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Marchevsky AM, Khoor A, Walts AE, Nicholson AG, Zhang YZ, Roggli V, Carney J, Roden AC, Tazelaar HD, Larsen BT, LeStang N, Chirieac LR, Klebe S, Tsao MS, De Perrot M, Pierre A, Hwang DM, Hung YP, Mino-Kenudson M, Travis W, Sauter J, Beasley MB, Galateau-Sallé F. Localized malignant mesothelioma, an unusual and poorly characterized neoplasm of serosal origin: best current evidence from the literature and the International Mesothelioma Panel. Mod Pathol 2020; 33:281-296. [PMID: 31485011 PMCID: PMC10428660 DOI: 10.1038/s41379-019-0352-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 12/12/2022]
Abstract
Localized malignant mesotheliomas (LMM) is an uncommon and poorly recognized neoplasm. Its pathologic diagnosis is often surprising in patients with serosal/subserosal based localized tumors that are clinically suspicious for metastatic lesions or primary sarcomas. Once a tumor is diagnosed as "mesothelioma", LMM is often mistaken for diffuse malignant mesothelioma (DMM). Best currently available evidence about LMM was collected from the literature and cases diagnosed by members of the International Mesothelioma Panel (IMP). One hundred and one (101) LMM have been reported in the English literature. Patients had localized tumors with identical histopathologic features to DMM. Patients ranged in age from 6 to 82 years; 75% were men. Most (82%) of the tumors were intrathoracic. Others presented as intrahepatic, mesenteric, gastric, pancreatic, umbilical, splenic, and abdominal wall lesions. Tumors varied in size from 0.6 to 15 cm. Most patients underwent surgical resection and/or chemotherapy or radiation therapy. Median survival in a subset of patients was 29 months. Seventy two additional LMM from IMP institutions ranged in age from 28 to 95 years; 58.3% were men. Sixty tumors (83.3%) were intrathoracic, others presented in intraabdominal sites. Tumors varied in size from 1.2 to 19 cm. Median survival for 51 cases was 134 months. Best evidence was used to formulate guidelines for the diagnosis of LMM. It is important to distinguish LMM from DMM as their treatment and prognosis is different. A multidisciplinary approach is needed for the diagnosis of LMM as it shows identical histopathology and immunophenotype to DMM.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Child
- Diagnosis, Differential
- Evidence-Based Medicine
- Female
- Humans
- Male
- Mesothelioma, Malignant/diagnostic imaging
- Mesothelioma, Malignant/mortality
- Mesothelioma, Malignant/pathology
- Mesothelioma, Malignant/therapy
- Middle Aged
- Pleural Neoplasms/diagnostic imaging
- Pleural Neoplasms/mortality
- Pleural Neoplasms/pathology
- Pleural Neoplasms/therapy
- Predictive Value of Tests
- Prognosis
- Solitary Fibrous Tumor, Pleural/diagnostic imaging
- Solitary Fibrous Tumor, Pleural/mortality
- Solitary Fibrous Tumor, Pleural/pathology
- Solitary Fibrous Tumor, Pleural/therapy
- Tumor Burden
- Young Adult
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Affiliation(s)
| | | | - Ann E Walts
- Departments of Pathology Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Yu Zhi Zhang
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | - Sonja Klebe
- Flinders University, Adelaide, SA, Australia
| | - Ming-Sound Tsao
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Marc De Perrot
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew Pierre
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David M Hwang
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Yin P Hung
- Massachusetts General Hospital, Boston, MA, USA
| | | | - William Travis
- Sloan Kettering Memorial Cancer Center, New York, NY, USA
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Kato K, Gemba K, Fujimoto N, Aoe K, Takeshima Y, Inai K, Kishimoto T. Pleural irregularities and mediastinal pleural involvement in early stages of malignant pleural mesothelioma and benign asbestos pleural effusion. Eur J Radiol 2016; 85:1594-600. [PMID: 27501894 DOI: 10.1016/j.ejrad.2016.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/23/2016] [Accepted: 06/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To elucidate differences in the level and localization of pleural irregularities in early malignant pleural mesothelioma (eMPM) and benign asbestos pleural effusion (BAPE) using CT. STUDY DESIGN Retrospective assessment of CT findings of consecutive patients with BAPE at a single centre and patients with eMPM reported in Japanese vital statistics. METHODOLOGY Thirty-six patients with confirmed diagnoses of BAPE and sixty-six patients with confirmed diagnoses of eMPM (mesothelioma stages T1 or T2) were included. Informed consent, CT scans, and clinical and pathologic details were obtained for all patients and were reviewed by one radiologist, two pathologists, and two pulmonologists. Asbestosis, pleural plaque, rounded atelectasis, and diffuse pleural thickening were assessed in all patients. RESULTS Prevalence of asbestosis, pleural plaque, rounded atelectasis, and diffuse pleural thickening was significantly higher in the BAPE group. Low-level irregularity was more common in the BAPE group (p<0.001), whereas high-level irregularity, mediastinal localization, and interlobar fissure were more prevalent in the eMPM group (p<0.001). Interlobar pleural irregularity was not observed in any patients in the BAPE group, although 55% of patients in the eMPM group showed interlobar pleural irregularity. Mediastinal pleural involvement was observed in 74% of patients in the eMPM group and had a positive predictive value of 89%. CONCLUSION This study demonstrates that the level and localization of plural irregularities significantly differed between patients with BAPE and eMPM. Large-scale prospective studies are needed to fully establish the diagnostic utility of such differences.
