Surgically debulked malignant pleural mesothelioma: Results and prognostic factors

Background: We analyzed morbidity and mortality, sites of recurrence, and possible prognostic factors in 95 (78 male, 17 female) patients with MPM on phase I–III trials since 1990. A debulking resection to a requisite, residual tumor thickness of ≤ 5 mm was required for inclusion. Methods: Preoperative tumor volumes were determined by three-dimensional reconstruction of chest computerized tomograms. Pleurectomy (n=39) or extrapleural pneumonectomy (EPP; n=39) was performed. Seventeen patients could not be debulked. Preoperative EPP platelet counts (404,000) and mean tumor volume (491 cm³) were greater than that seen for pleurectomy (344,000, 114 cm³). Results: Median survival for all patients was 11.2 months, with that for pleurectomy 14.5 months, that for EPP 9.4 months, and that for unresectable patients 5.0 months. Arrhythmia (n=14; 15%) was the most common complication, and there were two deaths related to surgery (2.0%). Tumor volume of >100 ml, biphasic histology, male sex, and elevated platelet count were associated with decreased survival (p<0.05). Both EPP and pleurectomy had equivalent recurrence rates (27 of 39 [69%] and 31 of 39 [79%], respectively); however, 17 of 27 EPP recurrences as opposed to 28 of 31 pleurectomy recurrences were locoregional (p₂=0.013). Conclusions: Debulking resections for MPM can be performed with low operative mortality. Size and platelet count are important preoperative prognostic parameters for MPM. Patients with poor prognostic indicators should probably enter nonsurgical, innovative trials where toxicity or response to therapy can be evaluated. Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

'Pleural' and pulmonary carcinosarcomas.

The histological distinction between carcinosarcoma and mesothelioma has received little attention. The object of this study was to describe the histology and immunohistochemistry of two carcinosarcomas presenting as pleural tumours. These were compared with 12 carcinosarcomas from sites within the lung, and with the established features of mesothelioma. Histologically and immunohistochemically, these 'pleural' carcinosarcomas are similar to conventional pulmonary carcinosarcomas but accurate recognition is hindered by their gross appearance and biphasic histology which closely mimic mesothelioma. They may exhibit features such as neutral mucin, expression of carcinoembryonic antigen, squamous differentiation, and neuroendocrine differentiation which, when present, are evidence against mesothelioma. These tumours are rare and have passed unnoticed until now.     

恶性胸膜间皮瘤：3例尸解病例的组织化学和免疫组织化学研究

本文报告8例恶性胸膜间皮瘤尸解病例,上皮型2例,1例纤维型大体改变为巨大结节,并推挤膈肌至脐平面。对此3例进行了PAS、D-PAS,CM、AB、H-AB、CI、H-CI和CEA、Keratin、Vimentin等组化和免疫组化研究,并结合文献复习对人体胸膜间皮的组化和免疫组化特征进行了讨论,提出了人体胸膜间皮瘤的临床病理诊断与鉴别诊断意见。本组3例均合并DIC,推测本病有产生DIC的倾向性,临床对此病应警惕DIC发生的危险。     

An Autopsy Case of Peritoneal Malignant Mesothelioma in a Radiation Technologist

A case of peritoneal maligant mesothelioma in a radiation technologist, who had worked in this field for 34 years, is reported. Histopathologically, a biopsy specimen from the retroperitoneal tumor revealed a biphasic type of malignant mesothelioma. Electron microscopy disclosed that the tumor cells contained prominent microvilli, basal laminae adjacent to the stroma, junctional complexes, desmosomes, tonofilaments, clusters of glycogen granules, welt developed rough endoplasmic reticulum (RER), confronting cisternae showing direct continuity with the RER and membrane-bound granules suggestive of secretory activity. No increased amount of asbestos was detected in autopsied lung material or the peritoneal mesothelioma. The estimated cumulative dose of occupational irradiation was calculated to be about 40 to 50 rad at most. Irradiation was discussed in relation to the etiology of the peritoneal mosothelioma. Acta Pathol Jpn 40: 57–62, 1990.     

Histologic distinction between malignant mesothelioma,benign pleural lesion and carcinoma metastasis

Summary Thirty men and 7 women with malignant mesothelioma seen at the Free University Hospital from 1st January 1960 until 1st July 1981 were reviewed.The histological, histochemical and morphometrical findings are reported. These findings are compared with 25 cases of pleural metastatic carcinoma and 25 cases of reactive pleural lesions.Fourty-nine percent of malignant mesotheliomas produced hyaluronic acid, however all cases of pleural metastatic carcinomas failed to produce this substance. All cases of malignant mesothelioma were D-PAS negative while 15 cases of pleural metastatic carcinoma showed reactivity to D-PAS. All cases of malignant mesothelioma and 9 cases of metastases were CEA negative.To distinguish malignant mesothelioma from metastases it is advisable to perform the D-PAS staining first. If it is negative mesothelioma can be confirmed by showing hyaluronic acid activity. A positive CEA staining rules out mesothelioma. In our study it was shown that with these methods 18 of 37 mesotheliomas could be identified with certainty, and 22 of the 25 carcinoma metastases.Morphometrically the malignant mesotheliomas could not be distinguished from the metastases, however the reactive pleural lesions had smaller nuclei than the malignant cells with mean values below 30 mu². In the malignant cases these values had a range from 36 to 101 mu².In distinguishing between reactive pleural lesions and malignant mesothelioma the production of hyaluronic acid points to the malignant character of the lesion.Thus histochemistry and immunostaining are important in the distinction of malignant mesothelioma from metastases, while the value of morphometry lies mainly in the separation of reactive lesions from malignant mesothelioma.     

