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Difference between revisions of "Malignant mesothelioma"
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| Micro = infiltrative atypical cells (epithelioid, spindled or both) | | Micro = infiltrative atypical cells (epithelioid, spindled or both) | ||
| Subtypes = biphasic mesothelioma, epithelioid mesothelioma, desmoplastic mesothelioma, sarcomatoid mesothelioma. | | Subtypes = biphasic mesothelioma, epithelioid mesothelioma, desmoplastic mesothelioma, sarcomatoid mesothelioma. | ||
| LMDDx = mesothelial hyperplasia, fibrosing pleuritis, [[adenocarcinoma]] - esp. [[lung adenocarcinoma|lung]], [[serous carcinoma]] | | LMDDx = mesothelial hyperplasia, [[fibrosing pleuritis]], [[adenocarcinoma]] - esp. [[lung adenocarcinoma|lung]], [[serous carcinoma]] | ||
| Stains = | | Stains = | ||
| IHC = calretinin +ve, D2-40 +ve, CK5/6 +ve, WT-1 +ve, CK7 +ve, CEA -ve, TTF-1 -ve | | IHC = calretinin +ve, D2-40 +ve, [[CK5/6]] +ve, WT-1 +ve, [[CK7]] +ve, CEA -ve, [[TTF-1]] -ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = +/-p16 deletion | ||
| IF = | | IF = | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = | ||
| Site = [[lung]], [[peritoneum]], [[omentum]], pericardium | | Site = [[lung]], [[peritoneum]], [[omentum]], [[pericardium]] | ||
| Assdx = | | Assdx = [[asbestosis]] | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = asbestos exposure | | Clinicalhx = +/-asbestos exposure | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
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==General== | ==General== | ||
*Incidence | |||
**Rare tumor accounting for 4-7 cases per million individuals. | |||
**More common in men in 5th and 6th decades of life. | |||
*Poor prognosis<ref>{{Cite journal | last1 = Haber | first1 = SE. | last2 = Haber | first2 = JM. | title = Malignant mesothelioma: a clinical study of 238 cases. | journal = Ind Health | volume = 49 | issue = 2 | pages = 166-72 | month = | year = 2011 | doi = | PMID = 21173534 }}</ref> - median survival <12 months.<ref name=pmid23413596>{{Cite journal | last1 = Mineo | first1 = TC. | last2 = Ambrogi | first2 = V. | title = Malignant pleural mesothelioma: factors influencing the prognosis. | journal = Oncology (Williston Park) | volume = 26 | issue = 12 | pages = 1164-75 | month = Dec | year = 2012 | doi = | PMID = 23413596 }}</ref> | *Poor prognosis<ref>{{Cite journal | last1 = Haber | first1 = SE. | last2 = Haber | first2 = JM. | title = Malignant mesothelioma: a clinical study of 238 cases. | journal = Ind Health | volume = 49 | issue = 2 | pages = 166-72 | month = | year = 2011 | doi = | PMID = 21173534 }}</ref> - median survival <12 months.<ref name=pmid23413596>{{Cite journal | last1 = Mineo | first1 = TC. | last2 = Ambrogi | first2 = V. | title = Malignant pleural mesothelioma: factors influencing the prognosis. | journal = Oncology (Williston Park) | volume = 26 | issue = 12 | pages = 1164-75 | month = Dec | year = 2012 | doi = | PMID = 23413596 }}</ref> | ||
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*Lung. | *Lung. | ||
*Primary [[peritoneum|peritoneal]]. | *Primary [[peritoneum|peritoneal]]. | ||
*Primary pericardial.<ref name=pmid22740748>{{Cite journal | last1 = Sardar | first1 = MR. | last2 = Kuntz | first2 = C. | last3 = Patel | first3 = T. | last4 = Saeed | first4 = W. | last5 = Gnall | first5 = E. | last6 = Imaizumi | first6 = S. | last7 = Lande | first7 = L. | title = Primary pericardial mesothelioma unique case and literature review. | journal = Tex Heart Inst J | volume = 39 | issue = 2 | pages = 261-4 | month = | year = 2012 | doi = | PMID = 22740748 }}</ref> | *Primary [[pericardium|pericardial]].<ref name=pmid22740748>{{Cite journal | last1 = Sardar | first1 = MR. | last2 = Kuntz | first2 = C. | last3 = Patel | first3 = T. | last4 = Saeed | first4 = W. | last5 = Gnall | first5 = E. | last6 = Imaizumi | first6 = S. | last7 = Lande | first7 = L. | title = Primary pericardial mesothelioma unique case and literature review. | journal = Tex Heart Inst J | volume = 39 | issue = 2 | pages = 261-4 | month = | year = 2012 | doi = | PMID = 22740748 }}</ref> | ||