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Affiliation(s)
- Katsuya Kato
- Department of Radiology, Okayama University Hospital, 2-1-1 Shikatacho, Okayama 7008558, Japan.
| | - Kenichi Gemba
- Department of Medical Oncology, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 7028055, Japan
| | - Nobukazu Fujimoto
- Department of Medical Oncology, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 7028055, Japan
| | - Keisuke Aoe
- Department of Medical Oncology, National Hospital Organization Yamaguchi-Ube Medical Center, 685 Higashikiwa, Ube 7550241, Japan
| | - Yukio Takeshima
- Department of Pathology, Hiroshima University Graduate School of Medicine, 1-2-3 Kasumi, Hiroshima 7340037, Japan
| | - Kouki Inai
- Department of Pathology, Hiroshima University Graduate School of Medicine, 1-2-3 Kasumi, Hiroshima 7340037, Japan
| | - Takumi Kishimoto
- Department of Internal Medicine, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 7028055, Japan
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Nakano T, Hamanaka R, Oiwa K, Nakazato K, Masuda R, Iwazaki M. Localized malignant pleural mesothelioma. Gen Thorac Cardiovasc Surg 2012; 60:468-74. [DOI: 10.1007/s11748-012-0025-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 07/28/2011] [Indexed: 11/29/2022]
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Liu H, Cheng YJ, Chen HP, Hwang JC, Chang PC. Multiple bowel intussusceptions from metastatic localized malignant pleural mesothelioma: A case report. World J Gastroenterol 2010; 16:3984-6. [PMID: 20712062 PMCID: PMC2923775 DOI: 10.3748/wjg.v16.i31.3984] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local recurrence 10 mo after initial en bloc surgical resection. Abdominal computed tomography was performed for intractable, vague abdominal pain with episodic vomiting, which showed a “target sign” over the left lower quadrant. Laparotomy revealed several intra-luminal metastatic tumors in the small intestine and colon and a segmental resection of metastatic lesions was performed. Unfortunately, the patient died of sepsis despite successful surgical intervention. Though local recurrence is more frequent in LMPM, the possibility of distant metastasis should not be ignored in patients with non-specific abdominal pain.
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Abstract
Localized malignant pleural mesothelioma is very rare tumor disease. There are sporadic reports in the literature showing that this entity has a different biologic behavior compared with diffuse pleural mesothelioma. We report two cases of radically resected localized pleural malignant mesothelioma, with a previous history of asbestos exposure. Both cases showed a microscopic and immunohistochemical findings of malignant mesothelioma, biphasic and sarcomatoid lympho-histiocitoid variant type, respectively, without evidence of diffuse pleural spread. The first is very peculiar case of bilateral localized malignant pleural mesothelioma with complete response to chemotherapy and localized late recurrence, radically resected and treated with adjuvant radiotherapy. The second case revealed as a solitary localized mass, underwent a complete en bloc resection and adjuvant radiotherapy. Both cases demonstrate that the localized malignant mesothelioma should be distinguished from diffuse form and that complete resection is associated with good prognosis.
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