Malignant Pleural Mesothelioma and Thoracic Needle Biopsy

Abstract

To the Editor: We read with interest a recent article entitled “Diagnosis of Malignant Pleural Mesothelioma by Axillary Lymph Node Biopsy” by Kim et al (Chest 1987; 91:279–81). In the past, malignant mesothelioma was a rare tumor. The diagnosis was difficult, sometimes diagnosed merely by exclusion of other tumors. In the past 20 years, however, the incidence of the tumor has been increasing. The mainstream of thought emanating from the literature is that techniques are, at the present time, capable of producing a completely reliable diagnosis of malignant mesothelioma. The combination of cytologic, enzyme immunohistochemical, electron microscopic and morphometric study may be useful in the early diagnosis.1Kwee WS Veldhuizen RW Golding RP Mullink H Stam J Donner R Boon ME. Histologic distinction between malignant mesothelioma, benign pleural lesion and carcinoma metastasis.Virchows Arch [Pathol Anat]. 1982; 397: 287-299Crossref PubMed Scopus (65) Google Scholar More recently, we attempted to obtain not only a cytologic specimen by aspiration, but also a core of tissue for histologic examination.2Weisbrod GL. Percutaneous fine-needle aspiration biopsy of the mediastinum.Clin Chest Med. 1987; 8: 27-41PubMed Google Scholar Our 37 cases (32 pleural, four peritoneal and one pericardial) of malignant mesothelioma revealed no axillary lymph node involvement and only five cases of primary malignant pleural mesothelioma with neoplastic involvement of cervical node.1Kwee WS Veldhuizen RW Golding RP Mullink H Stam J Donner R Boon ME. Histologic distinction between malignant mesothelioma, benign pleural lesion and carcinoma metastasis.Virchows Arch [Pathol Anat]. 1982; 397: 287-299Crossref PubMed Scopus (65) Google Scholar This tumor has a tendency to develop along the serosa, with invasion into surrounding tissue such as the submesothelial connective tissue, the chest wall, diaphragm and subserosal parenchyma. Fourteen of 32 cases of pleural malignant mesothelioma had destroyed intercostal structures and/or ribs. Generally, collection of a biopsy specimen of malignant pleural mesothelioma is easier than other deep part tumors because subserosal invasion is notorious for this tumor and destruction of chest wall frequently occurs. We recently diagnosed a case of pleural malignant mesothelioma by a simple subcutaneous needle aspiration biopsy. The tissue block was prepared for enzymhistochemical and immunoperoxidase techniques. The absence of epithelial mucin (periodic acid-Schiff negative staining after diastase); presence of hyaluronc acid (alcian blue staining become negative after hyaluronidase digestion); presence of keratin protein; absence of carcinoembryonic antigen in the epithelial cells and positive vimentin staining in fibrous component were compatible with the diagnosis of biphasic malignant mesothelioma. CT scan findings supported this diagnosis. Thoracic needle aspiration biopsy is a useful diagnostic technique. It offers the advantages of a rapid diagnosis, minimal trauma to the patient, low complication rate, and relatively low cost.3Conces DJ Schwenk R Doering PA Giant MD. Thoracic needle biopsy improved results utilizing a team approach.Chest. 1987; 91: 813-816Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar Malignant Pleural Mesothelioma and Thoracic Needle BiopsyCHESTVol. 93Issue 5PreviewTo the Editor: Full-Text PDF