Spindle cell tumors of the pleura: Differential diagnosis

Thoracic Oncology Program, Cardinal Bernardin Cancer Center, Loyola University, Maywood, Illinois, USA.
Seminars in Diagnostic Pathology (Impact Factor: 2.56). 03/2006; 23(1):44-55. DOI: 10.1053/j.semdp.2006.06.002
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Spindle cell tumors that arise in or metastasize to the pleura must be thoroughly evaluated to arrive at a definitive diagnosis. Malignant mesothelioma is the most common tumor arising in the pleura, but metastatic tumors to the pleura occur more frequently. Additionally, many tumors arising in the lung and surrounding tissues involve the pleura. It is crucial to arrive at a correct diagnosis since many of these neoplasms show different prognoses and require varying treatment modalities. Sarcomatoid malignant mesothelioma is a rare tumor that arises in the pleura, and can be confused with numerous tumors arising in or metastasizing to the pleura, including synovial sarcoma, metastatic sarcomatoid carcinoma, metastatic melanoma, thymoma, renal cell carcinoma, localized fibrous tumor, leiomyosarcoma, and other types of sarcoma. Desmoplastic malignant mesothelioma is a fibrous sarcomatoid variant of malignant mesothelioma, and is occasionally mistaken for chronic fibrous pleurisy. Here, we review morphological, clinical, histological, immunohistochemical, ultrastructural, and molecular methods that aid in the diagnosis of spindle cell tumors of the pleura, and we provide specific examples of patients in which this multi-modal approach proved to be helpful.

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    • "Synovial sarcoma is a relatively rare malignancy that typically occurs in adolescents and young adults between the ages of 15 and 50 years of age and most commonly affects the extremities in the vicinity of large joints such as the knee or the thigh (Cadman et al., 1965; Cordon-Cardo, 1997; Nicholson et al., 1998; Cappello and Barnes, 2001; Kumar et al., 2005c) and the hands or feet (Michal et al., 2006). Because synovial sarcoma can be difficult to distinguish from reactive mesothelial proliferation and sarcomatoid mesothelioma by use of histology and immunohistochemical markers alone (Shiraki et al., 1989; Moran et al., 1992; Nicholson et al., 1998; Miettinen et al., 2001; Carbone et al., 2002; Gladish et al., 2002; Vohra et al., 2004; Taylor et al., 2005; Michal et al., 2006; Rdzanek et al., 2006), it represents another alternative carcinoma to consider when evaluating suspected sarcomatoid mesothelioma cases. This has been particularly true since the discovery of highly specific genetic lesions [t(x;18), SYT-SSX1, SSX2, and SSX4 fusion genes] in synovial sarcoma tumors that clinically distinguish this particular this tumor type (Colwell et al., 2002; Amary et al., 2007; Weinbreck et al., 2007). "
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