The etiopathogenesis of multiple neoplasms includes hereditary aspects, the influence of environmental agents, previous therapies and tumor-producing hormones[5-8]. Multiple neoplasms could be defined by when they occur as synchronous and metachronous. The latter is applied for the neoplasms appearing in a single patient with an interval more than 6 months[9].
The co-existence of malignant mesothelioma and pulmonary carcinoma is a rare entity and generally such reports regard single cases and series with a small number of cases in the English literature[10-15]. Moreover, this co-existence has been reported in patients with significant exposure to asbestos. Herein, we report a rare case of metachronous malignant mesothelioma and pulmonary carcinoma with a suspicious history of asbestos exposure.
Multiple neoplasms may occur at any age. However, in the reviewed literature the patients tend to be older than those with a single tumor[4]. The reason for increased incidence of multiple neoplasms by age could be related with long exposure to environmental causative agents and more effective antitumor therapies that also prolong patients' lives and increase the risk of other primary neoplasms. Our patient was also from the older population and treated earlier with an aggressive anticancer medication.
Asbestos exposure is a well-recognized risk in the development of malignant mesothelioma. Epidemiological studies have demonstrated an increased risk of lung cancer by asbestos exposure but still the precise pathogenic mechanisms are unclear. The infrequency of reported co-existence of malignant mesothelioma and lung carcinoma suggests that the pathogenic mechanisms of asbestos-induced tumors could be different. It may also be related with the awareness of concomitant lung carcinoma because of the extensive mesothelioma.
The evidence of asbestos exposure can be determined from the patient history as occupation, macroscopic documentation as pleural plaques, microscopic identification of asbestos bodies in lung tissue and mineral analysis. In our patient, although the history was suspicious for asbestos exposure because of the house that he had been lived in during his childhood, we could not demonstrate any asbestos body by light microscopy in the lung tissue and any pleural plaque in his surgical specimens. It should also be kept in mind that the consensus statement from the International Mesothelioma Interest Group that defined the guidelines for pathologic diagnosis of malignant mesothelioma has pointed out the uselessness of the presence or absence of an asbestos history in making a diagnosis of mesothelioma[17].
In conclusion, a review of the existing data from the literature showed that the development of malignant pleural mesothelioma and lung carcinoma has infrequently been reported and could be associated with asbestos exposure. However, the history of asbestos exposure is not required for the diagnosis. Generally, a patient who developed one malignancy might be at greater risk of developing a second. This might be related with the initiating and promoting factors which probably still exist after occurrence of the first tumor. The influence of effective anticancer therapies which improve the survival rates and population ages could also be related. Further studies are needed to address the potential of cancer patients being at higher risk of multiple primary tumors and to explain the causative agents.
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