Epidemiology: | Epidemiology: | ||
*Strong association with asbestos exposure. | *Strong association with asbestos exposure. | ||
Treatment: | |||
*+/-Surgical debulking (cytoreduction) with heated chemotherapy - for intraperitoneal mesothelioma.<ref name=pmid24158467>{{cite journal |author=Wong J, Koch AL, Deneve JL, Fulp W, Tanvetyanon T, Dessureault S |title=Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience |journal=Ann. Surg. Oncol. |volume=21 |issue=5 |pages=1480–6 |year=2014 |month=May |pmid=24158467 |doi=10.1245/s10434-013-3341-7 |url=}}</ref> | |||
Note: | |||
*No association with [[smoking]].{{fact}}<ref name=pmid24351898>{{Cite journal | last1 = Offermans | first1 = NS. | last2 = Vermeulen | first2 = R. | last3 = Burdorf | first3 = A. | last4 = Goldbohm | first4 = RA. | last5 = Kauppinen | first5 = T. | last6 = Kromhout | first6 = H. | last7 = van den Brandt | first7 = PA. | title = Occupational asbestos exposure and risk of pleural mesothelioma, lung cancer, and laryngeal cancer in the prospective Netherlands cohort study. | journal = J Occup Environ Med | volume = 56 | issue = 1 | pages = 6-19 | month = Jan | year = 2014 | doi = 10.1097/JOM.0000000000000060 | PMID = 24351898 }}</ref> | |||
===Asbestos=== | |||
Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref> | Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref> | ||
*Pleural plaques. | *[[Pleural plaques]]. | ||
*[[Asbestosis]]. | *[[Asbestosis]]. | ||
*[[Lung carcinoma]]. | *[[Lung carcinoma]]. | ||
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Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref> | Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref> | ||
*Infiltrative atypical cells - '''key feature'''. | *Infiltrative atypical cells - '''key feature'''. | ||
**Infiltration into fat - ''diagnostic''. | |||
**+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing. | **+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing. | ||
***Variable architecture: sheets, microglandular, tubulopapillary. | ***Variable architecture: sheets, microglandular, tubulopapillary. | ||
***+/-[[Psammoma bodies]]. | ***+/-[[Psammoma bodies]]. | ||
**+/-Spindle cells. | **+/-Spindle cells. | ||
*+/-''Ferruginous body'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref> | *+/-''[[Ferruginous body]]'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref> | ||
** Looks like a (twirling) baton - segemented appearance, brown colour. | ** Looks like a (twirling) baton - segemented appearance, brown colour. | ||
** Thin (asbestos) fiber in the core. | ** Thin (asbestos) fiber in the core. | ||
Notes: | |||
*''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''. | *''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''. | ||
*Don't diagnose ''mesothelioma in situ''.{{fact}} | |||
DDx:<ref name=pmid15559051>{{Cite journal | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }} | DDx:<ref name=pmid15559051>{{Cite journal | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }} | ||
</ref> | </ref> | ||
*[[Fibrosing pleuritis]]. | <ref name="pmid15725802">{{Cite journal | last1 = Bégueret | first1 = H. | last2 = Galateau-Salle | first2 = F. | last3 = Guillou | first3 = L. | last4 = Chetaille | first4 = B. | last5 = Brambilla | first5 = E. | last6 = Vignaud | first6 = JM. | last7 = Terrier | first7 = P. | last8 = Groussard | first8 = O. | last9 = Coindre | first9 = JM. | title = Primary intrathoracic synovial sarcoma: a clinicopathologic study of 40 t(X;18)-positive cases from the French Sarcoma Group and the Mesopath Group. | journal = Am J Surg Pathol | volume = 29 | issue = 3 | pages = 339-46 | month = Mar | year = 2005 | doi = | PMID = 15725802 }}</ref> | ||
*[[Fibrosing pleuritis]] - should ''not'' have nodules, more cellular on the aspect adjacent to the effusion. | |||
*Reactive mesothelial cells - may be atypical. | |||
*Mesothelial hyperplasia. | *Mesothelial hyperplasia. | ||
