**1. Introduction**

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166 Principles and Practice of Cardiothoracic Surgery

Malignant mesothelioma is a tumour which arises from mesothelial or possibly more primitive sub-mesothelialcells.Itoccursmostcommonlyinthepleura,butalsointheperitoneumandrarely in the pericardium or tunica vaginalis testis [1]. The vast majority of cases (almost 80%) arise from the pleural mesothelium, and of these, most (60-70%) are associated with asbestos exposure [2]. Thefirstclearevidenceofacausallinkbetweenasbestosexposureandprimarymalignanttumours of the mesothelium was the observation by Wagner et al. (1960) of 33 cases of pleural mesothelio‐ ma in the Northwest Cape Province of South Africa, 28 in individuals who had lived close to the crocidolite mines, mostly as children [3]. Subsequent studies, especially work by Selikoff and associates (1965) and Whitwell and Rawcliffe (1971) in the United States, confirmed that asbes‐ tos exposure was the major risk factor for malignant pleural mesothelioma [4–6]. The epidemiol‐ ogy of malignant pleural mesothelioma is now well understood, but its biological behavior remains an enigma and the treatment of this cancer is still controversial.
