Mesothelioma Registry Research Articles

Environmental asbestos exposure and mesothelioma cases in Bari, Apulia region, southern Italy: a national interest site for land reclamation

Asbestos is an environmental carcinogen, and asbestos-related diseases are a global-scale public health issue. We report three cases (one male and two females) of pleural malignant mesothelioma (PMM) caused by environmental asbestos exposure reported by the Apulia Regional Operating Centre (COR) to the National Mesothelioma Registry (ReNaM). The patients revealed no history of asbestos exposure even after detailed assessment. The environmental (neighborhood) asbestos exposure for each of the three cases was due to both the residential history of the subjects and their workplace, close to a military barracks, at a distance of between 45 and 100 m. Moreover, in addition to this new source of pollution, an asbestos cement factory was located in the urban area of Bari municipality, in the Apulia region, southern Italy. Environmental-residential/neighborhood asbestos exposure in the city of Bari, a contaminated area classified as a site of national concern for land reclamation, is discussed also with reference to the military barracks.

Response to Letter to the Editor on the Mortality of Talc Miners and Millers From Val Chisone, Northern Italy.

Readers are invited to submit letters for publication in this department. Submit letters online at http://joem.edmgr.com. Choose “Submit New Manuscript.” A signed copyright assignment and financial disclosure form must be submitted with the letter. Form available at http://www.joem.org under Author and Reviewer information. Reply: We thank Dr. Mirabelli for his letter about a patient with pleural mesothelioma who was identified in the Regional Mesothelioma Registry, and allegedly was employed as talc miner and belonged to the cohort whose analysis of mortality during 1946 to 2013 we recently reported in the Journal.1 Dr. Mirabelli was courteous enough to share the personal data of this patient; we double-checked this information against the roster of the cohort and we were not able to identify him. The number of observed deaths from pleural mesothelioma in our cohort remains therefore zero. We can offer three possible explanations for the discrepancy between the data in our cohort and those in the Mesothelioma Registry. First, this patient might have been employed in graphite production, since a graphite plant, including a mine, was operated in the same alpine valley by the same company that owned the talc mine. We have some records of the workers employed in graphite production, and could not identify the patient. However, contrary to the talc, the graphite records might not be complete and we are not fully confident that this patient had not been employed there. Second, the patient might have been employed by a subcontractor involved in maintenance operations at the talc site; however, we have no data to test this hypothesis. Third, the information on employment available in the Mesothelioma Registry, which was provided by a next-of-kin, might be wrong. Dr. Mirabelli's statement on the possible contamination of talc by asbestos is contradicted by the available evidence, as we have recently discussed in detail.2 Exposure to asbestos in maintenance jobs is a hypothesis without supporting evidence. This example stresses the need for a cautious interpretation of the information collected retrospectively—often from next-of-kin, as in this case—on occupational history and circumstances of exposure within the frame of surveillance systems, such as a Mesothelioma Registry.3 While such data might have some value in identifying general patterns and trends at the population level, their validity for assessing exposures of individual patients may be suboptimal.

Histological findings and lung dust analysis as the basis for occupational disease compensation in asbestos-related lung cancer in Germany.

This study has researched the significance of histologically raised findings and lung dust analyses in the context of claiming the recognition of and thus compensation for an asbestos-associated occupational disease. For this approach, all findings from the German Mesothelioma Register in 2015 that included lung dust analyses were evaluated and were compared with information on asbestos fiber exposure at work based on fiber years, and with the results of radiological findings. For 68 insured persons, recognition of an asbestos-induced lung disease according to Section 4104 of the German Ordinance on Occupational Diseases (Berufskrankheitenverordnung - BKV) could be recommended solely on the basis of the histological examinations of lung tissues and complementary lung dust analyses. Neither did the calculation of the cumulative asbestos dust exposure at work yield 25 fiber years, nor could bridge findings (e.g., plaques) be identified. In addition, the autopsies of 12 patients revealed plaques that had not been diagnosed during radiological examinations. These results show that - irrespective of the prescribed working techniques and radiological diagnosis - pathological/anatomical and histological diagnostics are often the only way for the insureds to demonstrate the causal connection between asbestos and their disease. Even after long intervals of up to 40 years post last exposure, the asbestos fibers would still be easily detectable in the lung tissues evaluated. Whenever suitable tissue is available, it should be examined for mild asbestosis with the aid of a lung dust analysis. Otherwise there is a risk that an occupational disease is wrongfully rejected. In the context of health insurance, the lung dust analysis and the resulting proof of the presence of asbestosis often constitute one option of providing evidence of an occupational disease. Int J Occup Med Environ Health 2018;31(3):293-305.

