Robert Foster Moore
1921 The Lancet  
The great difficulty in naming a tumour endothelioma is to demonstrate its origin from endothelium, and it is practically impossible, as Du Bray and Rosson point out, to eliminate the supposition that they are carcinomata originating from the lung tpithelium, either alveolar or bronchial, as the eumours are never seen when confined purely to pleura and without having extended to some degree into the lung substance. Writers on histology 2 classify endothelium generally as pavement epithelium of
more » ... ment epithelium of mesoblastic origin, and there does not seem to be any satisfactory method of distinguishing this mesoblastic epithelium from the true epior hypoblastic type. Miller and Wynn 3 describe a case of endothelioma of the peritoneum in which, using Van Gieson stain, they demonstrate an apparent connexion between the processes of the epithelial-like cells and the fibrils of the stroma, and suggest that this points to a connective tissue origin. Adler 4 thinks they originate from the lining endothelium of the pleura, while Schultz and Eppinger believe that these tumours usually originate in the endothelium of the lymphatic vessels. Bloch collected 63 cases, which he divided into two groups, the larger (47 cases) being endotheliomata, which he considers had origin in the endothelial lining of the pleura, and the smaller (16 cases) being spindle-celled sarcomata from the subjacent connective tissue. Adami 6 calls these tumours mesotheliomata, grouping them with epitheliomata as lining membrane growths, in this case of mesoblastic origin. In the case described above the uniform growthalmost entirely confined to the pleura, with only slight and superficial involvement of the lung, and the general histological appearance-seem to indicate the endothelial lining cells of the pleura as the primary source, and so, adopting Adami's nomenclature, it would be called a mesothelioma. The general characteristics in this case correspond with most of those recorded, but it seems to be at a rather earlier stage. The age of incidence (Patterson') is said to be usually between 40 and 60 ; the tumours are slightly more common in males than females, and are more often right-sided. They are frequently associated with profuse blood-stained exudate, although many cases are described in which the pleural cavity is completely obliterated with growth. Extension is usually by direct infiltration rather than by the blood stream. We are much indebted to Dr. MacAlister for his help and for permission to publish this case, and to Mr. R. Gick for the drawing (Fig. 1 ) reproduced here.
doi:10.1016/s0140-6736(01)32060-3 fatcat:zuu2k57fp5b43byjtger6wze6m