Document Gmx4r3wKq3Xe0Qm8kDvk8wnYY

276 Dennoi O'B. Hourihane TABLE ll Histology of Tumour Jtfk l < o ir. ii <C0 1 UJ E 5 Group C 18.334 38 19. 467 41 20.109 45 21. 241.44 22. 7.V48 23. 18151 24. 49'55 25. 116'55 26. 56 58 27. 3 27'60 28. 152 61 29. 291.61 30.295 62 Group D 31. 19 43 32. 140 56 33. 170 53 34. 304'54 6 ) 6 3 12 12 8 12 3 1 -- ___ 4 63 M 45 m : >s ' F ,.(F| : - IK) 42 ; F 0 37 . F 58 : F ' 0 61 F i -M--'IF) 65 F 1 50 m ; i ! -! (F) ' 70 i- ; 49 1 M * I--! -1 (F) ! 53 M ; 1 -1 i (F) , 47 : M . ! -! - 59 , M 1 58 ; F | 5_5 F 52 ; F ! 1 1 0 , '! l1 `i -1- "r -1- - 5 c * Cases include in a previous report (ICcal, 1910); Present series Case 20 (Real's Case 9); Present series Case 24 (Keul's Case 3); Present Series Case 26 (KcaTs Case 24). F=* Fibrosis of lung. 3 } _i Keal's cases had had a necropsy examination, and obvious (Fig. 12). Epithelial type tumours I have classified three of these as peritoneal resembled adenocarcinomata, but the loose V i mesotheliomata. arrangement of the tubules, (he regularity of the Of the 37 peritoneal tumours rejected as meso cells, the absence of epithelial mucin (P.A.S. stain). ;f ; i n) theliomata. 11 had lung tissue available, and in the infrequency of mitoses, and the cytology of none of these were asbestos bodies seen. the cells all suggested the possibility of meso- * IK thelioma. I think it is possible to be reasonably (</ DISCUSSION certain of mesothelioma when only a small piece till. of tissue is available (biopsy). The most difficult t(, (HU The tumours here recorded are in accord with differential diagnosis is inflammatory pleural .1 /(IV aiv those in the literature (Godwin, 1957 ; Winslow thickening, and when small pieces of tissue are all ^ </<r and Taylor. 1960). There were no cases regarded that is'available, then the differential diagnosis * mo. as arising in the pericardium, although this was may be impossible. hvh commonly involved by tumour which also involved the pleura or peritoneum. Histologically, the mixed type, with epithelial and fibromatous elements, was most easily dis Collagenous, acellular areas may be found in each. In the cellular areas, the cells in inflam matory thickening are usually less plump than those in a tumour, but unless invasion of muscle 1 Y i" /allj wit/ xtai tinguished (Campbell, 1950), although occasionally the fibroblasts of young granulation tissue gave rise to difficulty in recognition and might easily be confused with the fibromatous element of a tumour. If the pattern of indistinct fasciculation, the relative paucity of blood vessels, and the cytology of the plump cells with prominent nucleoli were noted, then the difficulty was usually resolved. Foci of inflammatory cells were occa sionally prominent within the tumours, usually or vessels is seen, this can still be a difficult distinction. The epithelial type of reaction in inflammatory lesions is usually restricted closely to the mesothelial surface, but tubules with papillae and folds are occasionally found. Foci of inflammatory cells are prominent in benign (inflammatory) pleural thickening, but are usually restricted to the deeper layers of the pleura. Inflammatory cells in mesothelioma are only a feature when fibrin is present on the sur- ^ < ^ ; | Y' ^ j j thii scri in disl mu cell fou infr V lymphocytes and plasma cells, but diffuse inflam matory infiltrate was not seen. When the fibromatous element abutted upon epithelial areas, the similarity of the cells was face, but in this circumstance the distinction between the two is extremely fine. This differentiation reaches its most difficult point in cases of asbestosis, where fibrous pleural ' sugi 1 turn j rem evid