The effects of improving the mesothelioma surveillance network on sensitivity, timeliness in reporting and asbestos exposure assessment.

In Italy, Mesothelioma Registries (MRs) have been established by law for the epidemiological surveillance of occupational cancers. MRs collect information about asbestos exposure of incident cases, through interviews. In the Emilia-Romagna region, MR was implemented in 1996 and extended its network of health professionals who report suspected mesothelioma in 2001 and 2007. This study evaluated the impact of the extension of the network on MR sensitivity and timeliness. Mesothelioma cases were analysed in three subsequent periods: 1996-2001 (before any network extension), 2002-2007 (after first extension) and 2008-2014 (after second extension). Sensitivity was evaluated by the proportion of cases directly reported by the network out of the total number of incident cases; reporting and interview timeliness were assessed by median times between diagnosis and, respectively, reporting and interview. Pleural mesothelioma reporting timeliness was also evaluated by use of quantile regression models, stratified by diagnostic certainty and adjusted by sex and age. Sensitivity increased from 79.4% (1996-2001), to 89.0% (2002-2007) and to 91.4% (2008-2013). For mesothelioma with diagnostic certainty, we recorded considerably reduced reporting times from the 50th percentile on, whereas for uncertain mesothelioma relevant reductions were observed also in the lower percentiles. A reduced time to interview was observed too, which was more significant for uncertain cases. The proportion of patients directly interviewed increased from 33.5% (1996-2001), to 39.1% (2002-2007), to 49.5% (2008-2014). The extended network improved the MR sensitivity and allowed shorter reporting and interview times and more frequent patient interviews, thus improving accuracy of exposure definition.

Differences between peritoneal and pleural mesothelioma in Lombardy, Italy

BackgroundWe examined characteristics of peritoneal (PEM) and pleural (PLM) mesothelioma in Lombardy, Italy. MethodsFrom the Lombardy Mesothelioma Registry we selected PEM (N=300) and PLM (N=5011) cases diagnosed in 2000–2014. We investigated asbestos exposure and presence of asbestosis or pleural plaques. ResultsIncidence rates (per 1,000,000 person-years, world standardized) of PEM were 1.2 (men) and 0.9 (women), compared with 22.6 and 8.4 for PLM.Asbestosis (both genders) and pleural plaques (men) were more frequent among PEM cases. Occupational asbestos exposure was similar in PEM and PLM cases. We found higher proportions of PEMs employed in the asbestos cement production. ConclusionThe higher frequency of pleural plaques in PEM cases confirm the association between asbestos and peritoneal mesothelioma. The higher proportions of asbestosis and of past employment in the asbestos-cement sector among PEM cases suggest a possible role of high exposures to asbestos in the peritoneal mesothelioma genesis.

Mesothelioma incidence and asbestos exposure in Italian national priority contaminated sites.

