Deciduoid Mesothelioma Research Articles

Pleural malignant deciduoid mesothelioma: Case report of a rare variant of epithelioid mesothelioma

Malignant deciduoid mesothelioma (MDM), a rare variant of epithelioid mesothelioma, accounts for less than 5% of mesotheliomas. The term deciduoid mesothelioma was introduced by Nascimento et al. in 1994 to describe a rare variant of epithelioid mesothelioma that bears a morphological resemblance to decidua or decidual-type changes. It has an unknown etiology, and the relation with asbestos exposure remains debatable. The presence of decidual-type cells often makes the diagnosis difficult in the small biopsy specimen, especially in the peritoneal biopsy of young female patients, as they can be misdiagnosed as normal decidualized tissue. The prognosis of deciduoid mesothelioma was considered poor, but now reports suggest that the prognosis depends on the grade of the tumor. Mesothelioma is more commonly seen in older men, but deciduoid mesothelioma most often occurs in young women and is initially thought to occur only in the peritoneum of young women. Later case reports of this rare variant occurring in the pleura, the pericardium, and the tunica vaginalis of older adults are also seen. Herein we report a case of a 60-year-old male patient diagnosed with high-grade malignant deciduoid pleural mesothelioma on small biopsy, treated with four cycles of neoadjuvant chemotherapy (Pemetrexed + Carboplatin + Bevacizumab), with partial favorable response to chemotherapy underwent pleurectomy. Following this, the patient was on maintenance chemotherapy; unfortunately, he had progressive disease with adrenal and lymph node metastasis.

Mesotelioma deciduoide pleural: presentación de 3 casos y revisión de la literatura

Deciduoid mesothelioma is an uncommon histological variant of epithelial mesothelioma which is extremely clinically aggressive. We report 3 cases of pleural caducoid mesothelioma in women of 75, 74 and 23 years of age. All patients presented with dyspnoea, vomiting and pelvic pain. Their imaging studies showed nodular pleuropericardic thickening, a parietal pleuropericardic solid mass and a large thoracic mass, respectively. Only one of them could be treated with chemotherapy, surgery and radiotherapy. Post diagnostic survival was 24 days, 1 month and 17 months respectively (mean 6.2 months).We describe the clinicopathological and immunohistochemical findings together with a review of the relevant literature.

Clinicopathologic study of deciduoid mesothelioma using SMARCB1/INI1 immunohistochemistry and fluorescence in situ hybridization

Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma. Malignant rhabdoid tumors, renal medullary carcinoma, and some synovial sarcomas show a loss of SMARCB1/INI1 protein, a member of the SWI/SNF chromatin-remodeling complex. All of those tumors are known to have rhabdoid cells. Some mesothelioma cases, such as those of the deciduoid type, have also been reported to possess such rhabdoid features. Since this topic has not been studied in malignant mesothelioma, we analyzed the immunohistochemical expression of SMARCB1/INI1 in malignant mesotheliomas [45 epithelioid type (including 9 deciduoid type), 12 biphasic type, and 17 sarcomatoid type]. We employed (a) SMARCB1/INI1 immunohistochemistry, using an antibody to the INI1 gene product and (b) Fisher exact test, logistic regression analysis, the Kaplan-Meier method, and the Wilcoxon test for survival analysis for prognostic factor evaluation (SAS 9.4; SAS Institute, Cary, NC). The results showed that 17 of 74 (23%) malignant mesothelioma cases (epithelioid: 24%; biphasic; 8%; sarcomatoid; 29%) had reduced SMARCB1/INI1 expression. Reduced SMARCB1/INI1 expression appeared to be more frequent in the deciduoid type (67%), of which there were admittedly only a few cases, than in either the epithelioid type (14%) or biphasic type (8%), whether or not rhabdoid cells were present, but not different between the deciduoid and sarcomatoid types. However, there was no statistically significant difference in prognosis between malignant mesotheliomas with reduced versus preserved SMARCB1/INI1 protein expression. The results suggest that in differential diagnosis, cases with reduced SMARCB1/INI1 protein expression should not be excluded from a diagnosis of malignant mesothelioma.

Primary Malignant Deciduoid Mesothelioma: A Challenging Diagnosis.

Primary malignant deciduoid mesothelioma is a rare subtype of epithelioid mesothelioma that was first described in the peritoneum in young women without a history of asbestos exposure. It was thought to be a distinct clinicopathologic entity with ominous prognosis; recent studies have better characterized this entity. On morphology, primary malignant deciduoid mesothelioma is characterized by cytomorphologic features resembling decidualized tissue. Pleomorphism is variable. The immunoprofile is similar to other epithelioid mesotheliomas. The prognosis is the same as other epithelioid mesotheliomas and seems to depend on histological grade.

