Localized Malignant Mesothelioma

ArticleinAmerican Journal of Surgical Pathology 29(7):866-73 · August 2005with23 Reads
DOI: 10.1097/01.pas.0000165529.78945.dc · Source: PubMed
Localized malignant mesotheliomas are uncommon sharply circumscribed tumors of the serosal membranes with the microscopic appearance of diffuse malignant mesothelioma but without any evidence of diffuse spread. Little is known about their behavior. We report 23 new cases. The mean age at presentation was 63 years, and the sex ratio was approximately 2:1 (male/female). Twenty-one tumors were pleural and 2 were peritoneal. Sixteen tumors reproduced microscopic patterns of diffuse epithelial mesotheliomas, 6 had mixed epithelial and sarcomatous patterns, and 1 was purely sarcomatous. After surgical excision of the tumor, 10 of 21 patients with follow-up data were alive without evidence of disease from 18 months to 11 years after diagnosis. Patients who died had developed local recurrences and metastases, but none had diffuse pleural spread. Localized malignant mesotheliomas should be separated from diffuse malignant mesotheliomas because of their localized presentation, quite different biologic behavior, and far better prognosis.
    • "Nonspecific clinical symptoms, an unusual growth pattern, and lack of pleural effusion made it difficult for the cytopathologist to recognize this rare entity. In diffuse MM, the epithelioid type has a somewhat better prognosis than other types, but the histologic subtype does not correlate with survival or clinical course in the localized form.[2] However, because of its localized nature, it can be cured by surgical excision with longer survival rate than diffuse MM.[3] Weissferdt et al. have reported 10 cases of adenomatoid variant diffuse MM that showed a mean survival of only 10 months after diagnosis. "
    [Show abstract] [Hide abstract] ABSTRACT: A 58-year-old man presented with productive cough and fever. Computed tomography (CT) scan of the chest showed an upper right paraspinal mass. CT-guided fine-needle aspiration biopsy showed lobules of vacuolated cells against a background of myxoid material. The cells demonstrated moderate to severe nuclear atypia and occasional mitoses. Immunohistochemistry revealed tumor cells to be immunoreactive for calretinin, WT-1, D2-40, cytokeratin (CK) 7, AE1/AE3, high molecular weight keratin, vimentin and epithelial membrane antigen, and negative for thyroid transcription factor-1, Ber-EP4, carcinoembryonic antigen, S100 protein, CK20, and CDX2. The combined morphologic and immunohistochemical findings confirmed the diagnosis of microcystic variant of localized malignant mesothelioma. The subsequent lung resection showed a pleural-based mass in the right upper lobe and confirmed the diagnosis. Awareness of the existence of unusual morphologic variants and localized forms of mesothelioma are necessary to avoid misdiagnosis of fine needle biopsy samples. Recognition of characteristic cytomorphologic features along with optimal use of panel of immunohistochemistry studies is crucial for making a specific diagnosis.
    Article · Jun 2014
    • "In some cases, diagnostic imaging such as CT, MRI, and PET may provide useful information for reference, but in most cases, the definitive diagnosis is obtained by tumor resection, as in the case described in our report [3,4]. Surgery is the first choice treatment for localized tumors; however, recurrence occurs a few months after surgery and long-term survival is rarely achieved [5]. Particularly for localized tumors, patients with positive lymph node metastasis are believed to have a poor prognosis despite tumor resection [9] . "
    [Show abstract] [Hide abstract] ABSTRACT: We report an extremely rare case of resection of localized biphasic malignant peritoneal mesothelioma of the transverse colon.Case report: Computed tomography and magnetic resonance imaging in a 72-year-old man showed a tumor with enhanced borders consistent with the transverse colon. Colonoscopy showed ulcerative lesions in the transverse colon, but histological examination showed no malignancy. A gastrointestinal stromal tumor was strongly suspected, so an extended right hemicolectomy was performed. Histopathological examination showed that the tumor was a localized malignant peritoneal mesothelioma of the transverse colon. The patient did not receive postoperative chemotherapy and died 18 months after surgery. The number of patients with malignant mesotheliomas is predicted to increase in the future both in Japan and in western countries. We report this case due to its probable usefulness in future studies pertaining to the diagnosis and treatment of malignant mesotheliomas.
    Full-text · Article · Apr 2014
    • "In contrast to diffuse mesothelioma, the majority of forms of localized pleural mesothelioma have been reported to be benign, although the malignant potential of localized mesothelioma remains unclear due to its rarity. Allen et al (7) reviewed cases of localized malignant mesothelioma and proposed that it should be a separate entity from diffuse malignant mesothelioma, due to its superior prognosis and localized presentation in comparison with diffuse mesothelioma. "
    [Show abstract] [Hide abstract] ABSTRACT: Malignant mesothelioma in the mediastinum is rare and the majority of known cases have been reported as 'localized mesothelioma'. The present study reports a case of an upper mediastinal tumor, which was diagnosed through thoracoscopic surgery and surgical biopsies of the mass. A computed tomography scan revealed a giant upper mediastinal tumor, adjacent to the aortic arch, trachea, superior vena cava and left pulmonary artery. The vessels in the mediastinum were compressed and were shifted to the lower right. The trachea became stenotic and a small amount of bilateral pleural effusion was observed. The mass was relatively well encapsulated. There was no pleural thickening or clearly swollen lymph nodes in the mediastinum. The histopathological and immunohistochemical examinations of the tumor verified the diagnosis of a malignant mesothelioma. The tumor was demonstrated to be derived from the mediastinal pleural mesothelium cells. The patient received pemetrexed disodium and cisplatin combination chemotherapy for four cycles. At present, the patient is undergoing follow-up.
    Full-text · Article · Jul 2013
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