Objectives This study aimed to (i) describe mesothelioma incidence in the Italian national priority contaminated sites (NPCS) on the basis of data available from the Italian National Mesothelioma Registry (ReNaM) and (ii) profile NPCS using Bayesian rank analysis. Methods Incident cases of mesothelioma and standardized incidence ratios (SIR) were estimated for both genders in each of the 39 selected NPCS in the period 2000-2011. Age-standardized rates of Italian geographical macro areas were used to estimate expected cases. Rankings of areas were produced by a hierarchical Bayesian model. Asbestos exposure modalities were discussed for each site. Results In the study period, 2683 incident cases of mesothelioma (1998 men, 685 women) were recorded. An excess of mesothelioma incidence was confirmed in sites with a known past history of direct use of asbestos (among men) such as Balangero (SIR 197.1, 95% CI 82.0-473.6), Casale Monferrato (SIR 910.7, 95% CI 816.5-1012.8), and Broni (SIR 1288.5, 95% CI 981.9-1691.0), in sites with shipyards and harbors (eg, Trieste, La Spezia, Venice, and Leghorn), and in settings without documented direct use of asbestos. The analysis ranked the sites of Broni and Casale Monferrato (both genders) and Biancavilla (only for women) the highest. Conclusions The present study confirms that asbestos pollution is a risk for people living in polluted areas, due to not only occupational exposure in industrial settings with direct use of asbestos but also the presence of asbestos in the environment. Epidemiological surveillance of asbestos-related diseases is a fundamental tool for monitoring the health profile in NPCS.

The asbestos fibre burden in human lungs: new insights into the chrysotiledebate.

The traceability of asbestos fibres in human lungs is a matter of discussion especially for chrysotile. This issue is of high significance for differential diagnosis, risk assessment and occupational compensation. At present no intra-individual longitudinal information is available. This study addresses the question whether the asbestos fibre burden in human lungs decreases with time after exposure cessation.The database of the German Mesothelioma Register was screened for patients with asbestos body counts of at least 500 fibres per gram of wet lung, which had been analysed twice from different tissue excisions at minimum intervals of 4 years.Twelve datasets with individual longitudinal information were discovered with a median interval of about 8 years (range 4–21 years). Both examinations were performed after exposure cessation (median: surgery, 9.5 years; autopsy, 22 years). Pulmonary asbestos fibre burden was stable between both examinations (median 1623/4269 asbestos bodies per gram wet lung). Electron microscopy demonstrated a preponderance of chrysotile (median 80%).This study is the first to present longitudinal intra-individual data about the asbestos fibre burden in living human lungs. The high biopersistence of amphiboles, but also of chrysotile, offers mechanistic explanations for fibre toxicity, especially the long latency period of asbestos-related diseases.

Pleural mesothelioma in doll manufacture: possible asbestos exposure.

The occurrence of malignant mesothelioma is almost always causally associated to asbestos exposure but, considering women occurrences, this association is often difficult to demonstrate and consequently the asbestos exposure is defined as 'unknown'. To describe the working activity and to give occupational asbestos exposure probability estimation related to an uncommon and poorly investigated productive sector: doll manufacture. From the Province of Brescia Mesothelioma Registry, established in 1993 on population-based criteria, we have extracted the certified mesothelioma diagnosis cases, related to patients who were employed for some time in doll manufacture. Among the 757 total cases of malignant mesothelioma registered and studied up to 2016, we found 3 cases of pleural epithelial mesothelioma histologically diagnosed in young women who had worked in two doll manufacturing companies and whose asbestos exposure had been initially defined as 'unknown', because an environmental, family or extra-professional asbestos exposure was considered unlikely. However, the judicial autopsy performed on one of the 3 women had allowed examining lung tissue samples with Scanning Electron Microscopy. This technique showed a concentration of amphiboles fibers of about 12,000,000 per gram of dry lung tissue, with a consequent re-classification of asbestos exposure from 'unknown' to 'occupational certified'. Mesotheliomas in women with no apparent occupational asbestos exposure are normally referred to life or family environmental exposure. Moreover, it is known that occupational asbestos exposure in women is difficult to recognize. Previously, only one publication had reported two cases of mesothelioma in cloth doll manufacture. The occurrence of two mesothelioma cases in the same company out of the three here presented was suggesting an occupational exposure. The finding of a high amphibole fibers lung concentration confirmed the previous hypothesis, despite the impossibility to determine the circumstances with good evidence. The three cases of mesothelioma in doll production workers suggest that also in this restricted manufacturing sector had occurred an occupational asbestos exposure, which is up to now unknown and isn't due only to the use of sewing or ironing machines. The lung asbestos fibers burden analysis is confirmed to be a decisive factor in the assessment of mesothelioma cases with 'unknown' exposure.

