Chest
Volume 142, Issue 5, November 2012, Pages 1267-1273
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Original Research
Disorders of the Pleura
Postmortem Findings of Malignant Pleural Mesothelioma: A Two-Center Study of 318 Patients

https://doi.org/10.1378/chest.11-3204Get rights and content

Background

Malignant pleural mesothelioma (MPM) is an incurable cancer with a rising incidence. MPM is often perceived as a locally invasive cancer, and the exact cause of death is poorly understood. This two-center study describes the anatomic features of patients with MPM at postmortem.

Methods

The Western Australia Mesothelioma Registry (Australia) and Coroner's Office reports from the Avon region (England) were interrogated for the postmortem records of confirmed mesothelioma cases.

Results

Postmortem records of 318 patients with pleural mesothelioma (169 from Western Australia and 149 from Avon) were identified. Most patients (91.5%) were men (mean age, 68.4 ± 11.5 years), and MPM was right-sided in 55.3%. Extrapleural dissemination of tumor was found in 87.7% of cases and lymph node involvement in 53.3%. Tumor dissemination in extrathoracic sites was common (55.4% of patients), and almost all organs were involved, including liver (31.9%), spleen (10.8%), thyroid (6.9%), and the brain (3.0%). Pulmonary emboli were found in 6% of cases and considered as directly contributing to death in 13 patients (4.1%). The precise cause of death could only be determined in 63 (19.8%) cases even after postmortem. The BMI was significantly lower in cases that had no identifiable anatomic cause of death at postmortem (18.8 ± 4.3 vs 21.0 ± 4.7, P = .034).

Conclusions

In this largest, to our knowledge, postmortem series on MPM, extrathoracic dissemination of mesothelioma was common and often underrecognized. No anatomic cause of death was identified in the majority of patients even at autopsy, raising the possibility of physiologic and metabolic causes of death.

Section snippets

Databases

The Western Australia Mesothelioma Registry (Australia) and the Coroner's Office postmortem reports from the Avon area (England) were interrogated. The Western Australia Mesothelioma Registry contains complete data on all cases diagnosed in the state. Each case in the registry is individually scrutinized by an expert panel prior to inclusion, and this database has been used in previous epidemiology reports.12, 13 The entire registry, from establishment in 1969 to May 2009, was manually searched

Demographics

A total of 344 patients with proven mesothelioma and a complete postmortem record were identified, of which 26 had primary peritoneal mesothelioma. In the 318 patients with primary pleural mesothelioma (169 from Western Australia and 149 from Avon), most (91.5%) were men, and 55.3% had a right-sided pleural mesothelioma. The detailed demographic and disease characteristics of the Australian and Avon cohorts were similar (Table 1) except for the age of death. The mean overall age of death was

Discussion

This largest postmortem report, to our knowledge, in the English-language literature describes the tumor distribution pattern and related postmortem findings in patients with MPM. The data show that pleural mesothelioma is seldom limited to the ipsilateral hemithorax, and extrathoracic (often multiple) and lymphatic involvement of mesothelioma are common. Deposits of mesothelioma can be found in most organs. No direct anatomic cause of death was identified in the majority of patients (80%)

Acknowledgments

Author contributions: Dr Brims acts as guarantor of the paper.

Dr Finn: contributed to data collection, analysis, and manuscript preparation.

Dr Brims: contributed to data collection, analysis, and manuscript preparation.

Mr Gandhi: contributed to data collection and manuscript preparation.

Ms Olsen: contributed to providing access and oversight to the Western Australian Mesothelioma Registry and approval of the manuscript.

Dr Musk: contributed to providing access and oversight to the Western

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      The most frequent sites of metastasis associated with these tumours are regional lymph nodes, lung, liver, adrenal glands, kidneys,1–7,9,10 as well as a few cases of subcutaneous nodules.10,13 In post-mortem studies, extrapleural dissemination of these tumours has been detected in the liver (31.9%), spleen (10.8%), thyroid gland (6.9%) and brain (3%),7,10,11,14 while cutaneous metastases from MPM are rare.1,4,5,11 Exceptionally, distant metastases have also been diagnosed10 in the lips,1,5,10 oral cavity (floor of the mouth-gingival),4 face,1,3,5 umbilicus,5,7,12 scalp,5,6,8,9 cerebellum,6 fingers,1 neck,15 tongue,5,7,13 trunk,5 flank,2,5 abdominal wall,5 bone,4 upper back,11 skeletal muscle,5 and lacrimal gland.16

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    Drs Finn and Brims contributed equally as joint first authors. Drs Maskell and Lee contributed equally as last authors.

    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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