Yonsei Med J.  2015 Mar;56(2):311-323. 10.3349/ymj.2015.56.2.311.

Clinical and Prognostic Features of Erionite-Induced Malignant Mesothelioma

• Demirer E
• Ghattas CF
• Radwan MO
• Elamin EM

• KMID: 2070005
• DOI: http://doi.org/10.3349/ymj.2015.56.2.311

Abstract

This review analytically examines the published data for erionite-related malignant pleural mesothelioma (E-MPM) and any data to support a genetically predisposed mechanism to erionite fiber carcinogenesis. Adult patients of age > or =18 years with erionite-related pleural diseases and genetically predisposed mechanisms to erionite carcinogenesis were included, while exclusion criteria included asbestos- or tremolite-related pleural diseases. The search was limited to human studies though not limited to a specific timeframe. A total of 33 studies (31042 patients) including 22 retrospective studies, 6 prospective studies, and 5 case reports were reviewed. E-MPM developed in some subjects with high exposures to erionite, though not all. Chest CT was more reliable in detecting various pleural changes in E-MPM than chest X-ray, and pleural effusion was the most common finding in E-MPM cases, by both tests. Bronchoalveolar lavage remains a reliable and relatively less invasive technique. Chemotherapy with cisplatin and mitomycin can be administered either alone or following surgery. Erionite has been the culprit of numerous malignant mesothelioma cases in Europe and even in North America. Erionite has a higher degree of carcinogenicity with possible genetic transmission of erionite susceptibility in an autosomal dominant fashion. Therapeutic management for E-MPM remains very limited, and cure of the disease is extremely rare.

Keyword

Asbestos; malignant mesothelioma; pleural effusion

MeSH Terms

Adult
Asbestos/*adverse effects
Asbestos, Amphibole
Environmental Exposure/*adverse effects
Female
Humans
Lung Neoplasms/*chemically induced/radiography
Male
Mesothelioma/*chemically induced/radiography
Middle Aged
Pleura/radiography
Pleural Effusion/radiography
Pleural Neoplasms/*chemically induced/radiography
Prognosis
Prospective Studies
Retrospective Studies
Tomography, X-Ray Computed
Zeolites/*adverse effects
Asbestos
Asbestos, Amphibole
Mesothelioma, Malignant
Zeolites

Figure

• 

  Fig. 1 Flow diagram of included and excluded studies.

• 

  Fig. 2 Characteristics of erionite studies that met the inclusion criteria.

Reference

1. Carbone M, Kratzke RA, Testa JR. The pathogenesis of mesothelioma. Semin Oncol. 2002; 29:2–17.

2. Senyiğit A, Babayiğit C, Gökirmak M, Topçu F, Asan E, Coşkunsel M, et al. Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey. Respiration. 2000; 67:610–614.

3. Boffetta P. Health effects of asbestos exposure in humans: a quantitative assessment. Med Lav. 1998; 89:471–480.

4. Artvinli M, Bariş YI. Malignant mesotheliomas in a small village in the Anatolian region of Turkey: an epidemiologic study. J Natl Cancer Inst. 1979; 63:17–22.

5. Rohl AN, Langer AM, Moncure G, Selikoff IJ, Fischbein A. Endemic pleural disease associated with exposure to mixed fibrous dust in Turkey. Science. 1982; 216:518–520.

6. Carbone M, Emri S, Dogan AU, Steele I, Tuncer M, Pass HI, et al. A mesothelioma epidemic in Cappadocia: scientific developments and unexpected social outcomes. Nat Rev Cancer. 2007; 7:147–154.

7. Boman G, Schubert V, Svane B, Westerholm P, Bolinder E, Rohl AN, et al. Malignant mesothelioma in Turkish immigrants residing in Sweden. Scand J Work Environ Health. 1982; 8:108–112.

8. Metintas M, Hillerdal G, Metintas S. Malignant mesothelioma due to environmental exposure to erionite: follow-up of a Turkish emigrant cohort. Eur Respir J. 1999; 13:523–526.

9. Powers A, Carbone M. The role of environmental carcinogens, viruses and genetic predisposition in the pathogenesis of mesothelioma. Cancer Biol Ther. 2002; 1:348–353.

10. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials. 1996; 17:1–12.

11. Oxford Centre for Evidence-based Medicine. Levels of Evidence (March 2009). Available at: http://www.cebm.net/index.aspx?o=1025.

12. Metintas M, Hillerdal G, Metintas S, Dumortier P. Endemic malignant mesothelioma: exposure to erionite is more important than genetic factors. Arch Environ Occup Health. 2010; 65:86–93.

13. Mousavi SM, Sundquist J, Hemminki K. Is risk of pleural mesothelioma an environmental risk outside Turkey? A study on immigrants to Sweden. Lung Cancer. 2010; 68:125–126.