Pleural and peritoneal mesotheliomas in the Friuli Venezia Giulia register: data analysis from 1995 to 2015 in Northeastern Italy.

The Friuli Venezia Giulia Mesothelioma Register contains a case-list of 1,109 mesotheliomas (1,034 pleural, 75 peritoneal) during 1995-2015. Exposure data are available for almost all cases. The aim was to assess mesothelioma incidence in the Region, an area with several shipyards, and to investigate determinants of mesothelioma latency among occupational cases. Incidence rates were calculated. Univariate and multivariate analyses were performed to estimate latency time by anatomical site, gender, diagnostic period and industry sector. Mesothelioma incidence rates among men were higher than among women during the overall period. The incidence of pleural mesothelioma in men leveled off until 2009 (6.50 per 100,000) with a slight decrease thereafter. For women, the rate increased until 2006 (1.31 per 100,000) and then remained relatively stable. The incidence of peritoneal mesothelioma in men was constant whereas rate among women increased during 2010-2015. The number of cases diagnosed during three-year periods remained level. In multivariate model, site and gender were not relevant for latency period whereas construction workers had a shorter latency than shipyard workers. Despite the asbestos ban since 1992, occupational exposure is still at risk. This highlights the need to assess exposure levels and to find a reliable health surveillance tool.

Pleural mesothelioma in household members of asbestos-exposed workers in Friuli Venezia Giulia, Italy.

Malignant mesothelioma is closely associated to asbestos exposure. One such exposure may occur through contact with occupationally exposed household members and their belongings. This study examines the features of pleural mesothelioma attributable only to asbestos brought home by another family member. The data sources were 1063 mesothelioma cases diagnosed between 1995 and 2014, from the Friuli Venezia Giulia Mesothelioma Register. In all cases the diagnosis of mesothelioma was based on the pathology report. Exposure information and demographic data were acquired by an occupational medical standardized questionnaire/interview. Household-exposure mesothelioma cases included 33 women and 2 men. Relationships were: wives (N = 22), daughters (N = 9), sons (N = 2), and mothers (N = 2). Asbestos exposure in the workers predominantly occurred in shipyards. Out of the 35 pleural cases, 19 were epithelial, 9 biphasic, 3 sarcomatoid, and 4 not specified. The mean age at diagnosis was 77 years old. The mean latency was 59 years, with wives having a significant shorter latency than offspring. Latency was not significantly related to morphology and asbestosis. The overall mean survival was 16 months (median 11 months) but treatment was beneficial (mean 16 months vs. 7 months). Biphasic/sarcomatoid histology and presence of asbestosis were associated with a decreased survival, although not with statistical significance. Our data confirms that household exposure increases the risk for pleural mesothelioma amongst women with no history of occupational asbestos exposure. This is an ongoing problem in many countries, as well as in Italy, where the evaluation of a framework for the compensation of these cases is under debate. Int J Occup Med Environ Health 2017;30(3):419-431.

Risk factors for malignant mesothelioma in people with no known exposure to asbestos.

Malignant mesothelioma (MM) is a rare and generally fatal cancer, usually caused by asbestos, although about 5-10% of cases report no asbestos exposure. This study aimed to identify sources whereby people in Western Australia (WA) may be unknowingly exposed to asbestos or to other exposures which may cause MM. Cases with no known asbestos exposure were selected from the WA Mesothelioma Register (WAMR). Matched controls were selected from hospital patients admitted for conditions unrelated to asbestos. Occupational histories were coded by an industrial hygienist. Data were analyzed using conditional logistic regression. Thirty-eight MM participants and 134 controls were recruited. Risk of MM was increased (OR = 3.1, 95%CI 1.0-9.6) after no known, but likely, exposure to asbestos at work. Because of its extensive use, few people in WA have never been exposed to asbestos. Unrecognized exposure may cause most MM cases initially regarded as "no exposure." Am. J. Ind. Med. 60:432-436, 2017. © 2017 Wiley Periodicals, Inc.

