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What is involved? (including coding of cases) SABRE Case Studies and Information
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Case Study: Malignant
mesothelioma of the pleura
A
56 year old engineer developed sudden breathlessness on walking from the car
park to his office. He again noticed this while at the opera that evening, and
subsequently went to visit his GP, who diagnosed a pleural effusion. He was
admitted to a private hospital, where a chest drain was inserted and 5 litres of
blood stained fluid drained. The fluid recurred and he eventually underwent
thoracoscopy, pleural biopsy and talc pleurodesis. A diagnosis of epithelial
type malignant mesothelioma was made. He had never worked directly with
asbestos, but had trained as a Civil Engineer some 40 years before and then had
worked as a trainee divisional engineer at railway yards, inspecting the tracks
and performing other survey work. He recalled asbestos troughing being present
but could not remember this being worked upon while he was present. His only
other asbestos exposure was as a site manager supervising construction over 4
years in the 1970s. Several of the projects he had supervised had involved
demolition of old buildings. He had only smoked socially over a period of about
2 years some 40 years before. Malignant
mesothelioma of the pleura may occur after low levels of asbestos exposure,
especially after exposure to amphiboles (e.g. crocidolite and amosite). These
were widely used in NSW until the early 1980s. Such exposures are easily
forgotten, especially as the latency period for development of the disease is
characteristically 20-40 years. Malignant mesothelioma has been reported in the
wives of asbestos workers whose only exposure was washing their husbands’
clothes. There are 3 main subtypes:
epithelial, sarcomatous and mixed, and the median survival is approximately 10
months. Sarcomatous type has a significantly worse prognosis. There is no
relationship with tobacco smoking. The number of cases of malignant mesothelioma
is increasing in NSW, with over 160 per year being reported to the Cancer
Council. The number is predicted to increase further into the 21st
century, possibly peaking in the 2020s. No treatment has been shown to be
effective, although there are several trials running. These usually use
combination therapy of cisplatin and another agent such as mitomycin. New drugs
recently reported to have possible efficacy include pemetrexed and vinorelbine.
In this case, the man sadly died some 7 months after diagnosis. |