Asbestos exposure in malignant mesothelioma of the pleura: a survey of 557 cases

A series of 557 malignant mesotheliomas of the pleura diagnosed in the Trieste-Monfalcone area, Italy, in the period 1968-2000 were reviewed. The series included 492 men and 65 women, aged between 32 and 93 years (median age 69 years). Necropsy findings were available in 456 cases (82%). Occupational histories were obtained from the patients themselves or from their relatives by personal or telephone interviews. Routine lung sections were examined for asbestos bodies in 442 cases. In 109 cases isolation and counting of asbestos bodies were performed. A majority of people had histories of working in the shipyards. Asbestos bodies were observed in lung sections in 67% of the cases. Lung asbestos body burdens after isolation ranged between 20 bodies and about 10 millions of bodies/g dried tissue. Latency periods (time intervals between first exposure to asbestos and death) ranged between 14 and 75 years (mean 48.8 years, median 51.0). Latency periods among insulators and dock workers were shorter than among the other categories. High asbestos consumption occurred in many countries in the 1960s and in the 1970s. The data on latency periods obtained in the present study suggest that a world mesothelioma epidemic has to be expected in the coming decades.

Atherosclerosis and pancreatic damage

The appearance of diabetes in advanced age may be considered as a part of the involutive processes of aging, and as such, it might have a pathogenesis completely different from that of type 2 diabetes of medium age. As a matter of fact, it has been observed that the pancreas undergoes numerous structural and functional alterations with advancing age, both in exocrine and endocrine parts. The present studies have been performed to reveal the quantity and quality of the pancreatic lesions, which may be attributed to atherosclerosis. We have already studied elderly subjects, therefore, we were now looking for further supports in a population of middle age people, died in complications of malignant hypertension. We investigated the pancreas, kidney and heart of 36 subjects (20 males and 16 females) with mean age of 48.6+/-8.9 years. Of this group, eight subjects (22.2%) became diabetic after the appearance of malignant hypertension. Arteriolar atherosclerosis damage (hyalinosis, thickening and stenosis) of the pancreatic arterioles were found in 92.8% of the non-diabetic, and in 87.5% of the diabetic subjects. Lesions of the pancreatic islets were observed in 32% of the non-diabetics, and in 50% of the diabetic subjects. The pancreas is an organ, which tends particularly to develop atherosclerotic damage. The vascular lesion of atherosclerotic origin, independently from the mechanism of its appearance, causes first only a decrease of the blood flux and hypoxia in the pancreatic islets with a consecutive functional decline of the beta-cells. This is then followed by structural modifications of the islets accompanied by the appearance of hyalinosis, loss of beta-cells, and a further decrease of insulin production.

[On the transition of the cadaver from the "opposite" to the "helper" of life]

Death and corpse were incompatible with god's and family doctor's presence in the Greek-Roman world. This incompatibility between life and the death was surmounted by the admittance of Saints' bodies in the Churches and believers' burial "ad Sanctos". From this, to body's utilization as discloser of the "causae morborum" the way was relatively short, culminating in the stage marked by Morgagni's name.

Malignant mesothelioma of the pleura in the Trieste-Monfalcone area, with particular regard to shipyard workers

A series of 421 malignant pleural mesotheliomas, diagnosed in the Trieste-Monfalcone area, northeastern Italy, were reviewed. A large majority of the patients had been employed in "naval" work (shipbuilding, maritime trades, and dock work). Latency periods (time intervals between first exposure to asbestos and death), showed wide variations from one occupational category to another. Such variations were attributable, but only partly, to differences in the intensity of the exposure to asbestos. Various family cases were identified, including people with and without blood relationships. The data, obtained in the studies on Trieste-Monfalcone mesothelioma, suggest that interactions between asbestos and other factors play a considerable role in the pathogenesis of asbestos-related mesothelioma.

Latency periods in asbestos-related mesothelioma of the pleura

Latency periods (time intervals elapsing between first exposure to asbestos and death) were examined in 421 cases of malignant pleural mesothelioma, diagnosed in the Trieste-Monfalcone area, Italy. Occupational data were collected from the patients or from their relatives by personal or telephone interviews. Routine lung sections were examined for asbestos bodies in 370 cases. Latency periods, calculated in 312 cases, ranged from 14 to 72 years (mean 48.7, median 51). Latency periods differed significantly from one occupational group to another. Mean latency periods were 29.6 among insulators, 35.4 among dock workers, 43.7 in a heterogeneous group defined as various, 46.4 in non-shipbuilding industry workers, 49.4 in shipyard workers, 51.7 among women with a history of domestic exposure to asbestos, and 56.2 in people employed in maritime trades. The ANOVA test indicated a correlation between latency periods and occupational groups. Latency periods in people with asbestos bodies visible in routine lung sections did not differ from those seen in cases with no evidence of asbestos bodies. These data suggest that intensity of exposure is a relevant, but not the only, factor in determining the duration of latency periods.

