Diffuse malignant pleural mesothelioma: A multi-institutional clinicopathological study

Purpose  The relative rarity of malignant pleural mesothelioma (MPM) in Japan makes it difficult to perform a large-scale clinicopathological study of this tumor at a single institute. Thus, we performed a multiinstitutional study to evaluate the current status of diagnosis and treatment in Japan. Methods  We analyzed the records of 65 patients with MPM, obtained from the 13 institutions comprising the Japanese Chiba Multicenter Study Group. Results  In 56 patients, the tumor was detected after a visit to a medical facility for subjective symptoms such as chest pain, shortness of breath, and cough. It took a median period of 2 months from the initial visit to establish the diagnosis. The overall survival rates of 33 patients with unresectable MPM 1, 2, and 3 years after the diagnosis were 40.5%, 10.8%, and 0%, respectively, whereas those of 32 patients who underwent surgery were 67.9%, 35.0% and 10.9%, respectively (P = 0.0035). According to multivariate analysis, histological type, International Mesothelioma Interest Group clinical stage, sex, and the presenting symptom of shortness of breath were significant prognostic factors. Conclusions  The definitive diagnosis of early MPM is difficult, but establishing the best diagnostic modality would improve survival rates, since radical surgery is likely to be effective for resectable disease. All the authors are members of the Chiba Pleural Tumor Study Group. See Appendix.     

Localized malignant mesothelioma in the middle mediastinum: Report of a case

Localized malignant mesothelioma in the mediastinum is rare and most known cases have been reported as "localized malignant pericardial mesothelioma." We report a case of a middle mediastinal tumor, which we were able to resect completely. Histopathological examination of the tumor confirmed that it was a malignant epithelial lymphohistiocytoid mesothelioma. We assumed that the tumor was derived from the pericardium. Local recurrence was detected 1 year after resection, and the patient died of the disease about 2 years later.     

睾丸鞘膜恶性间皮瘤1例报告

目的 探讨睾丸鞘膜恶性间皮瘤的临床特征及诊治方法.方法 报告1例睾丸鞘膜恶性间皮瘤患者的临床资料.男性,73岁,临床表现右侧阴囊进行性增大1年,B超睾丸周围可见约7.5 cm×4.1 cm液性暗区.检索Pubmed和CBM数据库相关文献进行学习.结果 患者行右侧睾丸鞘膜切除术,术后病理:睾丸鞘膜间皮细胞增生,伴非典型性增生,局灶恶变,免疫组化:CK5/6(+),Calretinin(+),E-cadlherin(+).3周后行右睾丸切除,术后11个月患者出现右侧阴囊肿物及腹股沟淋巴结肿大,行右侧阴囊肿物切除及腹股沟淋巴结切除,术后病理:脂肪结缔组织及纤维组织中恶性间皮瘤浸润,免疫组化:CK5/6(+),Calretinin灶状(+).结论 睾丸鞘膜恶性间皮瘤临床罕见,生物学行为进展快,临床症状不典型,缺少特异性肿瘤标记物,术前诊断较难,诊断主要依据病理,治疗以根治性手术为主,术后需长期严密随访,患者预后差.     

Malignant mesothelioma originating in the hepatic falciform ligament: Report of a case

(Received for publication on Apr. 23, 1997; accepted on Nov. 6, 1997)     

Malignant mesothelioma of the tunica vaginalis testis related to recent asbestos

Abstract:   We report an extremely rare case of malignant mesothelioma in the tunica vaginalis testis. A 67-year-old man was referred to our hospital complaining of painless swelling in the right scrotum. Ultrasonography and computed tomography demonstrated a mass of approximately 6 cm in the right scrotum. He underwent tumor resection under a diagnosis of right intrascrotal tumor. The histopathological diagnosis was malignant mesothelioma, and he died 26 months later from multiple metastases. Asbestos may be a significant contributor to malignant mesothelioma in Japan. There have been 46 cases reported in urology departments in this country of the related symptoms, but only two of these have been clearly attributable to asbestos, which may be due to the investigations being insufficient to obtain a definitive diagnosis. In addition, this symptom is often diagnosed preoperatively as hydrocele testis; it is therefore important to carry out ultrasonography when a hydrocele testis has been diagnosed.     

