Introduction Bari municipality (Apulia region, Southern Italy) has been defined as a contaminated site of national priority for remediation because of diffuse environmental contamination caused by an asbestos cement factory. Up to date, the regional mesothelioma registry listed 66 environmental mesothelioma cases among residents. We report two peculiar cases of malignant mesothelioma, one peritoneal and one pleural, due to residential asbestos exposure close to a military barracks, located inside the urban area and reclaimed only in 2006.
Methods The records of the two cases with environmental exposure were listed in the Apulia regional mesothelioma registry. The registry ensures complete, quality information on exposure and diagnosis thanks to the adoption of operative guidelines agreed at national level. Molecular analysis with CGH-array was performed on paraffin-embedded tissue.
Results The peritoneal case in a 36-year-old man shows a peculiar characteristics long survival (more than 17 years). The patient was treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Molecular analysis detected multiple chromosomal imbalances. The gains were prevalent. DNA copy number alterations (CNAs) observed loss at 1q21, 8 p23.1 and gains at 3 p22.2→3 p22.1, 3 p25.3→p25.1, 4q13.1 and Xq22.2. These are novel CNAs here identified and uncommon in malignant peritoneal mesothelioma.
The pleural case, a 74-year-old man, suffering from a familial Becker type muscular dystrophy, opted for chemotherapy (alimta +cisplatinum) with external hyperthermia. At follow-up in April 2017, about 2 years from diagnosis and 21 months from the beginning of chemotherapy treatments, he has left shoulder pain, general weakness but good respiratory expansion.
Both cases lived in apartments overlooking military barracks from 1963 to 1999.
Discussion Past intensive use of asbestos has implied severe public health consequences among Bari inhabitants. Our study showed that the presence of the asbestos cement factory, as well as the military barracks, have been related with the onset of malignant mesothelioma among the neighbouring resident population.