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Pleural mesothelioma in a non-shipyard electrician.

Case report A 38 year old white man was admitted to another hospital with left sided pleuritic chest pain with effusion (January 1974). Two previous episodes of pleurisy with effusion had occurred in March 1972 and November 1973, both of which cleared spontan eously. Both episodes were of unknown aetiology. The patient denied any weight loss, chills, fevers, cough, haemoptysis, or abdominal or joint pain associated with the effusion. His medical history included pneumonia at ages 10 and 18 and ana phylaxis after an intravenous pyelogram in 1974. Results of sputum and skin tests for tuberculosis were negative. A 45 pack-year smoking history was noted. In April 1974 a thoracotomy was performed during which dense broad adhesions were found in the pleural space. Nodules were removed from the diaphragm, left lung, and pleura, and pathological analysis showed". . . papillary masses of mesothelial cells . . . infiltrating skeletal muscle." The tumour was tested with thio-tepa and BCG. Interestingly, the patient was essentially asymptomatic until June 1982 when pleuritic chest pain recurred with weakness and weight loss. Needle aspiration of the pleural space "produced malignant cells consistent with mesothelioma." He was given radiotherapy and adriamycin. He did well until August 1983 when he was readmitted to hospital with increased left chest pain and malaise. Pronounced progression of the mesothelioma in the left lung was noted. The right lung was clear.