Source: Annals of Thoracic and Cardiovascular Surgery

In the article “Localized Malignant Mesothelioma of the Pleura,” published in the Annals of Thoracic and Cardiovascular Surgery, researchers from Japan describe the case of a 54 year-old man who presented with a pleural mass initially misdiagnosed as a benign pleural tumor. After growth of the tumor over a fourteen month period, a tissue biopsy revealed a diagnosis of malignant mesothelioma. The researchers describe the man’s case and give an overview of this extremely rare subclass of mesothelioma.

Introduction

Malignant mesothelioma typically presents as a diffuse disorder, with a large number of tumors spread throughout an entire tissue area. Localized presentations, where histological analysis clearly establishes a diagnosis of malignant mesothelioma but whose behavior is characterized by a single mass without evidence of diffuse spread or distant metastases, are exceedingly rare tumors. In fact, the literature only describes forty-five such cases. Due to its rarity, little is known about this form of mesothelioma.

The first descriptions of localized mesothelioma appeared in the early 1990s and described a cohort of six patients. After this initial report, additional studies and anecdotal reports began to appear, but these were few and relatively far between. In 2005, researchers presented the largest current analysis of localized mesothelioma, which described twenty-three new cases and summarized the literature on the previously reported cases. Of the forty-five known cases, thirty-nine presented with a localized pleural tumor. Two presented with a localized peritoneal tumor and two others presented with a localized pericardial tumor.

With so few cases to study, the Japanese researchers were not able to make definitive conclusions on the etiology and underlying development of the disease, but they were able to use their case report to make some general statements on localized mesothelioma.

Case Study

The researchers describe a 54 year-old man suffering from chest discomfort and heart palpitations. An x-ray revealed an abnormal shadow in the area of his chest associated with the discomfort and CT showed pleural thickening. He was given a diagnosis of a benign pleural tumor and then told to return in a few months for a follow-up. After six months the tumor had grown only slightly, but a CT taken fourteen months later showed significant increase in tumor size and some evidence of chest-wall invasion. A needle biopsy returned results positive for malignant mesothelioma, but physical examination revealed a localized neoplasm without tissue diffusion or distant metastases.

Surgery was then scheduled to remove the growing mass. Doctors identified and removed a single tumor approximately 5cm in size. The tumor had invaded the middle lobe of the lung, but no farther. Histopathology of the tumor itself confirmed malignant mesothelioma, biphasic type. There was neither diffuse spread of the tumor throughout the pleura, nor were any pleural effusions discovered—a clear indication of the behavioral differences between localized and diffuse mesothelioma.

The surgery was declared a complete success when all surgical margins were negative for malignant tissue. The doctors report the man’s prognosis as excellent. Two years after his surgery he is free of the cancer and it shows no signs of returning.

Conclusion

Localized malignant mesothelioma is a very rare subclass of mesothelioma. Normally characterized by gross tissue involvement and general resistance to treatment, malignant mesothelioma remains among the most difficult of all cancers to manage effectively. Prognosis is generally poor and life expectancy is often reduced.

The localized variant of the disease shows none of these characteristics. Histologically the disease is mesothelioma, but its behavior is quite different. Instead of diffuse spread, this version of the disease presents as a single mass with clear boundaries and a seemingly non-aggressive development pattern. As in the case of the man covered here, the tumor appears to be rather slow-growing (there was a period of 16 months between initial x-ray and surgery) and quite amenable to treatment. While a few of the cases in the literature report a metastatic potential and some recurrence after surgery, most do not, so the prognosis for a person with localized mesothelioma seems to much better than a person with the more commonly-seen diffuse disease.

Labels: mesothelioma

Source: Annals of Thoracic Surgery

Aprotinin is a serine protease inhibitor used during surgery to constrain excess bleeding. Two previous studies on aprotinin have shown a reduction in blood loss during thoracic surgery and a decrease in the volume of blood needed for transfusions during surgery. The study being discussed here looked at the use of aprotinin during extrapleural pneumonectomy and inquired into post-operative complications from aprotinin's use.

