mesothelioma and test the hypothesis of a causal association with exposure to naturally occurring fibres. To investigate if a sheep population could be used to monitor the environmental diffusion of the fibres, we examined lung specimens from 27 culled sheep, at least 3 years old and living near Monte Calvario to check for the presence of fluoro-edenite fibres, using scanning electron microscopy (SEM) analysis and X-ray microanalysis. Fourteen mineral species have been isolated in the mineral particulate matter taken from pulmonary parenchyma, and fluoro-edenite was detected in eight sheep. These preliminary data suggest a possible bio-indicative role of sheep as sentinel animals in the evaluation of environmental fibre diffusion, which merits further investigation.

Animals↗