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A 59-year-old man was hospitalized complaining of pain in chest and shoulder with some weightloss of two months' duration. Physical examination revealed dullness to percussion and decreased breath sounds in right lower lung field. Chest roentgenograms showed the multiple nodular densitres in the right hemithorax and irregularly thickened pleura extended over the right hemidiaphragm. Laminograms demonstrated these tumor masses were in periphery with extrapulmonary nature or entrapped in the interlobar fissure. The aspiration biopsy of mass was read as adenocarcinoma and showed the negative alcian Blue-PAS reaction. The patient became progressively weaker and died 4 months after admission. At antopsy, entire right pleural space was involved with yellow-white, fleshy tumor tissue, most severely involved in the diaphragmatic and costal surface of the lower lobe. On cut-section, there was a large semispherical tumor mass on the diaphragmatic surface and spread of the tumor involved the costal, diaphragmatic and interlobar pleura. The diaphragm had been penetrated, and tumor was present over the peritoneum and especially over the omentum. Microscopic examination showed the characteristic apperance of mesothelioma as described elsewhere. There were areas shown glandnlar, tubular or tubulopapillary pattern with well-defined epithelial cells that graded gradually fibrosarcomatous areas.

Greenberg, M., and Lloyd Davies, T. A. (1974).British Journal of Industrial Medicine,31, 91-104. Mesothelioma Register 1967-68. A register of mesothelioma cases is maintained by the Department of Employment, Medical Services Division (now Employment Medical Advisory Service). This paper describes an investigation of 413 notifications to the Register in 1967-68 from England and Wales and Scotland. Cases were regarded as `definite9 when histological confirmation of diagnosis had been obtained, either by hospital pathologists, or by the UICC Panel of Pathologists, to whom pathological material was submitted whenever possible. Two hundred and forty-six cases were accepted as `definite9 and 76 cases were regarded as `definitely not9 mesothelioma. The remainder were classified as `undecided9 or `insufficient pathological material9. Thirty-five of the 76 cases definitely not mesothelioma had nevertheless been so described on death certificates. The investigation carried out covers clinical aspects, survival, and evidence of exposure to asbestos. Twelve per cent of definite mesotheliomata were of peritoneal origin. The age range was 21 to 87 years, but, in general, mesothelioma occured at an earlier age than `carcinoma of bronchus and lung9 or `all malignant tumours9 in the Registrar General9s statistical mortality tables. Concomitant asbestosis and the finding of asbestos bodies or pleural plaques occured as frequently in those cases classified as definitely not mesothelioma as in confirmed cases. Occupational exposure to asbestos was found in 68% of definite cases, apparently significantly more frequently than in those definitely not mesothelioma, but there was observer bias. The interval between the first exposure and death from mesothelioma exceeded 25 years in 85% of cases but was only three and a half years in one case. The duration of exposure varied widely: in 12% of cases it was under five years. The type of asbestos could be ascertained in so few cases that it was impossible to asses the role of crocidolite in aetiology. There were 38 definite cases in which no history of any exposure to asbestos could be obtained. Definite mesotheliomata showed marked clustering in areas where there is substantial industrial use of asbestos. Whether this should be interpreted as evidence of causation or an effect of heightened awareness in these areas cannot be deduced from this study. Evidence is quoted suggesting that the observed annual incidence of approximately 120 definite mesotheliomata in England, Scotland, and Wales may considerably understate the true prevalence.

One mg of DBP for 12 weeks or 0.5 mg for 17 weeks instilled intratracheally once a week induced tumors in the respiratory system in 65% (0.5 mg) or 75% (1 mg) of the animals with a latent period of 8 weeks. Histologically, the tumors were mostly squamous cell carcinomas, the most common location was the bronchi, followed by the trachea. The significance of these findings for the causation of lung cancer in man is discussed.

This patient had marked polyclonal hyperimmunoglobulinemia associated with mesothelioma in the right sub-phrenic space. Histopathologically the lymph nodes around the mesothelioma showed marked plasma cell proliferation intermingled with infiltration of mesothelioma cells. The plasma cell proliferation was observed even in distant lymph nodes not infiltrated by the tumor cells. The review of the literature disclosed rather frequent occurrences of hyperimmunoglobulinemia in mesothelioma and significance of this association should be stressed.