*[[Adenocarcinoma]] - esp. [[lung adenocarcinoma]]. | *[[Adenocarcinoma]] - esp. [[lung adenocarcinoma]]. | ||
*[[Serous carcinoma]]. | *[[Serous carcinoma]]. | ||
*[[Synovial sarcoma]]. | |||
===Images=== | ===Images=== | ||
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Image: Malignant epithelioid mesothelioma - calretinin - high mag.jpg | MM - calretinin - high mag. | Image: Malignant epithelioid mesothelioma - calretinin - high mag.jpg | MM - calretinin - high mag. | ||
</gallery> | </gallery> | ||
====www==== | |||
*[http://www.rosaicollection.org/searchresults.cfm/ Mesothelioma (rosaicollection.org/index.cfm)]. | |||
===Subtypes=== | ===Subtypes=== | ||
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*GLUT1 +ve ~50% (vs. ~10%) | *GLUT1 +ve ~50% (vs. ~10%) | ||
*p53 +ve ~50% (vs. ~2%). | *p53 +ve ~50% (vs. ~2%). | ||
Note: | |||
*The above are ''not'' very useful in individual cases. | |||
*A simple pankeratin is useful for seening where epithelial cells are. | |||
===Mesothelioma versus adenocarcinoma=== | ===Mesothelioma versus adenocarcinoma=== | ||
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**WT-1. | **WT-1. | ||
**D2-40. | **D2-40. | ||
**CK5/6. | **[[CK5/6]]. | ||
*Carcinoma markers: | *Carcinoma markers: | ||
**CEA (monoclonal and polyclonal). | **CEA (monoclonal and polyclonal). | ||
**TTF-1. | **[[TTF-1]]. | ||
**Ber-EP4. | **[[Ber-EP4]]. | ||
**MOC-31. | **MOC-31. | ||
**CD15. | **CD15. | ||
**[[B72.3]]. | |||
===Other carcinoma markers=== | |||
*[[PAX8]] -ve.<ref name=pmid23846294>{{cite journal |author=Lee M, Alexander HR, Burke A |title=Diffuse mesothelioma of the peritoneum: a pathological study of 64 tumours treated with cytoreductive therapy |journal=Pathology |volume=45 |issue=5 |pages=464–73 |year=2013 |month=August |pmid=23846294 |doi=10.1097/PAT.0b013e3283631cce |url=}}</ref> | |||
*Claudin-4. | |||
**Mesothelioma may be focally positive.<ref name=pmid23775021>{{cite journal |author=Ohta Y, Sasaki Y, Saito M, ''et al.'' |title=Claudin-4 as a marker for distinguishing malignant mesothelioma from lung carcinoma and serous adenocarcinoma |journal=Int. J. Surg. Pathol. |volume=21 |issue=5 |pages=493–501 |year=2013 |month=October |pmid=23775021 |doi=10.1177/1066896913491320 |url=}}</ref> | |||
*[[p63]] -ve.<ref name=pmid18064689>{{Cite journal | last1 = Pu | first1 = RT. | last2 = Pang | first2 = Y. | last3 = Michael | first3 = CW. | title = Utility of WT-1, p63, MOC31, mesothelin, and cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in effusions. | journal = Diagn Cytopathol | volume = 36 | issue = 1 | pages = 20-5 | month = Jan | year = 2008 | doi = 10.1002/dc.20747 | PMID = 18064689 }}</ref> | |||
*[[CD138]] +ve. | |||
**Usually -ve in mesothelioma.<ref name=pmid12866374>{{Cite journal | last1 = Chu | first1 = PG. | last2 = Arber | first2 = DA. | last3 = Weiss | first3 = LM. | title = Expression of T/NK-cell and plasma cell antigens in nonhematopoietic epithelioid neoplasms. An immunohistochemical study of 447 cases. | journal = Am J Clin Pathol | volume = 120 | issue = 1 | pages = 64-70 | month = Jul | year = 2003 | doi = 10.1309/48KC-17WA-U69B-TBXQ | PMID = 12866374 }}</ref> | |||
==Molecular== | |||
*p16 deletion by [[FISH]].<ref name=pmid24503757>{{cite journal |author=Hwang H, Tse C, Rodriguez S, Gown A, Churg A |title=p16 FISH deletion in surface epithelial mesothelial proliferations is predictive of underlying invasive mesothelioma |journal=Am. J. Surg. Pathol. |volume=38 |issue=5 |pages=681–8 |year=2014 |month=May |pmid=24503757 |doi=10.1097/PAS.0000000000000176 |url=}}</ref> | |||
Notes: | |||
*p16 IHC does ''not'' give the same result. | |||
*Sensitivity of p16 deletion is low. | |||
==Sign out== | |||
<pre> | |||
Pleural Tissue of Right Lung, Removal: | |||
- MALIGNANT MESOTHELIOMA, epithelioid type. | |||
Comment: | |||
IHC confirms the morphologic impression. | |||
The tumour stains as follows: | |||
POSITIVE: calretinin (very strong), CK5/6. | |||
NEGATIVE: TTF-1. | |||
</pre> | |||
==See also== | ==See also== | ||