14. Ozesmi M, Hillerdal G, Svane B, Widström O. Prospective clinical and radiologic study of zeolite-exposed Turkish immigrants in Sweden. Respiration. 1990; 57:325–328.

15. Baris YI, Grandjean P. Prospective study of mesothelioma mortality in Turkish villages with exposure to fibrous zeolite. J Natl Cancer Inst. 2006; 98:414–417.

16. Roushdy-Hammady I, Siegel J, Emri S, Testa JR, Carbone M. Genetic-susceptibility factor and malignant mesothelioma in the Cappadocian region of Turkey. Lancet. 2001; 357:444–445.

17. Karakoca Y, Emri S, Bagci T, Demir A, Erdem Y, Baris E, et al. Environmentally-induced malignant pleural mesothelioma and HLA distribution in Turkey. Int J Tuberc Lung Dis. 1998; 2:1017–1022.

18. Emri S, Kocagoz T, Olut A, Güngen Y, Mutti L, Baris YI. Simian virus 40 is not a cofactor in the pathogenesis of environmentally induced malignant pleural mesothelioma in Turkey. Anticancer Res. 2000; 20:891–894.

19. Olut AI, Ertugrul DT, Kocagoz T, Er M, Emri S. HHV-8 is not a cofactor in the pathogenesis of environmentally induced malignant pleural mesothelioma. Monaldi Arch Chest Dis. 2000; 55:110–113.

20. Olut A, Firat P, Ertugrul D, Gungen Y, Emri S. Ras oncoprotein expression in erionite- and asbestos-induced Turkish malignant pleural mesothelioma patients--a pilot study. Respir Med. 2001; 95:697–698.

21. Kokturk N, Firat P, Akay H, Kadilar C, Ozturk C, Zorlu F, et al. Prognostic significance of Bax and Fas ligand in erionite and asbestos induced Turkish malignant pleural mesothelioma. Lung Cancer. 2005; 50:189–198.

22. Baris YI, Saracci R, Simonato L, Skidmore JW, Artvinli M. Malignant mesothelioma and radiological chest abnormalities in two villages in Central Turkey. An epidemiological and environmental investigation. Lancet. 1981; 1:984–987.

23. Hillerdal G, Baris YI. Radiological study of pleural changes in relation to mesothelioma in Turkey. Thorax. 1983; 38:443–448.

24. Baris I, Simonato L, Artvinli M, Pooley F, Saracci R, Skidmore J, et al. Epidemiological and environmental evidence of the health effects of exposure to erionite fibres: a four-year study in the Cappadocian region of Turkey. Int J Cancer. 1987; 39:10–17.

25. Selçuk ZT, Cöplü L, Emri S, Kalyoncu AF, Sahin AA, Bariş YI. Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases. Chest. 1992; 102:790–796.

26. Karakoca Y, Emri S, Cangir AK, Bariş YI. Environmental pleural plaques due to asbestos and fibrous zeolite exposure in Turkey. Indoor Built Environ. 1997; 6:100–105.

27. Sahin AA, Cöplü L, Selçuk ZT, Eryilmaz M, Emri S, Akhan O, et al. Malignant pleural mesothelioma caused by environmental exposure to asbestos or erionite in rural Turkey: CT findings in 84 patients. AJR Am J Roentgenol. 1993; 161:533–537.

28. Gulmez I, Kart L, Buyukoglan H, Er O, Balkanli S, Ozesmi M. Evaluation of malignant mesothelioma in central Anatolia: a study of 67 cases. Can Respir J. 2004; 11:287–290.

29. Erzen C, Eryilmaz M, Kalyoncu F, Bilir N, Sahin A, Baris YI. CT findings in malignant pleural mesothelioma related to nonoccupational exposure to asbestos and fibrous zeolite (erionite). J Comput Assist Tomogr. 1991; 15:256–260.

30. Ryan PH, Dihle M, Griffin S, Partridge C, Hilbert TJ, Taylor R, et al. Erionite in road gravel associated with interstitial and pleural changes--an occupational hazard in western United States. J Occup Environ Med. 2011; 53:892–898.

31. Gräsel B, Kaya A, Stahl U, Rauber K, Kuntz C. [Erionite-induced pleural plaques. Exposition to urban pollution in a female Turkish migrant in Germany]. Chirurg. 2008; 79:584–588.

32. Dumortier P, Göcmen A, Laurent K, Manço A, De Vuyst P. The role of environmental and occupational exposures in Turkish immigrants with fibre-related disease. Eur Respir J. 2001; 17:922–927.