An extrapleural pneumonectomy (EPP) is a very complex surgery used in the treatment of malignant pleural mesothelioma. During EPP, the lung and the affected pleural surface are removed, as are parts of the pericardium (the membrane covering the heart) and parts of the diaphragm (the muscle between the lungs and the abdomen). Due to its complexity, an EPP should only be performed by an experienced physician. Even then, an EPP is a very serious operation, so an agent or modality that can reduce possible complications, such as blood loss, would be helpful to the surgeon, as well as to the patient.

Description of Patients and Methods

The researchers who completed this study were physicians with the University of Texas MD Anderson Cancer Center, in Houston, TX. They conducted a retrospective study based on the hospital records of the 52 patients who had undergone an EPP at MD Anderson. 27 had received aprotinin and 25 had not. All patients treated had malignant pleural mesothelioma or another malignant pleural disease and all had similar workups and staging procedures. Data was compared on a variety of variables and special attention was paid to post-operative problems, especially problems with renal function or blood-clotting (thromboembolic) events.

Conclusion

The researchers concluded that aprotinin may be useful for EPP, but the attending doctor's decision should be based on the clinical facts at hand. Aprotinin's results on controlling blood loss were mixed: it significantly reduced the use of non-PRBC blood products and post-op chest tube output, but did not decrease interoperative blood loss or PRBC transfusions. More importantly though, use of aprotinin was not associated with an increase in adverse complications. Becuase of this, aprotinin is potentially useful for both surgeon and patient.

Labels: mesothelioma

Source: Wiley Interscience

Occupational exposure is the most common type of exposure to asbestos. Workers in a variety of industries have respirated or otherwise "taken-in" asbestos due to the presence of the fibers in a number of products. It is because of this fiber intake that certain occupations have higher-rates of mesothelioma and other asbestos-caused diseases than do other occupations. However, on-the-job exposure to asbestos is not the only cause of these diseases. Secondary exposures, known also as bystander exposures, do occur and are a greater source of disease onset than was previously realized.

Bystander exposure occurs in a variety of settings: at home, outside, in a school or place of business, etc. The exposure can take place from coming into contact with a person who was previously exposed and is inadvertently carrying the fibers on his or her clothing, from simply walking through a space with contaminated air because of construction or re-modeling or even walking by an area where asbestos was once manufactured where the kicked-up dust may have significant asbestos contamination.

Mesothelioma: You Do Not Have to Work for it

While bystander exposure has been a known cause of asbestos disease for quite some time, there have not been many formal studies done that attempt to quantify the available knowledge regarding it. The primary paper referenced in this document, "Mesothelioma: You Do Not Have to Work for it," written by Elizabeth J. Ampleford, Ph.D., and Jill Ohar, M.D, has summarized the results of the previous studies while providing case studies of three women who developed asbestos-disease from bystander exposure.

One study they referenced showed an increased risk for pleural mesothelioma from both environmental exposure and household exposure. The former showed a 10-fold increase over the non-exposed control group while the latter showed a 5-fold increase. Another study demonstrated that when comparing mesothelioma patients to a control group of patients with another form of asbestos-disease, women were disproportionately more represented in the mesothelioma control group. These studies, among others, show that mesothelioma from bystander exposure to asbestos is a problem with serious public health repercussions-especially for women. In fact, one study showed that a shorter length of exposure, which would be the case with a bystander exposure, was not necessarily indicative of a lower disease risk if a high concentration of fibers was present.

Pleural Mesothelioma Bystander Exposure: Mrs. X

Ampleford and Ohar describe the case of Mrs. X, a 63 year-old woman without any known occupational exposure to asbestos. She did, however, spend most of her life in a neighborhood with a cement factory that manufactured a cement pipe containing crocidolite asbestos. The factory produced 10-20 tons of waste per day. Her father, as well as three uncles and an aunt, worked at this factory. She would meet her father for work for lunch and ride around the plant grounds on a bike and when she became a teenager she would assist in laundering her father's clothes. Years later, she presented with a right pleural effusion that was later diagnosed as malignant mesothelioma, epithelial type.