Comparison of outcomes following a cytological or histological diagnosis of malignant mesothelioma

Background:Survival with the epithelioid subtype of malignant mesothelioma (MM) is longer than the biphasic or sarcomatoid subtypes. There is concern that cytology-diagnosed epithelioid MM may underdiagnose the biphasic subtype. This study examines survival differences between patients with epithelioid MM diagnosed by cytology only and other subtypes diagnosed by histology.Methods:Demographics, diagnosis method, MM subtype and survival were extracted from the Western Australia (WA) Mesothelioma Registry, which records details of all MM cases occurring in WA.Results:A total of 2024 MM cases were identified over 42 years. One thousand seven hundred forty-four (86.2%) were male, median (IQR) age was 68.6 (60.4–77.0) years. A total of 1212 (59.9%) cases were identified as epithelioid subtype of which 499 (41.2%) were diagnosed using fluid cytology only. Those with a cytology-only diagnosis were older than the histology group (median 70.2 vs 67.6 years, P<0.001), but median survival was similar (cytology 10.6 (5.5–19.2) vs histology 11.1 (4.8–19.8) months, P=0.727) and Cox regression modelling adjusting for age, sex, site and time since first exposure showed no difference in survival between the different diagnostic approaches.Conclusions:Survival of cytologically and histologically diagnosed epithelioid MM cases does not differ. A diagnostic tap should be considered adequate to diagnose epithelioid MM without need for further invasive testing.

P3.03-049 Optimization of Malignant Mesothelioma Registration at the Belgian Cancer Registry: Topic: Mesothelioma Clinical

Malignant mesothelioma (MM) is a rare but aggressive cancer mostly caused by asbestos exposure, and for which diagnosis is difficult to make. Completeness and correctness of MM registration at the Belgian Cancer Registry (BCR) is assessed using information from three independent national databases, i.e. the standard cancer registration, the population-based mortality statistics (death certificates, COD) and the Belgian Mesothelioma Registry (BMR). The study cohort includes all MM diagnoses reported to BCR (incidence years 2004-2012; n=2,344), all patients reviewed by the pathology commission of BMR (2004-2012; n=2,019), and COD data for all Belgian citizens (2004-2013). All available data are compared for diagnosis and immunohistochemical (IHC) tests as derived from the available pathology reports (APD) at BCR or registered by BMR. Preliminary analyses (n=1,927; 81% of the study cohort) showed that 94% of diagnoses were concordant between BCR and BMR. The proportion of MM without specified histological diagnosis (28% before project start) could be reduced to less than 1%. IHC results derived from APD and/or BMR were available for 86% of the cases. The most commonly performed markers were calretinin, CEA, CK5/6 and TTF1, as expected. Different IHC patterns could be distinguished in concordance with MM histology. MM was mentioned in 165 COD between 2004-2011 that remained uncoupled to BCR. For 139 patients registered at BCR with a different diagnosis, COD indicated MM as cause of death. This projects aims to achieve a complete and correct registration of MM diagnoses in Belgium by comparing information from three independent national databases. Discordant cases will be explored in detail and if necessary, a pathology revision will be performed. Once a definitive database is obtained, further analyses will be conducted including in-depth profiling of long-term survivors and description of treatment patterns for MM.

Asbestos exposure and histological subtype of malignant mesothelioma

BackgroundMalignant mesothelioma (MM) has distinct histological subtypes (epithelioid, sarcomatoid and biphasic) with variable behaviour and prognoses. It is well recognised that survival time varies with the histological subtype of MM....

Malignant mesothelioma in Australia 2015: Current incidence and asbestos exposure trends

