Malignant mesothelioma: experience at the Singapore General Hospital

Malignant mesothelioma is a rare occupational disease in Singapore. There have been few reports of this condition in Singapore. We aim to describe the clinical characteristics, management and outcomes in a case series of 16 patients diagnosed in a teaching hospital in Singapore.

A chart review of all cases of malignant mesothelioma diagnosed in our institution during the period 1996 to 2001 was conducted, with particular attention to the occupational history.

There were 16 patients (15 male patients) with a median age of 61.5 (range, 46 to 78) years. Thirteen patients had malignant pleural mesothelioma (MPM) and 3 patients had mesothelioma of the periotoneum. Eleven of the patients with MPM (84.6%) presented with a pleural effusion and only 2 patients (15.4%) had chest pain. Initial pleural fluid cytology and closed pleural biopsies were negative in all patients who presented with a pleural effusion. Thoracoscopy confirmed the histologic diagnosis and allowed simultaneous talc pleurodesis in 9 patients. All patients had documented asbestos exposure, of which 14 (87.5%) were confirmed to be occupationally related. The median time from first exposure to symptoms was 33.5 (range, 16 to 53) years. The median survival was 6 months. Most of the patients (75%) received best supportive care alone.

In our experience, malignant mesothelioma is an aggressive disease with a poor prognosis. It is strongly associated with asbestos exposure. Thoracoscopy is an invaluable diagnostic modality in the evaluation of a patient with occupational asbestos exposure and an undiagnosed pleural effusion.