This report documents the antemortem diagnosis of two cases of malignant peritoneal mesothelioma. The diagnosis was established by laparotomy in one patient and by peritoneoscopy in the other. Both patients also demonstrated thrombocytosis and an increase in fibrinogen-fibrin degradation pro

Legrand, M. and Pariente, R. (1974).Thorax, 29, 164-171. Ultrastructural study of pleural fluid in mesothelioma. By means of electron microscopy, three types of malignant cell can be identified in the pleural fluid of patients with pleural mesothelioma. These cell types are described, and the use of cytology in the differential diagnosis of pleural effusion is discussed.

Meurman, L. O., Kiviluoto, R., and Hakama, M. (1974).British Journal of Industrial Medicine,31, 105-112. Mortality and morbidity among the working population of anthophyllite asbestos miners in Finland. A study has been made in Finland of the effects of anthophyllite asbestos on mortality and morbidity of 1 092 asbestos workers first employed at two mines between 1936 and 1969; 95% of workers were traced, 248 of whom had died. A similar number of age-sex-matched controls was selected from a township 60 km from the mines. The causes of death included an excess due to lung cancer and asbestosis, but cancers of the digestive system occurred in equal frequency, and neither the cases nor controls had any confirmed mesotheliomas. Assuming a multiplicative effect of asbestos and smoking, the relative risk of lung cancer was 17 for an asbestos worker who smokes in terms of a non-exposed non-smoker. The corresponding figures were 12 for a smoker without asbestos exposure and 1·4 for an asbestos worker who did not smoke. More heavy smokers were found among the asbestos workers than among the controls. A threefold excess of dyspnoea and a twofold excess of cough were recorded for the asbestos workers compared with the controls after adjustment for smoking.

Counting coated and uncoated inorganic fibers in sputum has been used to investigate the level of environmental or occupational asbestos exposure and the concentration of fibrous dusts in human lung. Inorganic fibers in sputum were counted by light microscopy after chemical digestion and microfiltration processing. The same method was used for processing gastric juice and lung tissue. There were no ferruginous bodies (FB) in sputum from 49 patients without any asbestos exposure. The study of sputum from 125 patients with various asbestos exposure pointed out a high correlation between the number of FB in sputum and the level of asbestos exposure. These 125 patients were classified into three groups according to the type of their asbestos occupational hazard: group I, raw asbestos workers; group II, workers manufacturing asbestos products; group III, workers with mixed industrial dust exposure. For these three groups, the mean number of FB in sputum was 100, 10, and 1, respectively. The comparison of the FB content of sputum and lung parenchyma showed the absence of FB in sputum when the concentration of FB in lung parenchyma was under 1000/cm(3) of lung parenchyma; above this concentration the number of FB in sputum was in good correlation with fiber concentration in lung parenchyma. A preliminary study with the use of gastric juice showed that gastric juice is a less sensitive sample for evaluating fiber concentration in lung. The microfiltration method for the counting of uncoated fibers gave results as accurate as those in the centrifugation method.

Twenty-seven patients with Pancoast tumors underwent fluoroscopically guided pulmonary needle aspiration biopsy, a diagnostic procedure which provided a cellular aspirate rather than a core of tissue. Diagnoses were made by cytologic rather than histologic techniques. A diagnosis of carcinoma was made in 26 of the 27 cases. The remaining tumor was a locally invasive pleural fibrous mesothelioma. Pulmonary needle aspiration biopsy gave diagnostic results far superior to those obtained by bronchoscopic biopsy, cytology of sputum or bronchial washings, or biopsy of scalene or supraclavicular lymph nodes.

Six patients with malignant mesothelioma were treated with various chemo-therapeutic agents. Two of three patients treated with 5-fluorouracil (5-FU) had relatively prolonged complete responses. The possible antitumor effect of 5-FU in malignant mesothelioma should be confirmed by a larger series or collection of cases.

Feeding of baboons with crocidolite showed small numbers of asbestos needles 0.5–1 μm in ashed tissue of the gut wall, which probably came from iron-containing macrophages. It is suggested that pleural plaques and hyaline nodules in the peritoneum represent a hypersensitivity reaction to ferritin protein coating on asbestos fibers. In South Africa only a few peritoneal mesotheliomas come from the asbestos areas, and the incidence of gastrointestinal carcinomas is no greater than normal. Intrapleural and intraperitoneal injection produces unrealistic situations. Calcium salts are deposited on asbestos cement pipes from hard water and organic material from soft water. It is difficult to envisage asbestos contamination of the water so reticulated. ImagesFIGURE 1.FIGURE 2.FIGURE 3.FIGURE 4.FIGURE 5.FIGURE 6.FIGURE 7.

