title: Clinicopathologic characteristics of malignant mesotheliomas arising in patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma.
abstract: OBJECTIVE
  Studies have reported an association between pleural diffuse malignant mesothelioma (PDMM) and chest radiation for lymphoma. The clinicopathologic characteristics of malignant mesotheliomas arising in these patients have not been established.
  
  
  METHODS
  We studied 1,618 consecutive patients diagnosed with pleural PDMM from July 1993 to February 2008 and identified patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma. We evaluated the histology in the surgical resection specimens and compared clinicopathologic features with overall survival.
  
  
  RESULTS
  We identified 22 patients who developed PDMM after chest radiation as part of their treatment for lymphoma (mean latency time, 21.4 years; 95% CI, 17.0 to 25.8 years). Asbestos bodies in lymphoma-associated PDMM were lower than in asbestos-associated PDMM (median count, 15 v 325 bodies, respectively; P < .001) and similar to an unexposed control group (median count, 15 v 10 bodies, respectively; P = .6). Seventeen lymphoma-associated PDMMs (77%) were epithelioid and five (23%) were biphasic. Seven PDMMs (32%) had unusual histologies (pleomorphic, myxoid, clear cell, and signet ring cell). Patients with lymphoma-associated PDMM were younger than patients with asbestos-associated PDMM (median age, 45 v 64 years, respectively; P < .001) and had a significantly longer overall survival time (median, 32.5 v 12.7 months, respectively; P = .018). In multivariate analysis, independent favorable predictors for overall survival were history of prior radiation (P = .022), female sex (P < .001), age ≤ 65 years (P = .005), cytoreductive surgery (P < .001), and epithelioid histology (P < .001).
  
  
  CONCLUSIONS
  Patients with lymphoma-associated PDMM are likely to have unusual histologic features, are significantly younger, and seem to have a longer overall survival compared with patients with asbestos-associated PDMM.
authors.affiliation: Lucian R. Chirieac, Justine A. Barletta, William G. Richards, Tamara Tilleman, Raphael Bueno, Elizabeth H. Baldini, John Godleski, and David J. Sugarbaker, Brigham and Women's Hospital; Beow Y. Yeap, Massachusetts General Hospital; and William G. Richards, Tamara Tilleman, Raphael Bueno, Elizabeth H. Baldini, and David J. Sugarbaker, Harvard Medical School, Boston, MA.
authors.forename: Lucian R
authors.initials: LR
authors.lastname: Chirieac
authors.forename: Justine A
authors.initials: JA
authors.lastname: Barletta
authors.forename: Beow Y
authors.initials: BY
authors.lastname: Yeap
authors.forename: William G
authors.initials: WG
authors.lastname: Richards
authors.forename: Tamara
authors.initials: T
authors.lastname: Tilleman
authors.forename: Raphael
authors.initials: R
authors.lastname: Bueno
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Baldini
authors.forename: John
authors.initials: J
authors.lastname: Godleski
authors.forename: David J
authors.initials: DJ
authors.lastname: Sugarbaker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001194:Asbestos / Q000633:toxicity*; D002273:Carcinogens / Q000633:toxicity*; D005260:Female; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000139:chemically induced / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000532:radiotherapy*; D008297:Male; D008654:Mesothelioma / Q000139:chemically induced / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000139:chemically induced / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors
chemical_list: D002273:Carcinogens; D001194:Asbestos