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Endemic Pleural Calcification and Mesothelioma

A. M. Langer, PhD; R. P. Nolan, PhD; S. H. Constantopoulos, MD
JAMA. 1988;260(3):339-340. doi:10.1001/jama.1988.03410030055019.
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To the Editor.—  A recent case report by Sichletidis et al1 and a letter on the case by Dr Germine2 merit comment. In 1985, we reported the occurrence of endemic pleural calcification and mesothelioma in northwestern Greece.3 Although an earlier report had described widespread pleural calcification observed during a tuberculosis survey in the region, we found that mesothelioma had occurred as well.3 No occupational or infectious agent could be found to explain this pattern, referred to as Metsovo lung.The number of pleural mesotheliomas observed, five among 5000 people in two years, was striking considering there was no commercial asbestos industry within 80 km of the area. We reported that asbestiform tremolite was found in five of the eight transbronchial biopsy specimens obtained from people with Metsovo lung. We suggested that this was the agent responsible for both Metsovo lung and the pleural mesotheliomas, although the

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