Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.

Localized malignant mesothelioma is an extremely rare form of presentation of malignant mesotheliomas. The definitive therapeutic modality of the disease is yet to be identified. A 50-year-old male, a former smoker without occupational and/or environmental exposure to asbestos, presented complaining of an intractable cough. The chest radiography showed a left upper lobe mass. The computed tomography showed a 3.5 cm left apical mass. The biopsy showed epithelial malignant cells. The patient underwent a lobectomy. The evaluation of the specimen disclosed a biphasic malignant mesothelioma. His postoperative course was uneventful, and he has been doing well for almost 1 year. A resection of the tumor has shown to increase survival in previous reports, though the role of oncologically justifiable resection, such as a lobectomy, and the biological behavior of such tumors are still difficult to predict.

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Lung Institute of Western Australia, Centre for Asthma, Allergy and Respiratory Research, The University of Western Australia, Nedlands WA, Australia.

Malignant mesothelioma is an aggressive cancer of the pleura that is causally related to exposure to asbestos fibres. The kallikrein serine proteases [tissue (hK1) and plasma (hKB1) kallikreins, and kallikrein-related peptidases (KRP/hK2-15)] and the mitogenic kinin peptides may have a role in tumourigenesis. However, it is not known whether hK1, hKB1, KRP/hK proteins or kinin receptors are expressed in pleural mesotheliomas. The expression of hK1, hKB1, KRP/hK2, 5, 6, 7, 8 and 9, and kinin B(1) and B(2) receptors was assessed in archived selected normal tissue and mesothelioma tumour sections by immunoperoxidase and immunofluorescence labelling. hK1, hKB1 and kinin B(1) and B(2) receptors were expressed in malignant cells of the epithelioid and sarcomatoid components of biphasic mesothelioma tumour cells. The percentage of cells with cytoplasmic and nuclear labelling and the intensity of labelling were similar for hK1, hKB1 and the kinin receptors. KRP/hK2, 6, 8 and 9 were also expressed in the cytoplasm and nuclei of mesothelioma cells, whereas KRP/hK5 and hK7 showed predominantly cytoplasmic localisation. This is a first report, but further studies are required to determine whether these proteins have a functional role in the pathogenesis of mesothelioma and/or may be potential biomarkers for pleural mesothelioma.

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Department of Pathology, Medical Faculty, Gaziantep University, Gaziantep, Turkey. tutar@gantep.edu.tr

AIM:To investigate the relationship of fragile histidine triad (FHIT) and Ki-67 expression with clinicopathological variables of patients with malignant pleural mesothelioma (MPM). METHODS: Formalin-fixed, paraffin-embedded tissue sections of 30 asbestos induced MPM (epithelial and biphasic) patients were examined for FHIT and Ki-67 expression using immunohistochemical techniques and results were compared with clinicopathological variables. RESULTS: Immunohistochemical study results were as follows: 12 (40%) cases showed low FHIT expression and 18 (60%) showed high expression. There was no significant relationship between FHIT and age, gender or histological subtypes (p > 0.05). Ki-67 expression was ‘low’ in 13 (43.3%) cases and ‘high’ in 17 (56.7%) cases. No correlation could be demonstrated between Ki-67 expression and age, gender or histological subtypes (p > 0.05). No significant association was observed between FHIT and Ki-67 expression in MPM. CONCLUSION: The results support the role of FHIT as a tumour suppressor gene in asbestos induced MPM. There is no significant correlation between FHIT and cell proliferation marker expressions in malignant pleural mesothelioma. Therefore, it can be concluded that loss of FHIT does not interfere with tumour proliferation. This can be accepted as evidence for an early role of FHIT loss in carcinogenesis; however, it needs to be strengthened by further studies.

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Ziekenhuisgroep Twente, locatie Twenteborg Ziekenhuis, Afd. Longziekten, Almelo.

OBJECTIVE: To determine whether a disease cluster of 22 additional cases of pleural mesothelioma among women could be attributed to environmental asbestos exposure due to asbestos fibers from waste material on roads and property yards. The women studied were observed in an area with substantial environmental exposure to asbestos during the period 1989-2002. DESIGN: Ecological study. METHOD: In the study period of 1989-2002, all cases of mesothelioma among women, based on a strict histopathologic definition, occurring in the region of Twente, The Netherlands (n = 59) were provided by the regional cancer register. Additional information was collected on the occupational histories of the cases and their partners and addresses of residence through medical records, general practitioners, and next-of-kin. Environmental asbestos exposure was assigned to all cases that had had a long-term stay in a house in the area around Goor with demonstrated local environmental asbestos pollution and where any contact with asbestos through occupation or in the household had been excluded. RESULTS: In the risk area around Goor, out ofa total of 28 cases ofwomen with pleural mesothelioma, asbestos in the environment was found to be the only source of asbestos exposure for to women. In a further 4 women, environmental asbestos exposure was found to be the most likely cause of pleural mesothelioma. The average cumulative exposure was around 0.11 fiber/ml x exposure years. The observed extra incidence of 22 cases was attributed to the environmental exposure to asbestos in 64% (14/22) of cases. CONCLUSION: The environmental pollution to asbestos waste materials in the area around Goor was the main cause of the strongly increased incidence of pleural mesothelioma among women in this area. Taking into account an equal risk among men, the consequences of asbestos exposure in the area around Goor in the next 25 years are likely to result in 2 cases of pleural mesothelioma each year.

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Service de Pneumologie, Hôpital d’Instruction des Armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart. j.margery@free.fr

Malignant pleural mesothelioma (MPM) is a rare incurable tumor. Interest in MPM has increased in recent years due to a steadily increasing incidence subsequent to the intensive use of asbestosis, the main causal agent, but also due to better awareness in the political and scientific communities faced with a serious public health issue. Our knowledge of MPM has improved regularly in terms of pathologic diagnosis and the mechanisms underlying the mesothelial carcinogenesis. MPM is also the subject of many technological innovations as illustrated by the recent identification of new biological markers, access to metabolic imaging, and clinical research on targeted treatments. Proper management implies the participation of the general population since the implementation of administrative procedures for social indemnities. In 2007, a more aggressive therapeutic approach is becoming common practice with the use of radiotherapy and the emergence of the concept of multimodal care centered on wide pleuropneumonectomy. These advances create real hope for improvement, but also many interrogations since no standard treatment protocol has been clearly identified.

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