Environmental asbestos and pleural malignant mesothelioma in the north-west of Pakistan; a serious health hazard with potentially fatal outcome

Background Mesothelioma was first reported in the Khyber Pakhtunkhwa KP in rsquo s The diagnosis was made on the basis of histopathology but no Immunohistochemical IHC markers were applied So a need was felt to conduct a more authentic study to establish a cause and effect relationship between environmental asbestos exposure and mesothelioma Aims Aims of the present study is to confirm the presence of mesothelioma with a more authentic diagnosis using histopathology and IHC markers together and to know the overall burden of mesothelioma as a cause of exudative pleural effusions Material and methods It was a prospective study and conducted at the department of Pulmonology Medical teaching Institute Lady Reading Hospital Peshawar KP Pakistan The hospital receives patients for consultation and admission from all over the KP the Federally administrative tribal areas FATA and Afghanistan The study period was three years from January to December All the patients with exudative effusions were biopsied after a verbal and written informed consent Three or four pieces of pleural biopsies were taken on an average using Abram s pleural biopsy needle Ultrasound guidance was used for biopsy site selection in cases of smaller and or loculated effusions Two percent injectable lignocain was used as local anesthetic Intravenous dormicum and or tramadol was were used in excessively apprehensive cases Results nbsp A total of were admitted to the department during the years being male and being female Of these patients had exudative pleural effusions and were biopsied A total of cases out of all the cases undergoing pleural biopsies turned out to be malignant out which were mesothelioma Male to female ratio for mesothelioma was cases cases Age distribution showed no cases below the age cases between the age range and cases above the age All the mesothelioma cases were histologically proven and supported by positive IHC markers for pleural mesothelioma and negative IHC markers for other malignancies Conclusion nbsp North Western areas of Pakistan the FATA and adjacent areas of the KP province have histopathologically and immunohistochemically proven cases of pleural mesothelioma The burden of mesothelioma is quite high accounting for almost two percent and one fourth of all the exudative and the malignant pleural effusions respectively