Clinical and Prognostic Features of Erionite-Induced Malignant Mesothelioma

This review analytically examines the published data for erionite-related malignant pleural mesothelioma (E-MPM) and any data to support a genetically predisposed mechanism to erionite fiber carcinogenesis. Adult patients of age > or =18 years with erionite-related pleural diseases and genetically predisposed mechanisms to erionite carcinogenesis were included, while exclusion criteria included asbestos- or tremolite-related pleural diseases. The search was limited to human studies though not limited to a specific timeframe. A total of 33 studies (31042 patients) including 22 retrospective studies, 6 prospective studies, and 5 case reports were reviewed. E-MPM developed in some subjects with high exposures to erionite, though not all. Chest CT was more reliable in detecting various pleural changes in E-MPM than chest X-ray, and pleural effusion was the most common finding in E-MPM cases, by both tests. Bronchoalveolar lavage remains a reliable and relatively less invasive technique. Chemotherapy with cisplatin and mitomycin can be administered either alone or following surgery. Erionite has been the culprit of numerous malignant mesothelioma cases in Europe and even in North America. Erionite has a higher degree of carcinogenicity with possible genetic transmission of erionite susceptibility in an autosomal dominant fashion. Therapeutic management for E-MPM remains very limited, and cure of the disease is extremely rare.

A study to evaluate asbestos fiber burden in lung and pleural malignancies.

Background: There is scarcity of data on asbestos fiber burden in lung and pleural malignancies. Aim: To evaluate asbestos fiber burden in biopsy samples of suspected lung and pleural malignancies. Study Design: This was a single-centre, observational study. Study Period: From August 2010 to July 2010. Setting: Department of Pulmonary Medicine, CSMMU, UP, Lucknow, a tertiary care hospital in India. Study Population: Suspected cases of lung and pleural malignancy. Materials and Methods: Biopsy tissues taken by computed tomography (CT)-guided biopsy, bronchoscopic biopsy, and pleural biopsy by Cope's needle were analyzed for histopathology and asbestos burden by Haq et al.'s method. Results: 20 patients were studied. Mean fiber burden was 9.25 × 10 4 fibers/g. Average burden in lung malignancies (11 patients) was 9.178 × 10 4 fibers/g and in pleural tissue (9 patients) was 9.332 × 10 4fibers/g. Among the different cell types, mean fiber burden in squamous cell carcinoma was 8.99 × 10 4 fibers/g, in adenocarcinoma was 9.71 × 10 4 fibers/g, and in small cell carcinoma was 7.54 × 10 4 fibers/g. Mean fiber burden in bronchoscopic endobronchial biopsy tissue was 10.69 × 10 4 fibers/g, while in CT-guided biopsy was 8.60× 10 4fibers/g. Conclusion: Maximum number of fibers was found in adenocarcinoma.

Mesotelioma maligno de pleura com associaçäo etiológica a asbesto: a propósito de três casos clínicos / Malign mesothelioma of pleura with etiological association to asbestos: apropos of 3 clinical cases

O mesotelioma maligno de pleura (MM) é tumor de ocorrência rara e nosso meio e tem-se mostrado, quando em elevada incidência, relacionado à exposiçäo pregressa a asbesto ou amianto nas séries descritas em outros países. OBJETIVO. A partir de casos clínicos atendidos no Hospital de Clínicas da UNICAMP, procurou-se evidenciar tal associaçäo epidemiológica, visando alertar profissionais médicos quanto à possível elevaçäo da incidência de tal tumor nesta década e, futuramente, por características próprias da história natural desse tipo de tumor. MÉTODOS. Säo descritos três casos de MM de pleura ocorridos na regiäo de Campinas, SP, num período de dois anos, dos pontos de vista clínico, laboratoriais complementares e anatomopatológico, incluindo minuciosa investigaçäo anamnésica ocupacional e ambiental. RESULTADOS. Todos os casos foram confirmados do ponto de vista anatomopatológico, incluindo microscopia eletrônica, como casos de MM. Os três casos mostraram relaçäo epidemiológica, comprovada por meio de história ocupacional, com exposiçäo a asbesto no passado. Um dos casos teve exposiçäo ocupacional pregressa de curta duraçäo (cerca de um ano); outro teve exposiçäo doméstica a partir de asbesto trazido do ambiente de trabalho por seu pai, durante sua infância, e o terceiro caso com contaminaçäo ocupacional indireta. CONCLUSÃO. A ocorrência de MM de pleura relacionada à exposiçäo a asbesto, no passado, parece ser realidade em nosso meio, como mostram estes três casos clínicos. Destaca-se a necessidade da anamnese ocupacional e ambiental detalhadas na abordagem desses casos, alertando-se para maior atençäo no diagnóstico dos tumores primários da pleura e do peritônio, nos próximos anos, em funçäo de provável aparecimento de novos casos relacionados a exposiçäo a asbesto pregressa, tendo em vista o intervalo de tempo entre o início da manipulaçäo do asbesto em nosso país e o aparecimento destes primeiros casos coincidir com o tempo de latência médio esperado para a ocorrência de MM. Destacam-se, ainda, as necessidades de definiçäo precisa de critérios diagnósticos, para esse tipo de tumor, e criaçäo de registro centralizado de casos.