Cancer of the oldest old. What we have learned from autopsy studies

Cancer in the oldest old is a novel problem, due to the recent burgeoning of the population aged 85 and older. This article addresses three critical questions related to cancer in the oldest old: Does the incidence of cancer increase after age 95? Is cancer a common cause of death for the oldest old? Is cancer accurately diagnosed in the oldest old? The authors analyzed a group of 507 autopsies of elderly, divided in three age groups, 75 90 years, 95 99, and over 99 (centenarians). The prevalence of cancer was 35% among the younger persons and 20% and 16% respectively for those aged 95 99 and for the centenarians. A fourth of the patients in the younger group died from cancer but only 9.5% of the people between 95 and 98 years and 7.1% of the centenarians died from cancer. The cancer was the direct cause of death for 67% of the younger persons and 41% of patients belonging to the two oldest groups. The prevalence of metastases was 63% for tumors occurring in persons aged 75 90, 32% in persons aged 95 98, and 29% in the centenarians. Cancer had been accurately diagnosed prior to death in 67.4% of persons aged 75 90, in 38.5% of those aged 95 99, and 29.4% of the centenarian. Cancer as cause of death had been underestimated in 16% of the cases in the younger persons and in almost 50% of cases of the oldest old. This study suggests that the incidence of cancer and the importance of cancer as a cause of death may decline after age 95 and that the clinical diagnoses underestimate significantly both the incidence of cancer and the prevalence of cancer deaths in the oldest old.

Malignant tumors at very old ages

Unselected autopsy findings of nonagerians reviewed by the authors in the last 20 years, confirm a decline in malignant tumors at very old ages. Two main factors are thought to be responsible for this evidence: a less aggressive biological behavior of cancer in the oldest old; the crucial role played by comorbidity as the cause of death.

[Lung cancer in the province of Trieste]

In our study we analyzed a file of 756 males with lung cancer and an equal number of controls matched by sex, age and year of death. All the subjects were resident in the Trieste area, died between 1979-81 and 1985-86 and underwent autopsy at the Istitute of Pathological Anatomy of the University of Trieste. The aim of the research was to analyze and quantify the risk to develop lung cancer in those exposed to asbestos, and well-recognized carcinogens (list A of I.A.R.C.) or suspected (list B). We have also analyzed the relative risk (R.R.) for lung cancer among those subjects with environmental exposure to air pollution in industrial and urban areas. The study was set up in the Trieste province, a geographic area which is particularly suitable for epidemiological studies. We have demonstrated on excess of risk for males exposed to asbestos (R.R. = 1.99) and to other well known carcinogens (R.R. = 2.28). The capability in differentiating the relative risk of smoking and professional exposure to oncogenetic substances allowed us to detect an excess of risk for people living in industrial and urban areas, when compared to those living in rural and peripheral areas.

Kaposi's sarcoma in Italy before and after the AIDS epidemic

The incidence of Kaposi's sarcoma (KS) in 1976-90 was assessed in Italy, taking advantage of a network of nine population-based cancer registries covering, at its maximum, approximately 5.6 million subjects. The first examined period (1976-84) substantially reflects the epidemiology of KS prior to the AIDS epidemic in the registration areas. Elevated incidence rates, standardised to the Italian population of 1981, of 1.05/100,000 men and 0.27/100,000 women emerged in 1976-84 (i.e. from two- to threefold higher than in the USA and Sweden, more than tenfold higher than in England and Wales). These high rates, especially remarkable in the Registry from the south of Italy (i.e. Ragusa, 3.01/100,000 men and 0.54/100,000 women) suggest that the prevalence of the still unknown causative agent for KS was high, at least in some parts of Italy, prior to the AIDS epidemic. In the most recent period (1985-90), an approximately twofold increase in KS incidence rates in Italian men below age 50 was observed (from 0.15 in 1976-84 to 0.47 in 1985-90). Conversely, declines in KS incidence were recorded in older men.