Kaposi’s sarcoma following malignant mesothelioma

We report the unusual occurrence of Kaposi’s sarcoma following asbestos-related malignant mesothelioma, in a human deficiency virus (HIV)-negative Italian man. Seropositivity to human herpes virus 8 (HHV8) was documented at the time of mesothelioma diagnosis and preceded the onset of Kaposi’ sarcoma with a time lapse of 13 months. HHV8 DNA was detected by polymerase chain reaction in lesional Kaposi’s sarcoma but not within mesothelioma. By immunostaining, mesothelioma cells expressed interleukin-6 and platelet-derived growth factor, which are important for survival of Kaposi’s sarcoma cells. Besides the possibility of a casual association, we hypothesize that mesothelioma-linked factors may have contributed to the development of Kaposi’sarcoma in the presence of HHV8 infection. Received: 12 April 1999 / Accepted: 24 June 1999     

Utility of cytokeratin 20 in identifying the origin of metastatic carcinomas in effusions

Using a commercially available monoclonal antibody (K_s20.1) and the avidin-biotin peroxidase method on cytospins and cell blocks, we analyzed cytokeratin (CK) 20 expression in 169 serous effusions. Cytoplasmic staining was observed in 44/151 malignant fluids. Colon, gastric, and pancreatic adenocarcinomas and mucinous ovarian tumors were most frequently positive. Single cases of transitional-cell and squamous cell carcinomas were reactive as well. Lung and breast cancers were mostly negative. Nonmucinous ovarian tumors were invariably unlabeled as were mesotheliomas and normal mesothelial cells. the study shows that CK 20 is valuable in distinguishing tumor cell origin in effusions. in particular, it identifies a set of carcinomas with the majority arising from the gastrointestinal tract, and represents a highly characteristic marker for colorectal cancer. © 1995 Wiley- Liss, Inc.     

Primary malignant pericardial mesothelioma

Summary Malignant primary tumors of the pericardium are rare. The autors present two male patients, aged 44 and 67 years, not exposed to asbestos, who died from pericardial mesothelioma. Repeated evacuation of fluid from the pericardium due to cardiac tamponade failed to reveal the cause of pericarditis. In one case, the diagnosis was made on surgical exploration, and in the other, at autopsy. A significant difference between benign and malignant pericardial effusion was observed. In cases of pericardial mesothelioma, symptoms of epicardial involvement cannot be attributed solely to the hindered inflow and cardiac tamponade, but also to congestive heart failure due to myocardial infiltration. In one patient, temporary improvement was achieved, first by pronisone therapy and then by radiotherapy.     

联合检测E-cadherin、CEA及Calretinin在浆膜腔积液细胞学鉴别诊断中的意义

背景与目的：浆膜腔积液中转移性腺癌细胞、恶性上皮型间皮瘤细胞和反应性间皮细胞的形态有不少相似之处，有时仅凭形态学特征不能做出准确诊断。近年来免疫细胞化学在这方面得到较多应用，但国内报道仅局限于用CK、EMA、CEA、Vim和HBME-1几种抗体，而且不能较好地进行细胞学的鉴别诊断。本研究旨在探讨联合检测E-cadherin、CEA及calretinin在浆膜腔积液鉴别诊断中的应用价值。方法：选用浆膜腔积液标本共93例，其中胸水66例、腹水24例、心包积液3例。经组织学检查或结合临床资料证实的转移性腺癌55例、恶性上皮型间皮瘤6例、间皮细胞反应性增生32例。每例均制备HE染色的涂片和细胞块，并用细胞块切片作免疫细胞化学染色。结果：E-cadherin、CEA对诊断转移性腺癌的敏感性分别为85．5％(47／55)、78．2％(43／55)，特异性分别为100％(38／38)、97．4％(37／38)。E-cadherin和CEA联合应用诊断浆膜腔积液转移性腺癌的阳性率为96．4％(53／55)。Calretinin对诊断间皮瘤和间皮细胞增生的敏感性和特异性分别为81.6％(31／38)和87．2％(48／55)。结论：E-cadherin、CEA和calretinin是鉴别浆膜腔积液转移性腺癌细胞和间皮源性细胞有价值的一组抗体。