Mesotheliomas all: long before their time.

Editorial Mesotheliomas all : long before their time In 1935 in the Ulster Medical Journal, Campbell and Young' reported a cluster of three cases of pleural tumour which they had observed in Belfast within five months. They concluded that each was a primary tumour of the pleura and they entitled their paper: "A Primary Tumour (Mixed-Cell Sarcoma) of the Pleura" The case reports are predominantly pathological, the gross appearance of the tumours and the histology are described and illustrated. In two cases neither sex nor occupation is given, the third case was a woman school teacher. It was possible through the records system of the Department of Pathology of the Royal Victoria Hospital to locate the tissue blocks and cut fresh sections, nearly sixty years later. On review of the histology two of the cases (A1026 and A1014) were typical tubulo-papillary mesotheliomas. In one case (A1026) asbestos bodies are identified in the adjacent lung tissue. In the third case (A 1143) the histological diagnosis was less certain: the tumour was composed of spindle shaped cells which could represent an undifferentiated carcinoma of lung or a spindle cell mesothelioma. So far as one can tell from Campbell and Young's paper, this was probably the case of the school teacher. All cases were scrutinized using a new immunohistochemical marker-HBME-17 which has just been made available. This new marker was positive in all three cases confirming them as mesotheliomas. It is remarkable that antigen preservation is maintained in paraffin blocks over a 60 year span. As early as 1928 Professor Young,2 then working at the Western Infirmary ofGlasgow, had observed three similar cases. Both Doctor Campbell and Professor Young were earnest and distinguished workers, but the clustering does not seem to have suggested to them the possibility of an environmental agent being a factor in the causation of the tumour, even though both Glasgow and Belfast were in those days shipbuilding centres of world importance. Twenty-three years later Doctor W. T. E. McCaughey,3 of the Department of Pathology in the Royal Victoria Hospital, published an account of eleven diffuse and two focal primary tumours of the pleura-another example of a cluster in Belfast. As Professor P. C. Elmes relates in thisjoumal in 1977, the association ofthe pleural tumours with asbestos exposure became clear with the observations of Wagner4 and his associates in South Africa. The work ofElmess and his colleagues was to revolutionise …