Malignant mesothelioma of the tunica vaginalis testis: Report of a case

(Received for publication on Aug. 27, 1998; accepted on Mar. 11, 1999)     

Localized malignant mesothelioma in the stomach and mediastinum

Localized malignant mesothelioma is rare. It has a histological pattern identical to diffuse malignant mesothelioma but without diffuse serosal spread. Localized malignant mesothelioma typically originates from the pleura, peritoneum or pericardium, but can occasionally develop from organs. Our cases represent what might be the largest mediastinal localized malignant mesothelioma described and the first presentation of the epithelioid type in the stomach of an adult.     

Intraoperative photodynamic therapy of the chest cavity in malignant pleural mesothelioma bearing rats

BACKGROUND AND OBJECTIVE: Experimental assessment of anticancer effect, normal tissue damage, and toxicity of intrathoracic mTHPC-mediated photodynamic therapy (PDT) combined to surgery in malignant pleural mesothelioma (MPM) bearing rats. STUDY DESIGN/MATERIALS AND METHODS: Six days after implantation of syngenic malignant mesothelioma cells in the left chest cavity of Fischer rats (n = 21) and 4 days after sensitization (0.1 mg/kg mTHPC), a left-sided pneumonectomy was performed, followed by intraoperative light delivery (652 nm, fluence 20 J/cm(2)), either by spherical illumination of the chest cavity (fluence rate 15 mW/cm(2)) or by focal illumination of a tumor area (fluence rate 150 mW/cm(2)). Controls comprised tumor-bearing untreated animals, tumor-bearing animals undergoing pneumonectomy, and tumor-bearing animals undergoing pneumonectomy and light delivery without sensitization or sensitization without light delivery. No thoracocentesis was performed during follow-up. RESULTS: An invasively growing sarcomatous type of mesothelioma was found in all animals at day 10, without tumor necrosis in control animals. PDT resulted in 0.5-1 mm deep inhomogeneous tumor necrosis after spherical, and in a 1-2 mm deep tumor necrosis after focal illumination. No injury to mediastinal organs was observed, neither after PDT with spherical nor with focal light delivery except focal interstitial lung fibrosis at the mediastinal area of the opposite lung. All animals with pneumonectomy followed by spherical PDT of the entire tumor-bearing chest cavity died within 72 hours whereas all other animals survived. All animals that died presented massive pleural effusion. CONCLUSIONS: PDT following pneumonectomy in mesothelioma bearing rats was technically feasible and allowed to study its effect on tumor and normal tissues. PDT-related tumor necrosis was observed after spherical and focal light delivery, however, pneumonectomy followed by PDT with spherical light delivery to the tumor-bearing chest cavity resulted in fatal complications.     

Stage Ia malignant pleural mesothelioma: clinical course and appropriate diagnostic process

Early-stage malignant pleural mesothelioma (MPM) is difficult for physicians to diagnose, and the disease is usually advanced at the time of diagnosis. We report a case of early-stage MPM in a 69-year-old man. The patient presented with fever and left chest pain. A computed tomography scan (CT) of the chest showed a small amount of left pleural effusion and slight left pleural thickening that remained unchanged for 1 year. One month after his inflammatory response spontaneously decreased, follow-up CT of the chest showed reduction in the effusion volume but no change in the pleural thickening. Positron emission tomography with ¹⁸F-fluorodeoxyglucose (FDG) showed increased FDG uptake in the pleural thickening on the left side. Because MPM could not be ruled out, video-assisted thoracoscopic surgery with pleural biopsy was performed for a definitive diagnosis. The postoperative histological diagnosis was early-stage MPM classified as T1a N0M0 disease.     

Malignant peritoneal mesothelioma in children: description of two cases and review of the literature

Malignant peritoneal mesothelioma (MPM) in children has been rarely described in the literature. During the last 10 years we have seen 2 cases. The first was a 2-year-old boy who died 3 months after surgery. The second is now alive two and a half years after the mesothelioma was found, has undergone 3 laparotomies for recurrent tumor, and is now receiving chemotherapy and is apparently free of tumor.     