Association of breast cancer and meningioma. Report of 12 new cases and review of the literature

We report 12 new cases of female breast cancer associated with intracranial meningiomas, inclusive of autopsy study. At the time of death the patients' age ranged from 52 to 95 years (average 70.6 years). Breast carcinomas were documented ante mortem in 11 cases and at autopsy in 1. Meningiomas were diagnosed at autopsy (10 cases) or in vivo (2 cases). The diagnosis of meningioma antedated that of mammary carcinoma in only one patient. Histologically, the cancers were of ductal (11 cases) and lobular infiltrating (1 case) types and showed a variable malignancy grade. Widespread extracranial metastases were present at autopsy in 7 cases. Brain metastases were seen in 1 case. Neurologic signs were referred in 4 subjects. Four breast cancers and one meningioma showed immunoreactivity for progesterone receptors, whereas all the cases were negative for estrogen receptors. In one case, metastatic breast carcinoma tissue was present within a psammomatous meningioma. A brief review of the literature, which includes 14 similar observations, is reported. Although the association of breast cancer and meningioma is still difficult to explain, its clinical implications are important and deserve proper attention. A proper work up in patients with suspected intracranial metastases is recommended so that resectable meningiomas are not mistaken for metastases.

Cytopathology of malignant mesothelioma: a study of its patterns and histological bases

We have reviewed the effusion cytology of 51 cases of histologically proven malignant mesothelioma of the pleura (49 cases) and the peritoneum (2 cases). The patient group included 45 males and 6 females, aged 45-83 yr. A cytological diagnosis of malignancy had been rendered on 43 cases, and in 30 of them it was consistent with, or at least suggestive of, a mesothelioma. Diagnostic clues, especially evident in epithelial and biphasic tumors were hypercellularity and/or morular aggregates of malignant cells showing scalloped borders and nuclei with dense chromatin and evident nucleoli. Cytomegaly with multinucleation was also frequently observed. Reactive mesothelial cells were often present along with other non specific features such as red blood cells, fibrin, necrotic debris. In 13 cases, a diagnosis of malignancy was entertained but mesothelioma, although considered, was not reported out because of scantiness of material. In four cases, adenocarcinoma was erroneously diagnosed for the presence of deceptive cell vacuoles. In eight cases, no diagnostic cells were recovered in repeated effusions. The first diagnosis was a cytologic one in 37 patients, Tissue study was performed on autopsy (35 patients) and surgical material. The latter was the only source of histology in six cases. Immunocytochemical investigation was negative for carcinoembryonic antigen in all but one tested cases (1/21) and positive for human milk fat globulin in about one-half of the epithelial and biphasic tumors. In 18 of 21 cases, positivity for combined high- and low-molecular-weight keratins was detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant mesothelioma of the pleura in Trieste, Italy

One hundred and seventy malignant pleural mesotheliomas seen at necropsy at the Institute of Pathological Anatomy of the Trieste University during the period 1968-1987 were reviewed. The series included 153 men and 17 women, aged between 33 and 92 years (median 70 years). Lifetime work histories were obtained from the patients' relatives by personal or telephone interviews in 162 cases. A majority of the male subjects had been employed in "naval" work, 99 people having worked in the ship-building industry, 19 in the navy and merchant marine, and 7 in docks. A variety of trades appeared in the remaining histories. Work histories were indicative of occupational exposure to asbestos in 150 cases. A further 5 patients with negative or insufficient data showed asbestos bodies in routine lung sections and 5 women had a history of domestic exposure. A majority of the patients had had their first exposure before 1950. The intervals between first exposure and death ranged from 14 to 71 years (median 48 years).

Intracranial metastases from malignant pleural mesothelioma. Report of three autopsy cases and review of the literature

We report three cases of brain metastases from malignant pleural mesothelioma that were seen at autopsy. We present a summarized review of 15 similar reports that were previously published. Our study included three aged male patients with a long occupational history of heavy asbestos exposure. In two patients, the metastases were discovered incidentally at autopsy, and there were no neurologic symptoms referred to before death. In the other patient, who had clinically occult mesothelioma, the intracranial tumor was discovered ante mortem: in this patient, the clinical features, as well as a computed tomographic scan, suggested a primary tumor of the brain. Interestingly, the histologic features of the latter case that were seen at autopsy depicted a spindle cell tumor that focally exhibited pseudopalisading, necrosis, vascular buds, which deceptively recalled a glioblastoma. All the three cases shared a basic sarcomatous pattern of malignant pleural mesothelioma in both primary and metastatic tumors. The immunohistochemical profile was consistent with such interpretation. It was concluded that metastases to the brain from malignant pleural mesothelioma, although rare, are not exceptional even if their clinical relevance is not prominent. They are seen concomitantly with high-grade tumors, and by mimicking a primary tumor on a clinical, instrumental, and histologic ground, they may occasionally represent a potential source of diagnostic pitfall.

