PLEURAL MESOTHELIOMAS

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Abstract
Thirty-seven cases of mesothelioma from Memorial and James Ewing Hospitals were reviewed. They were classified according to gross and microscopic morphology as follows: benign fibrous mesotheliomas - cellular, 2 cases, sclerosing, 4 cases; and malignant mesotheliomas - epithelial, 16 cases, fibrosarcomas, 15 cases. The validity of this classification was confirmed by the close correlation with clinical behavior. Most of the patients were in their 6th and 7th decades. Two-thirds of both the benign and malignant tumors were on the right side. Thoracotomy with pleural biopsy or resection of tumor was required for diagnosis of all patients with benign mesothelioma, and 27 of the 31 patients with malignant mesothelioma. Diagnosis in the remaining patients was made once by needle biopsy and on 3 occasions at autopsy. The most useful diagnostic laboratory procedure, short of biopsy, was cytologic examination of the fluid obtained by thoracentesis. Cancer cells were identified in specimens from 15 of the 20 patients with malignant mesothelioma who had such examinations performed. A significant number of the patients died from cardiorespiratory failure, with or without superimposed infection, because of local enlargement of the tumors causing lung compression and interfering with cardiac action. Several of these patients had clinical and autopsy confirmation that the tumor was confined to the chest. Most frequently, this was seen in older patients with fibrosarcomatous mesothelioma. Repeat pleurectomy may offer significant palliation for some of these patients, but the technical hazards of the procedure must be seriously considered before recommending it in any specific case. It is the apparent localization of this disease, even when the cancer is advanced, that makes the management of these patients difficult. Possibly newer methods of patient support during surgery will allow more extensive procedures, and possibly this will allow some patients to be cured.