Malignant Deciduoid Mesothelioma: case presentation of an exceptional variant and review of the literature

BackgroundMalignant Deciduoid Mesothelioma (MDM) is an extremely rare variant of epithelioid mesothelioma. It was first described in young females, in the peritoneum, and its relation with asbestos was not well defined.Later reports, have shown that this variant may also occur in the pleura, the pericardium and the tunica vaginalis of elderly people, who had been exposed to asbestos.Case presentationWe report a case of malignant deciduoid mesothelioma that occurred in the peritoneal cavity, and the omentum of a 35-year-old woman. The patient had never been exposed to asbestos.ConclusionsThrough this observation, we describe clinical, histopathological, and immunohistochemical findings of deciduoid mesothelioma, and review the literature reports.

Deciduoid mesothelioma of the thorax: A comprehensive review of the scientific literature.

Deciduoid mesothelioma is a rare variant of malignant epithelioid mesothelioma. It often involves the peritoneum, but also thoracic cases have been reported. The aim of the present review is to describe the demographic, clinical, radiological, and pathological features of such a rare variant of thoracic mesothelioma, and the state of the art regarding the therapeutic approaches currently available. English-language articles published from 1985 to June 2016, and related to thoracic deciduoid mesothelioma cases were retrieved using the Pubmed database. The search terms were "mesothelioma," "thoracic mesothelioma," "epithelial mesothelioma," "pleural mesothelioma," and "deciduoid mesothelioma." Forty-four cases included in 16 articles, published in the period under investigation, were analyzed in detail. The mean age of the patients was 63 years, and the male to female ratio 1.7:1. Approximately 58% had exposure to asbestos, and 73% had a smoking history; familiarity was rarely reported. The most common anatomical site of origin was the right pleura, and the most frequent clinical manifestations were chest pain, dyspnea, cough, and weight loss. Thoracic X-ray and computed tomography were the imaging techniques most employed for diagnosis and surgical planning. The pathological diagnosis was obtained by examination of surgical or biopsy specimens in most cases. The best treatment strategy of deciduoid mesothelioma is a matter of debate; nevertheless a multidisciplinary approach is currently the best option for the choice of the adequate therapeutic scheme.

Deciduosis peritoneal difusa simulando un mesotelioma deciduoide en una paciente primigrávida

We report a case of rare, florid peritoneal deciduosis in a 36 year old patient who underwent a caesarean section at the 37th week of her first pregnancy after labour induction failed. She had an unremarkable previous medical history. On laparotomy, multiple firm, whitish nodules measuring between 0.2 and 0.5cm were seen in the abdominal cavity. As peritoneal carcinomatosis was suspected, biopsies were taken of ovaries, bladder, omentum and appendix. A thoraco-abdominopelvic CT scan was performed postoperatively which showed abdominal-peritoneal involvement and ascites. Histopathology and immunohistochemistry confirmed a diagnosis of diffuse peritoneal deciduosis. Diffuse peritoneal deciduosis must be carefully differentiated from tumour metastases and deciduoid mesothelioma as it usually regresses spontaneously after delivery.

Malignant Mesothelioma Diagnosis.

Malignant mesothelioma is a relatively rare pleural tumor that may mimic benign mesothelial lesions and various other tumors including carcinomas and sarcomas. This makes the diagnosis challenging for the pathologist. To provide a brief but useful update on the immunohistochemical, cytogenetic, and molecular markers that are currently available for the diagnosis of malignant mesothelioma. Reference materials including peer-reviewed publications, text books, and consensus opinion reports among pathologists. It is important to correlate histologic findings on adequate biopsy samples with clinical and radiologic features. Useful diagnostic mesothelial markers include calretinin, WT-1, cytokeratin 5/6, and D2-40 (podoplanin). It is recommended that at least 2 mesothelial and 2 carcinoma markers with greater than 80% sensitivity and specificity be used for the diagnosis of mesothelioma when all clinical, radiologic, and histologic features are concordant. p16 deletion is reported in up to 70% of primary epithelioid and 90% to 100% of sarcomatoid pleural mesotheliomas. Presence of this homozygous gene deletion is so far the best indicator of mesothelioma. To date, this deletion has not been reported in any benign mesothelial lesion. The impact of various histologic patterns on the clinical and prognostic aspects of mesothelioma is addressed. The pleomorphic pattern, when present in more than 10% of tumor, translates into a highly aggressive behavior and is associated with poor survival. Recent studies have shown that the high-grade subgroup of deciduoid mesothelioma with pleomorphic histologic pattern also has a more aggressive clinical course. Nuclear grade (combination of nuclear atypia and mitotic count) may also prove to be an independent prognostic factor.