Primary liver cancer in non-cirrhotic liver. Epidemiological study based on autopsies performed in Trieste, Italy and Kurume, Japan

This study, aimed at elucidating the epidemiological features of primary liver carcinoma developing in non-cirrhotic livers, was based on 25,103 autopsies performed between 1975 and 1984 in Trieste, Italy. These autopsies correspond to approximately 70% of all deaths that occurred in this area. Various factors allegedly related to carcinomas were analysed in reference to our previous study on cirrhotic livers and in comparison with 5,603 autopsies in Kurume, Japan. There were 28 cases of hepatocellular carcinoma (HCC), 16 of cholangiocellular carcinoma (CCC) not associated with cirrhosis in Trieste, and 48 HCC and 19 CCC in Kurume. On the basis of our findings, it was concluded that cirrhosis, regardless of its cause, is the main pathogenetic factor in HCC; it is responsible for a much higher frequency (14.2:1) than in non-cirrhotic livers, as well as for early occurrence of tumours (an average of 6 years earlier in cirrhotic liver) in Trieste. Patients in Trieste were older than those in Japan, and the frequency of HCC among all autopsies was much greater in the latter. By contrast, the influence of cirrhosis on cholangiocellular carcinoma (CCC) was negligible, as such association appeared purely coincidental or absent. The incidence of CCC among autopsies was greater in Japan. Our data on CCC were not sufficient to demonstrate any clear aetiopathogenetic association between this tumour and alcohol abuse and hepatitis B virus (HBV) infection, except for a possible aetiological role of gallstones. The frequency of CCC relative to HCC was greater in Trieste than in Japan; the incidence of HCC was much less in Trieste, whereas CCC was more frequent in Japan.

Metastatic tumors to the female breast. An autopsy study of 12 cases

Twelve cases of metastatic tumors to the female breast are reported. Ten of them were incidentally discovered at autopsy; two cases were diagnosed ante mortem but one was misinterpreted as primary. The patients' mean age was 58 years. The metastasizing tumors included cutaneous malignant melanoma (four cases); ovarian, renal and gastric adenocarcinoma (two cases each); and individual cases of pulmonary and pancreatic carcinoma. The patients with melanoma were younger than the others (49.7 vs. 62.7 years). The results of the present study indicate that breast metastases, although rare, are not exceptional especially in large autopsy series. Their recognition in surgical material would result in more adequate treatment against the primary tumor, thereby avoiding unnecessary radical surgery to the breast.

[Ovarian metastases of extragenital tumors. Anatomo-pathological contribution to their interpretation]

Ovarian metastases from extragenital malignant tumours. An anatomohistopathologic approach. 102 cases of ovarian metastases from extragenital malignant non hematopoietic primaries have been studied in the Institute of Anatomy and Histopathology of the Trieste University. Breast cancers, followed by colonic, gastric and pancreatic tumours are the most frequent spreading primaries to the ovaries. Generally speaking the ovarian metastases seems to be closely related to the lower age at the tumour onset and to the width of metastatic spreading; this is true mainly for breast and colorectal cancer. These features should suggest that tumour aggressiveness, rather than some tropism of malignant cells, could play the most important role in the metastatic involvement of ovaries. A double behaviour should be instead suggested for gastric cancer: the first one is consistent with those previously described for the other tumours, the second one is related to a less aggressive gastric cancer, arising in the elderly (mean age 73 years old) with isolated involvement of the ovary showing the features of Krukenberg tumours.

Prevalence of hepatocellular carcinoma and relation to cirrhosis: comparison of two different cities of the world--Trieste, Italy, and Chiba, Japan