Lung Cancer Bystander Exposure: Ms. Y

Ms. Y was a 51 year-old woman who, like Mrs. X, did not have any occupational exposure to asbestos. She worked as a medical assistant in a hospital environment, where one would expect as clean of air quality as possible. Her bystander exposure came from the same cement factory that Mrs. X father and family worked at. In fact, Ms. Y lived quite close to Mrs. X for most of her life. She can remember "the grass in her yard, the tomatoes in the garden and the cars in the driveway constantly having a white dust on them. As a child, she remembers wiping the white dust from her bicycle and how the silt would build up on her bedroom furniture."

The white dust was asbestos.

At least two of her siblings without occupational exposure to asbestos developed asbestosis and another developed asbestosis and asbestos-induced pericarditis. When Ms. Y complained of chest pain in February of 2000, a chest x-ray raised the possibility of lung cancer that a subsequent PET scan confirmed. Aside from the tumor, significant chest scarring and pleural plaques were noted and a fiber burden analysis conclusively showed the presence of crocidolite fibers in a concentration consistent with occupational exposure-even though Ms. Y had no occupational exposure to crocidolite. Her environmental exposure was so great that her body presented with levels associated with occupational exposure.

Studies have shown a remarkable correlation between patients with disease from bystander exposure and family members with other forms of cancer. One study reported that 33% (17/52) of women with mesothelioma from bystander exposure had a parent with cancer. Another showed an increased frequency of close relatives with cancer among patients with primary or bystander mesothelioma. It is not insignificant to note Mrs. X's other family members (three uncles, an aunt) who worked at the cement factory each developed a form of cancer.

Peritoneal Mesothelioma Bystander Exposure: Miss S

Unlike Mrs. X or Ms Y, Miss S did not have a bystander exposure from environmental contamination from a large factory. Miss S's exposure came from exposure to asbestos fibers on her father's clothes. Mr. S worked a variety of jobs with heavy asbestos exposure and he and his wife washed his clothes at home. His wife noted that dust debris would build up on the floor of their washroom. Miss S would, on occasion, help with the washing of clothes.

Miss S was born prematurely between 28-30 weeks of gestation and stayed in the hospital for three months after being born. She had a patent ductus-arteriosis closed after birthing, bilateral chest tubes inserted when she was four because of a "pulmonary infection," hydrocephalus and mild cerebral palsy. During a physical examination at age 22, a pelvic mass was discovered and a subsequent CT revealed extensive abdominal ascites and other non-standard peritoneal findings. Upon admission, a chest x-ray showed scarring and rib abnormalities, a pathology test reported a finding of malignant mesothelioma, epithelial type and the pelvic mass was discovered to cover almost the entire peritoneal surface.

Miss S stands out as an exceptional case of peritoneal mesothelioma. Her age places her among the youngest patients diagnosed with mesothelioma. Studies on asbestos exposure during fetal development and early childhood reveal that exposures occurring during these critical development times may lead to the development of more aggressive tumors. One study documented the presence of asbestos fibers in placental tissue from health newborns, as well as fibers in the "lung, liver, skeletal muscle and placenta of stillborn infants." Ampleford and Ohar suggest that the results of this study may indicate that Miss S was actually first exposed to asbestos in utero.

Conclusion

The authors conclude their paper by suggesting that although regulations regarding asbestos use have helped protect people from occupational exposure, bystander exposure is still a serious concern and that medical professionals need to be on the lookout for mesothelioma in populations who do not evidence any primary exposure to asbestos.

Labels: mesothelioma

In the article “Identification of genomic events associated with progression of pleural malignant mesothelioma,” Belluck & Fox is thanked for its financial contribution to the Mesothelioma Biomarker Discovery Laboratory, the lab that completed the study the paper was based on. The researchers studied chromosomal aberrations and the breakdown of the normal genetic processes involved in the development of malignant mesothelioma. Using sophisticated analysis and technological methods, it identified the most common DNA changes and the most significant chromosomal areas and genes that lead to the disease.

Labels: Firm

Source: PubMed.Com

One of the most common research programs in the study of malignant mesothelioma is the search for biomarkers that improve upon the ability of current methodologies to diagnosis mesothelioma. The study that is referenced here looked at the expression of VEGFR-3 (vascular endothelial growth factor receptor-3) in patients with mesothelioma generally and its expression in subtypes of the disease. The population sample included 29 mesothelioma cases and 5 metastatic carcinomas. None of the metastatic carcinoma patients showed VEGFR-3 expression, while the majority of mesothelioma patients did. This expression carried through to all subtypes of the disease. The study concluded that VEGFR-3 expression is an important avenue of further research.

