title: Diffuse malignant mesothelioma and synchronous lung cancer: A clinicopathological study of 18 cases.
abstract: OBJECTIVE
  To examine the clinicopathologic characteristics of individuals with diffuse malignant mesothelioma (DMM) occurring concurrently with lung cancer (LC).
  
  
  METHODS
  A database of approximately 3800 patients with DMM was reviewed, from which 18 patients (0.5%) who had synchronous LC were identified. The clinicopathologic features, as well as the occupational exposure history and fiber burden analysis data were examined.
  
  
  RESULTS
  The patient median age was 68 years (range 58-84 years). Of the 18 patients (14 male, 4 female), 11 (61%) had epithelial, 5 (28%) had biphasic, and 2 (11%) had sarcomatoid DMM, with the majority (16 cases; 89%) originating in the pleura and only 2 were peritoneal. Among the histologic types of LC, adenocarcinoma was most frequent (12 cases; 67%), while 5 cases of squamous cell carcinoma, and 1 case of small cell carcinoma were observed. Three patients also had a history of prior malignancy (1 with testicular seminoma and bladder carcinoma and 2 with prostate carcinoma). Fifteen patients had a positive smoking history. All but 3 had documented asbestos exposure. Three had histologic features of asbestosis. Mineral analysis performed in 8 showed an elevated asbestos fiber burden in 4 (22%). Amosite was detected in 4 patients, crocidolite in 3, and non-commercial amphiboles in 5.
  
  
  CONCLUSIONS
  The finding of simultaneous carcinoma of the lung and DMM is distinctly unusual. The majority of patients are male smokers with pleural epithelial DMM and lung adenocarcinoma. This study represents the largest cohort of patients reported to date with synchronous malignant mesothelioma and lung cancer, and we propose guidelines for making a diagnosis of synchronous malignant mesothelioma and primary lung cancer.
authors.affiliation: Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710, United States. Electronic address: kelly.butnor@uvmhealth.org.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Butnor
authors.affiliation: Department of Pathology, Bon Secours Hospital, Greenville, SC 29414, United States. Electronic address: noel_brownlee@bshsi.org.
authors.forename: Noel A
authors.initials: NA
authors.lastname: Brownlee
authors.affiliation: Department of Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia. Electronic address: Annabelle.mahar@sswahs.nsw.gov.au.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Mahar
authors.affiliation: Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710, United States. Electronic address: elizabeth.pavlisko@duke.edu.
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Pavlisko
authors.affiliation: Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710, United States. Electronic address: sporn001@mc.duke.edu.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Sporn
authors.affiliation: Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710, United States. Electronic address: roggl002@mc.duke.edu.
authors.forename: Victor L
authors.initials: VL
authors.lastname: Roggli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001194:Asbestos / Q000009:adverse effects; D015415:Biomarkers; D001706:Biopsy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects
chemical_list: D015415:Biomarkers; D001194:Asbestos
keywords: Asbestos; Cancer; Lung carcinoma; Mesothelioma; Synchronous