33. Dumortier P, Coplü L, Broucke I, Emri S, Selcuk T, de Maertelaer V, et al. Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzköy, Cappadocia, Turkey. Occup Environ Med. 2001; 58:261–266.

34. Emri S, Akbulut H, Zorlu F, Dinçol D, Akay H, Güngen Y, et al. Prognostic significance of flow cytometric DNA analysis in patients with malignant pleural mesothelioma. Lung Cancer. 2001; 33:109–114.

35. Hillerdal G, Elmberger G. Malignant mediastinal tumor with bone formation--mesothelioma or sarcoma? J Thorac Oncol. 2007; 2:983–984.

36. Ozer N, Shehu V, Aytemir K, Ovünç K, Emre S, Kes S. Echocardiographic findings of pericardial involvement in patients with malignant pleural mesothelioma with a history of environmental exposure to asbestos and erionite. Respirology. 2000; 5:333–336.

37. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer. 1981; 47:207–214.

38. Tansan S, Emri S, Selçuk T, Koç Y, Hesketh P, Heeren T, et al. Treatment of malignant pleural mesothelioma with cisplatin, mitomycin C and alpha interferon. Oncology. 1994; 51:348–351.

39. Batirel HF, Metintas M, Caglar HB, Yildizeli B, Lacin T, Bostanci K, et al. Trimodality treatment of malignant pleural mesothelioma. J Thorac Oncol. 2008; 3:499–504.

40. Simonato L, Baris R, Saracci R, Skidmore J, Winkelmann R. Relation of environmental exposure to erionite fibres to risk of respiratory cancer. IARC Sci Publ. 1989; 398–405.

41. Bariş B, Demir AU, Shehu V, Karakoca Y, Kisacik G, Bariş YI. Environmental fibrous zeolite (erionite) exposure and malignant tumors other than mesothelioma. J Environ Pathol Toxicol Oncol. 1996; 15:183–189.

42. Butchart EG, Ashcroft T, Barnsley WC, Holden MP. Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients. Thorax. 1976; 31:15–24.

43. Tweedale G, McCulloch J. Chrysophiles versus chrysophobes: the white asbestos controversy, 1950s-2004. Isis. 2004; 95:239–259.

44. McDonald JC, McDonald A. Mesothelioma and asbestos exposure. In : Pass HI, Vogelzang NJ, Carbone M, editors. Malignant Mesothelioma. New York: Springer;2005. p. 267–292.

45. Peto J, Hodgson JT, Matthews FE, Jones JR. Continuing increase in mesothelioma mortality in Britain. Lancet. 1995; 345:535–539.

46. Pass HI, Vogelzang N, Hahn SM, Carbone M. Malignant pleural mesothelioma. In : DeVita VT, Hellman S, Rosenberg SA, editors. Cancer, Principles & Practice of Oncology. Philadelphia: Lippincott Williams and Wilkins;2005. p. 1687–1712.

47. Barış YI. Asbestos and Erionite Related Chest Diseases. Ankara, Turkey: Semih Offset Matbaacilik;1987.

48. Kliment CR, Clemens K, Oury TD. North American erionite-associated mesothelioma with pleural plaques and pulmonary fibrosis: a case report. Int J Clin Exp Pathol. 2009; 2:407–410.

49. Sullivan PA. Vermiculite, respiratory disease, and asbestos exposure in Libby, Montana: update of a cohort mortality study. Environ Health Perspect. 2007; 115:579–585.

50. Groppo C, Tomatis M, Turci F, Gazzano E, Ghigo D, Compagnoni R, et al. Potential toxicity of nonregulated asbestiform minerals: balangeroite from the western Alps. Part 1: Identification and characterization. J Toxicol Environ Health A. 2005; 68:1–19.

51. Putzu MG, Bruno C, Zona A, Massiccio M, Pasetto R, Piolatto PG, et al. Fluoro-edenitic fibres in the sputum of subjects from Biancavilla (Sicily): a pilot study. Environ Health. 2006; 5:20.

52. Thomas JA. Toxicological assessment of zeolites. Int J Toxicol. 1992; 11:259–273.

53. Yang H, Testa JR, Carbone M. Mesothelioma epidemiology, carcinogenesis, and pathogenesis. Curr Treat Options Oncol. 2008; 9:147–157.

54. Carbone M, Ly BH, Dodson RF, Pagano I, Morris PT, Dogan UA, et al. Malignant mesothelioma: facts, myths, and hypotheses. J Cell Physiol. 2012; 227:44–58.

55. Ataman G. [The role of erionite (zeolite) in pulmonary mesothelioma]. C R Seances Acad Sci D. 1980; 291:167–169.

56. Sebastien P, Gaudichet A, Bignon J, Baris YI. Zeolite bodies in human lungs from Turkey. Lab Invest. 1981; 44:420–425.