ABSTRACTAustralia is known to have had the highest per-capita asbestos consumption level of any nation, reaching a peak in the 1970s. Although crocidolite was effectively banned in the late 1960s, and amosite use ceased in the mid 1980s, a complete asbestos ban was not implemented until 2003. This resulted in an epidemic of asbestos-related disease, which has only now reached its peak. Between 1982 and 2011, 13,036 individuals were newly diagnosed with malignant mesothelioma, with 690 diagnosed in 2011. A further 778 cases were identified between 1945 and 1981 from retrospective searches and the first 2 years of the Australian Mesothelioma Program. The age-standardized malignant mesothelioma incidence rate has leveled off in the last 10 years (2.8 per 100,000 in 2011). There has been a marked increase over time in the age-specific incidence rates for individuals aged 75 years or older. Data from the current Australian Mesothelioma Registry on asbestos exposure history in Australia is available for 449 subjects diagnosed between July 1, 2010, and April 1, 2015. This asbestos exposure history data show that 60% (n = 268) of cases had probable or possible occupational asbestos exposure, with trade-based jobs being the most frequent sources of occupational asbestos exposure. In addition, out of the 449 cases, 377 were recorded as having probable or possible nonoccupational asbestos exposure. Continuous vigilance toward changes over time in the settings in which people are exposed to asbestos and in the descriptive epidemiology of malignant mesothelioma is recommended to enable a comprehensive understanding of the current and future impact of asbestos-related diseases in Australia.

SENTIERI-ReNaM Project: Malignant mesothelioma incidence in Italian Contaminated Sites

Introduction: One of the aims of the SENTIERI-ReNaM Project is to identify excess risks of malignant mesothelioma in National Priority Contaminated Sites and to discuss the results by means of data on individual case histories available from the Italian National Mesothelioma Register (ReNaM). Methods: Incident cases of mesothelioma and Standardized Incidence Ratios (SIRs), with corresponding 95% confidence intervals, have been estimated in 39 sites for both gender, in the period 2000-2011. Age-standardized rates of Italian geographical macro-areas (North-Eastern, North-Western, Centre, South-Islands) have been used to estimate expected cases. For each analyzed site the occupational and non-occupational asbestos exposure modalities are discussed. Results: An excess of mesothelioma incidence is confirmed in sites with a known past history of direct use of asbestos, such as Balangero (chrysotile mine) for men (SIR=197.11, 95% CI: 82.04-473.56), Casale Monferrato (asbestos-cement plant) for men and women (SIR=910.70, 95% CI: 816.45-1012.84 and SIR=1338.1, 95%CI: 1176.7-1515.4), Broni (asbestos-cement plant) for men and women (SIR=1288.52, 95%CI: 981.86-1690.97 and SIR=2006.7, 95%CI: 1488.3-2705.8), and in coastal areas (shipyards and harbours) (e.g. Trieste, La Spezia, Venice and Leghorn). A significant excess of mesothelioma has been observed in settings without documented direct use of asbestos, such as Cengio and Saliceto in the North, Falconara Marittima in the Centre, and the Litorale Domizio Flegreo and Agro Aversano in Southern Italy. Conclusion: The analysis of occupational risk in geographical studies with an ecological design is essential to attribute a weight to etiological factors. The evaluation of environmental risk for people living in polluted areas, considering also the risk for workers, and the assessment of a risk produced by industrial settlements, are feasible through the use of data available from surveillance systems of occupational tumors.

Incidence of malignant mesothelioma in Aboriginal people in Western Australia

ObjectivesTo describe the incidence of malignant mesothelioma (MM) in Aboriginal people in Western Australia (WA) and determine the main routes of exposure to asbestos in this population. MethodsAll MM cases in Western Australia, as well as the primary source of asbestos exposure, are recorded in the WA Mesothelioma Register. Aboriginal cases up to the end of 2013 were extracted from the register and compared with non‐Aboriginal cases with respect to the primary means/source of exposure. Age‐standardised incidence rates for each decade from 1980 were calculated for both Aboriginals and non‐Aboriginals. Age‐standardised mortality rates were calculated for the period 1994–2008 and compared with international rates. ResultsThere were 39 cases (77% male) of MM among WA Aboriginal people. Twenty‐six (67%) were a direct result of the mining of crocidolite at Wittenoom and the subsequent contamination of the surrounding lands. Of the non‐Aboriginal MM cases (n = 2070, 86.3% male), fewer than 25% can be attributed to Wittenoom. Aboriginals had consistently higher 10‐year incidence rates than non‐Aboriginals and, when compared to world populations, the highest mortality rate internationally. ConclusionWhen incidence rates in Aboriginal people are compared with non‐Aboriginal people, the Wittenoom mining operation has had a disproportionate effect on MM incidence in the local Aboriginal population.

