Pleural mesothelioma resulting from exposure to amosite asbestos in a building

Abstract

A 54-year-old female office worker presented with a six month history of malaise, persistent cough and exertional dyspnoea. She was a lifelong non-smoker with no significant past medical history. Examination revealed a left pleural effusion which was confirmed radiologically. No endobronchial lesion was observed at fibreoptic bronchoscopy. During aspiration of the effusion difficulty in traversing the pleura was noted. Pleural biopsy was unhelpful. Pleural fluid cytology was suggestive ofmesothelioma. Her disease progressed and she died nine months after her presentation. Post mortem examination confirmed the cause of death to be pleural mesothelioma. Histological examination showed a tubulo-papillary pattern (Plate 1). Histochemical stains showed a negative reaction for epithelial mucin (AB DiPAS) and a negative reaction for carcinoembryonic antigen (CEA). The histological diagnosis was made unequivocally and independently by two pathologists experienced in the diagnosis of mesothelioma. No asbestos bodies were obseFved on light microscopic examination of 30//thick sections of lung. Transmission electron microscopy of digested tissue showed 31 million fibres per gram of dry lung and 12 million fibres per gram of dry tumour. A count of Received on revised form I I July 1988 Correspondence to: R. M. Rudd, The London Chest Hospital, Bonner Road, London E2 9JX, U.K.