Document gDZvZVrwaZZJQzpge76rLXJ33

100 Morris Greenberg and T. A. Lloyd Davies TABLE 9(b) Geographical Distribution of Mesotheliomas associated with Occupational Asbestos Exposure and the Proportion of Thesb Cases to all Cases of Mesothelioma SqtM1 Greater London ............................................................ Rest of SB England .. ..................................... SE Lancashire conurbation.......................... .. .. Merseyside conurbation Rest of NW England....................................................................... Tyneside ......................... . ..................................... Rest of N England....................................................................... W Yorkshire conurbation .. .. .................................... Rest of Yorks A. Humberside .. .......................... N Wales.............................................................................................. SE Wales ................................................................................... E Anglia ................................................................................... Clydeside* .. Rest of Scotland .. ..................................... .............. ....................................................................... SW England .. ....................................................................... E Midlands................................................ .................................. W Midlands conurbation Rest of W Midlands .. .. ......................... England, Wales A Scotland............................................................ Mesotheliomas with definite occupational atbtslot , fjrposure Ho. Percentage of all mesotheliomas 29 so 12 47 1) 'll 22 It 8 too 0 19 6 47 II 92 2. 87 1 31 6 40 ---- 22 T9 3 50 II 12 1 33 4 47 i 17 147 41 'StaniSsrd regions of Regisirar General England & Wales, except Clydeside Dunbartonshire, Renfrewshire, Greenock. Glasgow, Hamilton, Motherwell carcinoma, can produce widespread sheet-like growth resembling late diffuse pleural mesothelioma. Histologically the cellular and intercellular charac teristics can be highly equivocal. The UICC patholo gists' panel criteria tor reaching a decision were modified in the course of the survey (see Appendix) and have not finally been decided (McCaughey and Oldham, 1974). Willis (1952) cautioned against accepting the diagnosis of mesothelioma until, by careful search, ah alternative primary neoplasm had been excluded. In a series of 3 771 necropsies Cameron, Litton, and Lyon (1961) found a prevalence ofprimary carcinoma multiplex of la2%. In the present series there were three with additional primary neoplasms in the 246 `definite' cases (one with carcinoma of the stomach, another with carcinoma of the bronchus, and the third with myelogenous leukaemia). This represents a prevalence of carcinoma multiplex of 1*2%. Sections referred to the UICC pathologists had previously been studied by other pathologists who bad not necessarily made a diagnosis of mesothe lioma. In 182 cases where adequate histological material h8d been studied by UICC pathologists they made a diagnosis ofmesothelioma in 134 (74%), were undecided In 10%, and made an alternative diagnosis on 30 occasions (16 %).Theconcordance of diagnosis between UICC and other pathologists it greater in view of the fact that a number of sections were referred to the UICC panelists for a second opinion when the other pathologist! had said the condition was not mesothelioma but an asbestos occupation history had been obtained by the clinicians. In those cases with adequate histological material, not referred to the UICC panel' (186 cases), a pathological diagnosis of definite mesothelioma was made in 112 (60%). The submission of sections to the UICC panel varied in different parts of the country. In Greater London 77 out of III cases were referred (69%), compared with only 12 out of 61 cases in Scotland (20%). The number of cases diagnosed is unlikely to be