Pathology reporting of malignant pleural mesothelioma first diagnosis: A population-based approach

Accurate pathologic diagnosis and reporting in malignant pleural mesothelioma are essential for clinical care, and cancer registration. Practical guidelines for pathologists are provided in publications and textbooks but it is unclear how these recommendations are applied in routine practice. We investigated the characteristics of pathology reports, and the extent to which they meet guideline standards. We reviewed 819 pathology reports relating to a first diagnosis of malignant pleural mesothelioma. Data sources were a regional section of the Italian network of the Mesothelioma Registry (2001–2014) and a pathology archive (1990–2000). We evaluated tumor characteristics, the diagnosis field including terminology and immunohistochemistry (IHC) workup, and report completeness (the proportion of items recorded). We investigated also two IHC panels identified by the most used markers in current practical guidelines, one best suited for epithelioid mesotheliomas (combinations of at least 2 positive and at least 2 negative mesothelioma markers) and the other best suited for sarcomatoid mesotheliomas (positive mesothelioma markers plus cytokeratins). Reports (753 histology, 66 cytology, IHC-confirmed 86%) were 74% complete and always narrative. Missing data were related to clinical history (76%), tumor laterality (61%), specimen size (38%), and histological subtype (23%). The proportion of cases with IHC was higher for epithelioid (90%) than sarcomatoid mesothelioma (87%). Compliance to IHC recommendations was higher for epithelioid (59%) than sarcomatoid mesothelioma (11%). The mean number of stains was significantly higher for sarcomatoid than epithelioid mesothelioma (p<0.000; Kruskal-Wallis test). Our findings show that although guidelines are designed to improve actual reporting practices, there is ample room for improvement in their application to standardize the diagnosis of mesothelioma. Synoptic pathology reporting needs to be implemented to better utilize pathology information.

Incidence of mesothelioma in Lombardy, Italy: exposure to asbestos, time patterns and future projections

ObjectivesIn Italy, asbestos has been extensively used from 1945 to 1992. We evaluated the impact of exposure to asbestos on occurrence of malignant mesothelioma (MM) in the Lombardy Region, Northwest...

Malignant pleural mesothelioma in the elderly patient. Retrospective study in the centers of Alessandria and Casale Monferrato

Introduction: This study aims to retrospectively evaluate the management of the diagnostic and therapeutic procedure and the clinical outcome of a case series of elderly patients followed at the Hospitals of Alessandria and Casale Monferrato. Methodology: From a total of 343 patients with MPM, treated between January 2005 and November 2011 at the Hospital SS. Antonio e Biagio and Cesare Arrigo Hospital in Alessandria and SS. Spirito Hospital in Casale Monferrato, 124 patients aged ≥70 years were selected. The following were analyzed for each patient: age, asbestos exposure, sex, histology, stage, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Charlson Comorbidity Index (CCI), and treatment performed. Results: Median overall survival (OS) was 9 months. The most frequent histotype was epithelioid (59%). Asbestos exposure was documented in 96% of cases. The diagnosis of MPM was documented by histological examination in 91% of patients (the rate of histological diagnosis from the data of the Italian Mesothelioma Registry was much lower). The stage at diagnosis in most cases (60%) was reported as I-II. The ECOG-PS of this case series was between 0 and 1 in almost all cases, confirming that old age is not synonymous with poor performance status. No major comorbidities were observed in 64% of cases, whereas a mean score of 4 and 5 was found in 18% and 10% of cases, respectively. Survival analysis showed a negative impact on median OS in the presence of a CCI ≥4. Pemetrexed-based chemotherapy in this elderly population was found to be feasible with a more than acceptable toxicity profile. Conclusion: This study demonstrated the influence also in the elderly population of some prognostic factors such as histological subtype, IMIG stage, presence of comorbidities according to CCI, and therapy with pemetrexed-based or non-pemetrexed-based regimens. On the basis of these analyses, greater attention to this category of patients is needed, hoping for the possibility of conducting prospective studies aimed also at the elderly population.