Some 99,000 new cases of cancer of the colon are expected next year, an incidence rate higher than that for both cancer of the lung and cancer of the breast. Evidence from geographic pathology suggests that some environmental factors play a strong role in its etiology. Data obtained in the 1959 survey of one million people by the American Cancer Society and followed since, has failed to show correlation with any of the large number of factors listed. It is suggested that the etiology is one of multiple factors. The synergistic effect of exposure to asbestos and cigarette smoking in the production of bronchogenic carcinoma is demonstrated by data on cohorts of insulation workers. There was also a modest increase in the number of deaths from gastrointestinal cancer in asbestos workers, but smoking did not seem to act in synergistic fashion at that site, except perhaps in the esophagus. Deaths from cancer occurred almost entirely after a period of 20 years or more from initial exposure. The death rate from cancer tended to increase with duration of exposure, but a distinct rise over the expected was seen in those who had been exposed less than one year to amosite dust.

Pleural plaques are generally accepted as an index to asbestos exposure. The occurrence of pleural plaques and other pleural lesions in workers exposed to asbestos must be carefully recorded to determine the precise prognostic value of this radiological sign in the study of the natural history of malignant mesothelioma of the pleura.

Two localized and two diffuse pulmonary mesotheliomas were studied with both light and electron microscopes. The diffuse mesotheliomas showed features and characteristics of mesothelial cells in the electron microscope, whether lining spaces or within solid parts of the tumor. The localized mesothelioma showed predominance of poorly differentiated cells and fibroblasts. The relationship between the localized and diffuse mesotheliomas is not clear, but the former could be a group of variegated tumors. It appears that a definite electron microscopic diagnosis of diffuse pulmonary mesothelioma can be made at least in some of the surgically removed tissues suspected to be diffuse mesothelioma by clinical and light microscopic findings.

Objectives: To determine the most common age and parity for the development of myoma uteri. To find out any relation between age of the last child and the development of myoma uteri. To determine the treatment protocal and outcome of treatment. Materials/methods: This study was carried out at Nepal Medical College Teaching Hospital from Jan 2001 to 31st June 2006. All cases of myoma uteri admitted in Gynaecological ward was included.. Histological evidence of myoma confirmed the diagnosis. Age, parity and age of the last child, clinical features, surgical procedures and outcome of surgery were considered. Results: A total of 137 cases of myoma uteri was operated during five and half years period. This represented 38.5 %of all abdominal hysterectomy performed during the same period. The mean age was 43.3 years with median parity at 1-3 and the mean age of last child at 12years. Excessive menstrual bleeding 73.0%, abdominal mass and pain 58.4%, dysmenorrhea 18.2% and infertility 7.3% were the common symptoms. Total abdominal hysterectomy was the mainstay of treatment. Patients were happy with the treatment specially those with severe and multiple symptoms Postoperative complications were not significant. There was one death due to pulmonary embolism who had mesothelioma of pleura diagnosed by pleural biopsy before operation. Conclusion: Early marriage and early completion of the family is the social trend in Nepalese society. Myoma is common in 4th-5th decade of life in multi parity with the age of last child around 12years. This long standing secondary infertility may be an underlying risk factor in the development of myoma uteri. doi:10.3126/njog.v1i2.2397 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 47-50 Nov-Dec 2006

Thirty-one patients with malignant melanoma and 22 patients with other neoplasms were treated with intravenous 5-(3,3-dimethyl-triazeno) imidazole-4-carboxamide (DIC), utilizing 2 different regimens

Summary The previously reported radiological features of asbestosis are reviewed. Attention is drawn to the value of calcified pleural plaques as an additional sign of long-standing asbestosis and two theories regarding the origin of these plaques are mentioned.

Summary There is an entity of solitary benign spindle cell mesothelioma which grows in relation to bronchi within the lung, but is unrelated to the pleura. Its similarity to growths reported as "fibrosarcoma of bronchus" is pointed out. There are morphogenetic sequences in embryonic pulmonary development which could account for a mesothelial tumor arising without pleural contact. A designation of paramesathelioma or stromal mesothelioma is suggested as more appropriate than "fibrous" mesothelioma for those mesothelial tumors which differentiate as spindle cell growths similar to ovarian fibrothecomas or are derived from submesothelial mesenchyme. Doctors Alfred Goldman, Edward Shapiro, Maurice Hyman, and Marvin Harris permitted use of the clinical material.

