Post Mortem Findings of Malignant Pleural Mesothelioma: A Two-Centre Study of 318 patients

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Post Mortem Findings of Malignant Pleural Mesothelioma: A Two-Centre Study of 318 patients


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.

Aim: This two-centre study describes the anatomical features of patients with MPM at post-mortem.

Methods: The Mesothelioma Registry of Western Australia (WA) and the Avon region (UK) Coroner’s reports were interrogated for the post-mortem records of confirmed mesothelioma cases.

Results: Post-mortem records of 318 pleural mesothelioma patients (169 from WA and 149 from Avon) were identified. Most (91.5%) patients were male (mean age 68.4±11.5) 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 extra-thoracic 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 (PE) were found in 6% of cases and considered as directly contributing to death in 13 (4.1%) patients. The precise cause of death could only be determined in 63 (19.8%) cases even after post-mortem. The body mass index was significantly lower in cases which had no identifiable anatomical cause of death at post-mortem (18.8±4.3 vs. 21.0±4.7, p=0.034).

Conclusion: In this largest post-mortem series on MPM, extra-thoracic dissemination of mesothelioma was common and often under-recognized. No anatomical cause of death was identified in the majority of patients even at autopsy, raising the possibility of physiological and metabolic causes of death.

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