Malignant mesothelioma is an aggressive tumor of serosal surfaces, such as the pleura and the peritoneum. This tumor was once rare, but its incidence is increasing worldwide, probably as a result of widespread exposure to asbestos, a factor with which it is associated. The authors review advances made in the past 5 to 10 years in the understanding, diagnosis, and management of mesothelioma.

Advances in Malignant Mesothelioma

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01238-6.pdf

Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial

Asbestos is a commercial term for a group of fibrous minerals often associated with the development of pulmonary interstitial fibrosis (asbestosis), lung cancer, and malignant mesothelioma in occupationally exposed individuals. The pathogenicity of different forms of asbestos varies--long, thin amphibole fibers are most pathogenic, particularly in the induction of mesothelioma. Available data do not support the concept that low-level exposure to asbestos is a health hazard in buildings and schools. The concentration of asbestos fibers in air, type of asbestos, and size of fibers must be considered in evaluation of potential health risks.

https://science.sciencemag.org/content/sci/247/4940/294.full.pdf

Asbestos: scientific developments and implications for public policy.

Three-hundred-sixty cases of solitary fibrous tumor of the pleura from the literature are analyzed, and eight new cases are described. Of patients reported on prior to 1972, 72% had symptoms due to the tumor at the time of diagnosis, but only 54% of patients reported on since then were symptomatic. This probably reflects earlier diagnosis as a result of increased use of chest radiographs in asymptomatic populations. Cough, chest pain, dyspnea, and/or pulmonary osteoarthropathy are each found in at least one-third of patients who have symptoms. Approximately 80% of solitary fibrous tumors of the pleura originate in the visceral and 20% in the parietal pleura. In the literature and in this experience these tumors are on the whole circumscribed. They range in size from 1–36 cm with a mean of 6 cm. Many are pedunculated on pleural-based pedicles that contain hypertrophic arteries and veins. Histologic examination of the tumor usually discloses cellular areas alternating with hyalinized and/or necrotic areas. Spindle-shaped cells typically have minimal nuclear pleomorphism and rare or absent mitoses. Numerous thin-walled vessels constitute an additional feature of large tumors. Electron microscopical examination reveals features of both fibroblasts and mesothelial cells. Solitary fibrous tumors behave in a benign fashion in 88% of cases after surgical resection. In 12% of the cases the tumor is responsible for the patient's death because of its extensive intrathoracic growth, by virtue of either late diagnosis or unresectable recurrence. No single histologic feature allows a definite prognosis. The best indicator of a good prognosis is the presence of a pedicle supporting the tumor. Also favorable is circumscription of the tumor without invasion of lung, mediastinum, or chest wall. Nuclear pleomorphism and a high mitotic rate are seen in larger tumors but do not necessarily indicate a poor prognosis if the tumor is circumscribed. Solitary fibrous tumors of the pleura are not associated with asbestos.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819810601%2947%3A11%3C2678%3A%3AAID-CNCR2820471126%3E3.0.CO%3B2-9

Solitary fibrous tumors of the pleura: Eight new cases and review of 360 cases in the literature

By the early 1980s, epidemiologists had identified many important causes of cancer. They had also proposed the 'multi-stage' model of cancer, although none of the hypothesized events in human carcinogenesis had then been identified. The remarkable advances in cell and molecular biology over the past two decades have transformed the scope and methods of cancer epidemiology. There have been a few new discoveries based purely on traditional methods, and many long-suspected minor risks have been estimated more precisely. But modern epidemiological studies often depend on genetic, biochemical or viral assays that had not been developed 20 years ago.

/pdf/cancer-epidemiology-in-the-last-century-and-the-next-decade-30pm3x0kg2.pdf

Cancer epidemiology in the last century and the next decade

Primary malignant tumours of the pleura are uncommon Thirty-three cases (22 males, 11 females, ages 31 to 68) of diffuse pleural mesothelioma are described; all but one have a probable exposure to crocidolite asbestos (Cape blue) In a majority this exposure was in the Asbestos Hills which lie to the west of Kimberley in the north west of Cape Province The tumour is rarely seen elsewhere in South Africa

https://oem.bmj.com/content/oemed/17/4/260.full.pdf

Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province.

Mesothelioma of the pleura is regarded as an uncommon tumour. In the last four years we have seen 33 histologically proven cases; 28 of these had some association with the Cape asbestos field and four cases had been exposed to asbestos in industry. The tumour is rarely encountered elsewhere in South Africa. During the past five years, with the exception of the present series, no neoplasm of this nature has been diagnosed amongst 10,000 lungs examined at the Pneumoconiosis Bureau in

https://www.jstor.org/stable/pdfplus/27721590.pdf

Paul Marchand

Papers

Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province.

Diffuse Pleural Mesothelioma and Asbestos Exposure in the North Western Cape Province