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Original Research: Disorders of the Pleura |

Postmortem Findings of Malignant Pleural MesotheliomaPostmortem in Mesothelioma: A Two-Center Study of 318 Patients

Rhian S. Finn, MD; Fraser J. H. Brims, MD; Arjun Gandhi, BSc; Nola Olsen; A. William Musk, MD; Nick A. Maskell, DM; Y. C. Gary Lee, PhD
Author and Funding Information

From the Southmead Hospital (Dr Finn), North Bristol NHS Trust, Bristol, England; the Respiratory Department (Drs Brims, Musk, and Lee and Mr Gandhi), Sir Charles Gairdner Hospital, Perth, WA, Australia; Center for Asthma, Allergy and Respiratory Research (Ms Olsen and Drs Musk and Lee), School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia; the Centre for Respiratory Research (Dr Brims), University College London, London, England; and the Pleural Trials Unit (Dr Maskell), Department of Clinical Sciences, Southmead Hospital, University of Bristol, England.

Correspondence to: Y. C. Gary Lee, PhD, University Department of Medicine, 4/F, G Blk, QE II Medical Centre, Perth, WA, 6009, Australia; e-mail: gary.lee@uwa.edu.au


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.


Chest. 2012;142(5):1267-1273. doi:10.1378/chest.11-3204
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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.


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