The history of the term mesothelioma has entailed more than 100 years of controversy. The earliest mention of a possible tumor of the chest wall was by Joseph Lieutaud (1), generally regarded as the founder of pathologic anatomy in France according to Wolf (2), as quoted by Robertson (3). Lieutaud published a study of 3000 autopsies, among which were two cases of “pleural tumors.” The published account mentions a boy who suffered from marked dyspnea following trauma, who at postmortem showed fleshy masses adherent to the pleura and the ribs. Laennec (4) in 1819 is also said by Robertson to have suggested that there was an entity of primary malignancy of the pleura based on the epithelial nature of these pleural cells. In 1843, von Rokitansky (5) actively opposed the idea of primary cancer of the pleura, and stated that pleural cancer always was secondary to a primary focus elsewhere.
Ironically von Rokitansky in 1854 described what were called primary tumors of the peritoneum, which he called “colloid cancer” and most likely were peritoneal mesotheliomas. This strong opinion on the metastatic origin of pleural mesotheliomas by the German pathologists was to remain the opinion of many pathologists up through the mid20th century as stated by Willis (6). There were further reports in the early 19th century of what could be considered pleural-based cancers.
It was Wagner in 1870 who first described a lesion, which he classified as “Das Tuberkelähnliche Lymphadenom.” He felt this was a primary malignancy of the pleura in a 69-year-old woman in whom an epithelial-based malignancy was found. Wagner had described lymph channels filled with tumor. Schultz (7) in 1875 reexamined the preparations of Wagner and emphasized the neoplastic nature of the process and renamed it endothelial cancer. The tumor was thought to arise from the lymph vessels and was commonly called an endothelioma.
This was not questioned until 1891, when Engelbach (8) first raised the question of whether these tumors arose from the endothelium of the lymph vessels or from the surrounding serosal surfaces.
During the late 19th century and early 20th century, there was general acceptance that some sarcomas arose from the pleura when there was no evidence of a primary elsewhere, and it was generally accepted that the only tumor that might be primary to the pleura or the subpleura was a primary sarcoma. This was generally the Italian view as summarized by De Renzi (9). In 1890 Biggs (10) was the first American to report two cases of “endothelioma of the pleura” at the New York Pathological Society. Primary fibrous sarcomas of the pleura were generally accepted as arising from the fibroblast but not the pleural tissue itself. The fact that the pleural lining was capable of producing tumors that were both epithelial and of connective tissue origin was first pointed out by Paltauf (11), Borst (12), and Kaufmann (13). By 1909 Patterson (14) found 96 cases in the literature and added two of his own. The disease occurred twice as frequently in men than in women, and the greatest number of cases was found in patients between the ages of 40 and 60 years.
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