Labels: mesothelioma

Source: PubMed.Com

That asbestos exposure causes multiple pulmonary diseases has been conclusively known since at least the 1920s. What have remained in question are the physiological mechanisms by which exposure leads to disease and/or death. Researches from the EPA have recently studied the relationship between asbestos and iron homeostasis and have determined that one of the mechanisms by which asbestos causes disease is through disruption of processes involved in iron homeostasis. Using bronchoalveolar lavage, the researches compared the lung condition of workers with known exposure to asbestos to those without known exposures and have proposed a descriptive model of how oxidant stress causes lung injuries after exposure to asbestos.

Labels: asbestos

Labels: cancer

Source: CancerPage.com

A study on the benefits of vinflunine for the treatment of mesothelioma was published in the Journal of Clinical Oncology on October 20. Vinflunine is a microtubule inhibitor that is being studied for its therapeutic effects on a number of different cancers. This particular study was looking at the effects of vinflunine as a first line therapy against malignant pleural mesothelioma and the initial results were positive.

The study sampled a population of 67 patients with pleural mesothelioma. Overall, patients showed a response rate of 13.8% and most maintained upon (60%) or improved (13.8%) their performance status. The median progression-free survival was 3.2 months and the median overall survival was 10.8 months. 1-year survival rate was 36.9%.

Because of the positive results exhibited during the study, the authors have concluded that vinflunine merits further research. They suggest vinflunine may be beneficial to patients with disease progression after Alimta/cisplatin treatment and feel combination therapy with cisplatin itself should also be studied.

Labels: mesothelioma

URL: www.mesotheliomafromnavy.com

Belluck & Fox is proud to announce the launch of www.mesotheliomafromnavy.com—a website providing Navy veterans and other mariners with the most up-to-date information available on mesothelioma treatment and support. Mesotheliomafromnavy.com is a mesothelioma reference portal with information about this tragic cancer, as well as information on lung cancer and other asbestos-related diseases. The website contains lists of ships and ship yards, as well as lists of Navy occupations and seafaring professions. The site details many of the asbestos-related hazards encountered by Navy veterans. For veterans who have already been diagnosed with mesothelioma and are looking to learn more about the disease, www.mesotheliomafromnavy.com provides contact information for mesothelioma specialists and treatment centers, as well as detailed descriptions of the current treatment options available for mesothelioma victims.

Belluck & Fox believes the large number of Navy veterans with mesothelioma is not only a tragedy that deserves recognition, but a wrong that needs to be made right. Many servicemen and shipyard workers gave their lives to the protection of the homeland and have now been diagnosed with mesothelioma—a disease caused by asbestos materials. Manufactures knew the dangers of asbestos, but kept them hidden from the Navy and veterans. We have developed this website so veterans, other mariners and their families will only need one place to go for all of their mesothelioma information needs.

Belluck & Fox is committed to continually updating http://www.mesotheliomafromnavy.com to provide the best and most current information on mesothelioma treatment and support.

Labels: asbestos, mesothelioma, Press Releases

Source: CancerConsultants.com

At the 12^th World Conference on Lung Cancer held in Seoul, South Korea researchers presented the results of two separate studies analyzing the effectiveness of Alimta^® for the treatment of malignant mesothelioma.

Researchers from Germany presented the results of an open-label study comparing Alimta alone to Alimta^® + Platinol^® (cisplatin) and to Alimta^® + Paraplatin^® (carboplatin). They found that all three treatments had a similar one year survival figure, but the combination of Alimta and a platinum compound caused a greater response than did treatment with Alimta alone. There was some concern that patient selection-bias had a negative affect on survival rates because previous studies have demonstrated a clear increase in survivability when combination theory was used over single agent therapy.

Researchers from the Netherlands presented the results of a study on patients previously treated for mesothelioma who were given an Altima regimen after their initial treatment. They found that previously treated patients can benefit from treatment with Alimta alone, Alimta with Platinol or Alimta with Paraplatin.

Labels: mesothelioma