The essential role of the mitochondria and reactive oxygen species in Cisplatin-mediated enhancement of fas ligand-induced apoptosis in malignant pleural mesothelioma

Cytotoxic chemotherapeutic drugs such as cisplatin (CDDP) synergistically interact with soluble Fas ligand (sFasL) to mediate profound induction of apoptosis in cancer cells, particularly those refractory to this death-inducing ligand. The goal of this study was to evaluate the roles of the mitochondria-dependent apoptotic cascade and the CDDP-generated reactive oxygen species (ROS) in mediating the supra-additive enhancement of cytotoxicity and apoptosis in combination-treated malignant pleural mesothelioma (MPM) cells. MPM cells were treated with sequential CDDP/sFasL in vitro. Cell viability and apoptosis were determined by MTT and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assays. Stable transfectants expressing high levels of Bcl2 were created by retroviral gene transfer. Specific proteolytic activity of caspases 3, 8, and 9 were measured using fluorescent substrates. Pretreating MPM cells with CDDP increased their susceptibility to sFasL by 2- to more than 20-fold. Overexpression of either Bcl-2, the selective caspase 9 inhibitor z-LEHD-fmk, or the antioxidant N-acetylcysteine significantly abrogated combination-induced cytotoxicity and apoptosis. Moreover, the robust activation of caspase 8 in combination-treated cells was completely suppressed by Bcl-2 overexpression, thus implicating a mitochondria-mediated amplification feedback loop. As an in vivo correlate, sequential intraperitoneal administration of CDDP and sFasL significantly inhibited the growth of intraperitoneal MPM human xenografts in nude mice. Our data indicate that the mitochondria-dependent feedback loop of the caspase activation cascade and the generation of ROS are both essential in mediating profound cytotoxicity and apoptosis of MPM cells treated with CDDP and sFasL. This mechanistic study establishes a the translational framework for the clinical application of sequential CDDP/sFasL in the treatment of MPM.     

Liposarcoma of oral cavity: Systematic review of cases reported to date and analysis of prognostic factors

The aim of this study was to integrate the available data published on Liposarcomas (LPSs) of the oral cavity into an analysis of its clinical features, treatment modalities, and prognostic factors. An electronic search was undertaken in January 2019. The eligibility criteria included publications that had enough clinical and histological information to confirm the diagnosis. Forty‐five publications (104 LPSs) were included. The lesion was more prevalent in males from the fifth to seventh decades of life. Treatment (P = .03) and distant metastasis (P = .0001) were independently associated with survival. A lower possibility of recurrence was statistically associated with age (younger patients) (P = .03), tumor size (smaller than 2.8 cm) (P = .001), and treatment (radical surgery) (P = .04). LPS presents a good survival for patients after 5 years of follow‐up (66.4%). Patients who were treated with conservative surgery and presented with distant metastasis showed poor prognosis.     

Metastases to the penis from carcinoma of the prostate

A 58-year-old man presented with dysuria at the Osaka Medical College Hospital in November 1996. Laboratory examination revealed elevated serum prostate-specific antigen (PSA) to > 100 ng/mL. Adenocarcinoma of the prostate with metastasis to the bone was diagnosed after a biopsy of the prostate and bone scintigraphy; hormonal therapy was administered. Although bone metastasis was well controlled and the serum PSA level declined to within normal levels (2.0 ng/mL), several painless nodules were found on the penile glans. Biopsy of the nodules showed that the penile tumor was a metastasis from the prostate cancer. The patient underwent partial penectomy for relief from penile pain. The serum PSA level showed no elevation 3 months after the partial penectomy, suggesting that careful observation of prostate cancer patients is necessary, even when oseous metastasis is well controlled and serum PSA levels are kept within normal ranges by hormonal therapy. The case also indicates that urologists should consider the possibility of metastasis to the penis from prostate cancer.     

Recurrent Lumbosacral Metastases from Intracranial Meningioma. Report of a Case and Review of the Literature

We report a case of a 31 year-old woman who in 1991 presented a clinical history of headaches, nausea and vomiting. CT scan showed a right frontotemporal meningioma. The first operation achieved a macroscopically complete resection. The tumour was histologically classified as a transitional meningioma. There were recurrences of the intracranial meningioma in 1994, 1996, 1997 and 1998. These recurrences were accompanied by differentiation to atypical and anaplastic meningioma. In all of these operations, a macroscopically complete resection of the tumour was performed. In 1996 adjuvant radiation therapy was given. In 1998 therapy with bromocriptine was adopted. In April 1999, the patient presented with lumbosacral pain associated with L5 bilateral sciatica. MRI showed a gadolinium enhancing mass lesion at L5-S1 level. Complete tumour resection was performed. The histological findings were the same as in 1998. In December 1999 the patient presented with perineal pain and MRI showed a L4 and S3 recurrence and the tumour was resected. The histological findings were those of a malignant meningioma. In February 2000 an intracranial recurrence was detected and operated on. The histological diagnosis was malignant meningioma. A review of the literature was undertake and is discussed.