Eleven cases of diffuse abdominal tumours in association with exposure to asbestos were discovered in the years 1958 to 1963. There were eight men and three women, all of whom had worked at the same factory. In seven of the men the age at death ranged from 38 to 78 years; one man is still alive at the age of 46. The women died at 44, 61, and 67. The survival time after the first exposure varied from 20 to 46 years. The shortest period of exposure was 10 months and the longest 32 years. All three of the main commercial types of asbestos had been involved in their working operations. Histological confirmation of the nature of the tumour has been obtained at necropsy in nine of the 10 deceased and at biopsy in six, including the survivor. A remarkable feature of these cases is the minimal fibrosis found in the lungs. In three men and one woman, asbestosis was not diagnosed during life, and no patient was completely disabled by pulmonary fibrosis.

Of 11,788 persons bom between 1891 and 1920 employed in the Quebec asbestos mining industry, 88.4% were traced. Of these 2,457 (23.6%) had died. Exposure indexes for each worker were calculated from job dust levels and duration of employment. The overall mortality was lower than expected for the population of Quebec but in the highest dust category, comprising 5% of the cohort, the age-standardized rate was 20% higher than in the other groups. Respiratory, cardiovascular, and malignant disease in equal proportions accounted for the excess. There were 101 deaths from respiratory cancer including three from malignant mesothelioma, an estimated excess of about 15 deaths. The difference in rates for respiratory cancer between those maximally and minimally exposed was fivefold and, though perhaps exaggerated, was apparently determined by accumulated dust exposure and duration of employment.

A group of 12 adenomatoid tumors, uncommon lesions involving the female and male genital tracts, is presented. Their origin is still a controversial matter, but it seems likely that they arise from primitive urogenital ridge structures either as hamartomas or true neoplasms. As no cases with definite malignant behavior have been reported, local excision seems indicated for these benign lesions.

A brief resume of the subject of endothelioma of the pleura is presented with the report of a case in which surgical removal was carried out.

A total of 40 cases of multiple pleural plaques is now analysed. The incidence is given of predominantly calcified, and predominantly non-calcified plaques. In addition to the faint shadow sign of the non-calcified plaque, the importance of the profile opacity is stressed. This may be the only sign in some cases. The concept of classical asbestosis is regarded with misgivings, and a re-interpretation is suggested of the ground-glass appearance. The scope and limitations of radiology in lesions due to asbestos inhalation are discussed. Associated neoplasms are illustrated.

DURING the last 100 years many materials have been used by industry for a while and then found to have unexpected harmful effects. Usually the risk ceases when safety measures are adopted but sometimes these measures are found to be inadequate and new ones must be introduced. This has happened recently after the re-investigation of flax byssinosis (Carey, Elwood, McAulay, Merrett and Pemberton, 1965). But with asbestos the situation is not so simple. Following the report in 1930 (Merewether and Price) on the dangers of exposure to asbestos dust safety measures were adopted in factories and certain workers kept under medical surveillance. Since then a series of other risks have been recognised which indicate that the measures were either inadequate or did not cover a sufficiently wide variety of asbestos workers. Both cancer of the lung and mesothelioma are now recognised as resulting from levels of exposure to asbestos which still occur in spite of these measures. The summary of present knowledge about the epidemiology of asbestosis and related diseases which follows is necessarily brief and emphasises those points at which our knowledge is as yet incomplete.

Nine patients from Teesside who had asbestosis are briefly described. In seven of them a needle biopsy was made to confirm the diagnosis. The advantages of the procedure, using the Jack needle (Smith, 1964a), are discussed.

Findings of mesothelioma among individuals living in the vicinity of asbestos plants suggested that asbestos air pollution might occur. Measurement of asbestos (chrysotile) content of ambient air in New York City and other locations showed levels of 10 to 50 × 10-9 gm/cu m, and lungs of New York residents examined at autopsy regularly showed chrysotile fibrils. Occurrence of asbestos air pollution is now established. What have not yet been defined, however, are the dimensions of disease hazard which may be associated. Epidemiological considerations suggest that it is improper to equate the several kinds of asbestos exposure: direct occupational, indirect occupational, exposure in family circumstances, neighborhood contamination, and general community asbestos air pollution. Since most urban air pollution is derived from commercial and industrial sources, the asbestos industry has both important responsibility and opportunity for its control.

IN 1960 Wagner, Sleggs and Marchand1 reported 33 cases of diffuse pleural mesothelioma from the North Western Cape Province of South Africa. The collection of such a large number of cases of a rare tumor within a short time (1956–1960) in one area was considered unusual enough. Even more striking was the fact that close questioning and investigation revealed that 32 patients had evidence, admittedly circumstantial in most cases, of some potential or actual contact with asbestos by virtue either of residence in mining areas or in industry twenty to forty years before. This remarkable concentration of cases in one . . .