The Exfoliative Cytology of Diffuse Maligant Mesothelioma

that is real, for without doubt … The final diagnosis was diffuse malignant peritoneal mesothelioma. The smears were ….

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In six cases of pleural and one of peritoneal mesothelioma it is shown that the abnormal cells of the effusions are of mesothelial type, and are exfoliated tumour cells. These observations afford further proof that diffuse malignant mesothelioma is an entity.
Case 1. A man aged 47 had a pleural effusion which was detected by routine X-ray of the chest. He had no symptoms. Smears of the pleural fluid were reported as negative for tumour cells. At thoracotomy the visceral and parietal pleura was studded with innumerable warty excrescences, diagnosed microscopically as malignant mesothelioma (fig. 1). The patient died 2 yr later; there was no necropsy.
This was the first mesothelioma encountered in the series. Cytologically it was the most differentiated, with the cells in the smears resembling greatly enlarged benign mesothelial cells. It was not until the diagnosis of mesothelioma had been made on the tissue that the possibility was considered that these apparently benign mesothelial cells were, in fact, cancerous.
Case 2. A man aged 65 had a pleural effusion, which was detected by routine X-ray of the chest. He had no symptoms. Smears of the pleural fluid were reported as malignant mesothelioma or extreme mesothelial hyperpksia, probably the former. The needle biopsy specimen of pleura was interpreted as highly suspicious for malignant neoplasm. A year later X-ray examination of the chest revealed numerous bilateral peripheral nodular masses. During the next 3 yr both lung fields became obscured by neoplasm. The patient died 4 yr after the discovery of the pleural effusion; there was no necropsy.
Though no satisfactory tissue specimen was ever obtained, there was no doubt, from the radiological findings and clinical course, that the patient had cancer involving the pleura. Significantly, the pleural fluid had the colour and consistence of honey, qualities that have been described in association with diffuse malignant mesothelioma (Meyer and Chaffee, 1939; Truedsson, 1951-52).

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