The patient was a man aged 73 who had lassitude, breathlessness and pain in the right side of the chest for 6 months. Massive right pleural effusion was found and was repeatedly tapped. For the few weeks before admission over 1000 ccs of yellow fluid were removed each week. Pleural biopsy provided a very small piece of tissue in which atypical cells suspicious of malignancy were seen. Tomograms showed bronchial narrowing on the right side. Bronchoscopy was considered inadvisable. He died after a few weeks in hospital. The notes contain no record of his previous occupational history.
The specimen consists of the right lung and respiratory passages sectioned to show a thick pale neoplastic layer coating almost the entire visceral pleura. It attains its greatest depth of about 1 cm over the inferior surface of the lower lobe. Tumour extends in continuity to involve lymph nodes lying beneath the bifurcation of the trachea and against the lateral aspect of the right main bronchus. Histology shows a mesothelioma composed of cells of varying shape from rounded forms to spindle cells, lying singly and in small strands in a dense fibrous and myxomatous stroma.