Mesothelioma: Current Perspectives
Thirty patients with the diagnosis of mesothelioma were admitted to the
Swedish Hospital Medical Center, Seattle, from 1975 to 1979. Of these, 26
had pleural and 4 had peritoneal mesothelioma. In 20 of the patients with
pleural mesothelioma, the diagnosis had been made by open thoractomy and
in only one by needle biopsy of the pleura. The average survival of the patients
with pleural tumors from time of diagnosis was 15 months, and two are alive
at three and eight months, respectively, one of whom had an apparent solitary
benign mesothelioma. The average survival of those with peritoneal mesothelioma
was ten months, although one has survived six years. There were 17
patients with a known history of exposure to asbestos, 14 while working in
shipyards. Because of the relatively high incidence of this previously rare
tumor in the Puget Sound, Washington, area, and the generally dismal results
of therapy, better methods of diagnosis including thoracoscopy and a more
systematic approach to treatment are recommended.
IN RECENT YEARS, mesothelioma, a tumor of
serosal surfaces, has become a subject of growing
interest among the medical profession and the lay
public. The attention is due both to its increasing
frequency of diagnosis and its strong epidemiological
link to asbestos exposure.1-7 Asbestos, a
mineral fiber, is valued for its thermal properties
and has found wide application in this century
as an insulating material. Until recently, including
the busy years of World War II, it was used extensively
in ship building as pipe insulation.
Growing evidence indicates that the populations
in those areas with ship building activities have a
significantly increased risk of developing mesothelioma.'
8 In a tumor registry study by Hinds8
of eight areas of the United States, the Puget
From the Department of Surgery, the Swedish Hospital Medical
Center, Seattle (Dr. Taylor), and the Department of Sturgery,
University of Washington School of Medicine, Seattle (Dr.
Johnson).
Submitted September 29, 1980.
Reprint requests to: Lloyd P. Johnson, MD, Seattle Surgical
Group, Inc., P.S., 801 Broadway, Suite 901, Seattle, WA 98122.
Sound area and New Orleans, both with substantial
shipyard activity, had the highest incidence
of mesothelioma. During the past 41/2
years, one registry reported 85 cases of malignant
pleural mesothelioma in western Washington
(written communication, June 1980, Fred Hutchinson
Cancer Research Center, Seattle).
Because of this somewhat unusual epidemiology,
the apparent increasing incidence of the disease
and the generally poor results of therapy, we
wish to review our recent experience with mesothelioma
and propose some new directions for
its diagnosis and management.
Clinical Presentation
The cases of 30 patients admitted to the Swedish
Hospital Medical Center in Seattle between
1975 and 1979 were reviewed. In all of the patients
mesothelioma had been diagnosed by tissue
analysis. There were 25 with diffuse malignant
pleural disease, 4 with peritoneal tumor a
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