PubMed · 11790671
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Albert Miller. 2002-01-15. Pleural plaques and lung function.. https://doi.org/10.1164/ajrccm.165.2.correspondence_c
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BACKGROUND: Malignant mesothelioma of the peritoneum is a very rare neoplasm, commonly associated with asbestos exposure and often rapidly fatal. Well Differentiated Papillary Mesothelioma of the Peritoneum (WDPMP) is regarded as a less aggressive variety of the tumor. Progressive ascites is often the only clinical manifestation of the disease and differentiation of WDPMP from benign mesothelial hyperplasia or adenocarcinoma is difficult. PATIENTS AND METHODS: Here we report the case of a 45-year-old patient who presented with ascites but without evidence of portal hypertension, liver disease or abdominal malignancy. On diagnostic laparoscopy small tumor nodules were found to cover the parietal peritoneum and the greater omentum and histopathologically corresponded to papillary mesothelial hyperplasia with minimal nuclear atypia. Histochemically biopsies were positive for Calretinin, Cytokeratins and Epithelial Membrane Antigen (EMA). Based on these findings the diagnosis of WDPMP was made and the patient was closely followed without primary cytostatic therapy. CONCLUSIONS: Progressive ascites was the only clinical symptom in this patient, while liver disease, portal hypertension and gastrointestinal malignancies were ruled out by clinical, laboratory and imaging techniques. Laparoscopic biopsy revealed WDPMP to be the underlying disease. Immunocytochemistry is required to establish the diagnosis of this rare malignant disorder which is even more uncommon in the absence of a history of asbestos exposure. Due to the indolent course of WDPMP therapy should only be initiated when signs of rapid tumor progression become apparent.
Between the early 1960s and his death, Irving John Selikoff (1915-1992) was the dominant figure in the field of asbestos and health. He was particularly important in helping to establish a causal association between relatively low and spasmodic exposure to asbestos dust on the part of insulation workers and excess mortality rates. Through scientific and other activities, he played as large a part as anyone in destroying the American asbestos industry. This article traces Selikoff's medical education across three continents between 1936 and 1945. This education was relatively brief, patchy, and in some respects substandard. Selikoff never obtained the M.D. degree he repeatedly claimed he possessed. Questions are raised about how he attained such high professional recognition given his very modest educational attainments. Reflections are offered about whether asbestos regulation and litigation might have been different if Selikoff's evasions had come to light before now.
Asbestosis can cause significant impairment and even death. It is also a well-recognized risk factor for the development of lung cancer. However, asbestosis is usually diagnosed on clinical grounds without the aid of pathology. Many physicians and researchers believe that in asbestos-exposed individuals with adequate latency, chest radiographic findings that are compatible with asbestosis are sufficient for the diagnosis. In order to determine whether this approach is reasonable, the positive predictive value of the chest radiograph for the diagnosis of pathologic asbestosis must be determined. This requires information about the prevalence of asbestosis, and the sensitivity and specificity of the chest radiograph in its diagnosis. In this article, the sensitivity and specificity of the chest radiograph in diagnosing asbestosis is determined from a literature analysis. The prevalence of asbestosis among present-day cohorts, such as construction workers and petrochemical workers, is assessed based on the relative risk of lung cancer in patients with asbestosis and the overall relative risk of lung cancer in these occupationally asbestos-exposed cohorts. The results indicate a positive predictive value for abnormal chest radiograph findings alone to be significantly < 50%. Therefore, the chest radiograph is inadequate as the sole clinical tool to be used to diagnose asbestosis in these cohorts. However, when rales and a low diffusing capacity of the lung for carbon monoxide are also present, the diagnosis of asbestosis on clinical grounds can be made with reasonable confidence.