A comparative, descriptive study on the prevalence of hepatocellular carcinoma either associated or not with cirrhosis was undertaken between the cities of Trieste, Italy, and Chiba, Japan. Data were derived from 12,340 and 2,052 autopsies consecutively performed in Trieste and Chiba during 1980 to 1984 and 1975 to 1985, respectively. During these years, more than 70% of all deaths were studied by autopsy in Trieste. Clinical cases of hepatocellular carcinoma admitted to the Chiba University Hospital were also analyzed to correct for the bias induced by the relatively small number of autopsies in Chiba. Serum hepatitis B surface antigen was more frequent in Chiba, whereas alcohol intake was greater in Trieste. From the comparison of the data, we conclude: (i) hepatocellular carcinoma was associated with cirrhosis in the large majority of the cases both in Trieste (87%) and Chiba (81%); (ii) in both sexes, the average age of hepatocellular carcinoma patients was significantly older (p less than 0.005) in Trieste than in Chiba; (iii) in the autopsy series, cirrhosis was more frequent in Trieste (9.7%) than in Chiba (1.5%); (iv) in Chiba, hepatocellular carcinoma was more frequent than cirrhosis not complicated by hepatocellular carcinoma (6.9 vs. 1.5%) at necroscopy, and (v) the age-standardized rate of hepatocellular carcinoma was significantly (p less than 0.01) higher in Trieste than in Chiba. These geographical differences might be related to the different type of cirrhosis observed in Trieste (alcoholic) and Chiba (postnecrotic).

[Primary adenocarcinoma of the bladder]

A clinicohistopathological study of 12 cases of primary adenocarcinoma of the bladder diagnosed over an 11 year period is presented. Six of these were pure adenocarcinomas, while the remainder consisted of 2 adenocarcinoma with transitional malignant elements, 2 adenosquamous carcinomas and 2 mesonephric adenocarcinomas. The biological behaviour of these neoplasms was particularly aggressive: in none of the cases was the neoplasm limited to the bladder epithelium, but was generally seen to have infiltrated the muscular wall. Leaving aside the specific treatment carried out, the prognosis was in all patients poor and a complete clinical recovery was achieved for just 2 subjects. Except for one case, death was always directly attributable to bladder cancer, but as a result of obstructive and inflammatory diseases relating to the size and the degree of local infiltration of the tumor rather than metastatic spread.

[Pure squamous cell carcinoma and mixed transitional and squamous carcinoma of the bladder. A clinico-histopathological comparative study]

The histopathological features and clinical courses of 32 patients with pure squamous cell carcinomas of urinary bladder and 42 mixed squamous and transitional carcinomas were compared. The natural history of 2 patients populations was based on the staging of specimens on which first histological diagnosis was made and on the specific treatments adopted. No significant differences in behaviour between two histological types were observed, even though median survival of pure squamous forms was lower than that of mixed forms. Only radical treatments seemed to offer a better prognosis for mixed transitional and squamous forms with pT2 stage, whereas none of the patients with squamous carcinomas survived for two years regardless of stage and treatment performed. A common origin between the two histological types of tumour is supposed.

Atherosclerosis and aging. A morphometric study on arterial lesions of elderly and very elderly necropsy subjects

A histomorphometric study was performed on arterial wall lesions of different arterial regions (arch, thoracic, abdominal parts of the aorta; right and left common and internal carotid arteries; coronary arteries; and basilar and middle cerebral arteries), collected from 108 elderly and very elderly (greater than 90 years of age) subjects who underwent necropsy. Lumen stenosis percentage, mean intimal thickening, and mean thickness of the media were measured by means of a computerized system using a manual input and graphic printout; statistical tests were performed using variance and regression analysis. Results showed that the arterial wall lesions in patients over 60 years of age tend to be stabilized in all regions studied except for the cerebral region, where the lesions tend to have a continuous progression related to age, even in a group of subjects over 90 years of age.

Intratracheal thyroid

A case of intratracheal ectopic thyroid tissue in the absence of clinical symptoms is described. It was an incidental finding observed at autopsy.

[Posterior uveitis in systemic diseases. A pathologic and epidemiologic study]

In the course of 2943 autopsies, during which the eyes were also removed, investigations were carried out concerning inflammatory lesions of the posterior uveal tract. Posterior uveitis was found in 202 cases (6.9%) of subjects whose mean age was 74.5 years. In 98% of the cases this was a non-granulomatous inflammation. The frequency of the associated systemic diseases in the cases of uveitis was compared with the frequency of such diseases in an accurately chosen control group. The results of our investigation showed that diabetes mellitus and inflammatory diseases, particularly rheumatoid arthritis, myocarditis, endocarditis and hepatitis are more frequently found in patients with uveitis.

Early (stage A) prostatic cancer. V. Stereotopography

In 67 prostates, collected at autopsy, besides length, the following measures were taken or calculated (Leitz, ASM): width, thickness (antero-posterior axis) and correlative half-diameters, mean area and ratio area/perimeter. When prostatic microcarcinoma was present, the angle to the antero-posterior axis and the mean percent distance from the urethral barycentre were calculated; over 74% of all cancer foci were in the lateral sextants between iso-distances 50-90.