A Rare Form of Mesothelioma: Malignant Pleural Deciduoid Mesothelioma

Mesothelioma usually develops in elder male patients that are exposed to asbestos. Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma and has a poorer prognosis than epithelioid mesothelioma. As this subtype was seen in the peritoneum of young females and its relation with asbestos was not definite, these lesions were formerly thought to be stimulated by endogenous hormones. In the subsequent years, a relation was established between this tumor and asbestos since it was seen in the pericardium and pleura of males. In this paper, we present a 64-year-old male patient with asbestos exposure, diagnosed as having malignant pleural deciduoid mesothelioma, in which a long survival was provided with chemotherapy after surgery.

腹膜に原発した脱落膜様悪性中皮腫の 1 例

We report herein on a case of malignant deciduoid mesothelioma arising in the peritoneum. A 74-year-old man was found to have ascites. Cytological examination of the ascites revealed large atypical oval cells with rich cytoplasm. The nucleus, single or multinucleated, was located at the center of the cell, and showed coarse granular chromatin and several nucleoli.Malignant mesothelioma was suspected from these findings. From the subsequent peritoneal biopsy, the tumor was diagnosed as a malignant deciduoid mesothelioma. Immunohistochemical and electron microscopic examinations confirmed the mesothelial characteristics of the tumor cells. Cytological findings of this rare variant of a malignant mesothelioma are shown for diagnostic purposes.

Deciduoid mesothelioma: report of 21 cases with review of the literature

Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma that was initially considered to occur exclusively in the peritoneum of young women who had no history of asbestos exposure and to be characterized by an aggressive clinical course, but it was later demonstrated that this tumor could also occur in the pleura of older men and women who had been exposed to asbestos. Some subsequent studies have also indicated that the clinical course is no different from that of conventional epithelioid mesothelioma. Herein are reported 21 cases of deciduoid mesothelioma that were investigated using a large panel of immunohistochemical markers, 9 of which were also studied by electron microscopy. Fifteen of the patients were male and 6 were female (mean age, 60 years). Seventeen of the cases originated in the pleura and four in the peritoneum. Histologically, all of the cases were composed of large, polygonal or ovoid cells with well-defined cell borders, dense eosinophilic cytoplasm, and single or multiple nuclei. In some cases, the cells exhibited a wide variation in their size and shape, frequent loss of cell cohesion, marked nuclear atypia, and high mitotic activity (>5 per 10 HPF); whereas, in others, the cells were more cohesive, less pleomorphic, and the mitotic activity low. As the survival of patients in the first group of cases was shorter (mean, 7 months), when compared with that of the latter (mean, 23 months), it is concluded that the differences in prognosis reported in deciduoid mesothelioma are due to the existence of a high-grade subgroup that presents highly aggressive clinical behavior. Therefore, when a high-grade deciduoid mesothelioma is present, it should be reported as it can significantly affect prognosis and treatment. The use of immunohistochemistry and electron microscopy in assisting in the differential diagnosis of deciduoid mesothelioma is also discussed.

Deciduoid pleural mesothelioma – A rare entity in a young woman

Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma; it was initially thought that it only occurred in the peritoneum of young women and had nothing to do with asbestos exposure. However, since these early findings it has also been observed in the pleura and the pericardium, with possible association to asbestos. In general the prognosis is poor compared to epithelioid mesothelioma. 45 cases have been reported in the literature up to now, 22 of these were located in the pleural cavity. The authors describe a case of deciduoid pleural mesothelioma in a 40-year-old-woman who presented with right pleuritic chest pain, with no history of asbestos exposure, treated with chemotherapy followed by surgery and who died postoperatively.

Deciduoid mesothelioma: Cytologic presentation and diagnostic pitfalls

We report two cases of malignant deciduoid mesothelioma (MDM), a very rare variant of malignant mesothelioma (MM). Case 1: An 18-year-old male with no history of asbestos exposure presented with worsening abdominal pain, anorexia, and vomiting after a motor vehicle accident. A CT scan showed small amount of ascites and abdominal mass. An exploratory laparotomy revealed multiple yellow tan, firm nodules on the peritoneum and omentum. He received palliative treatment and died 5 months after the diagnosis. Case 2: A 64-year-old female with history of asbestos exposure initially presented with abdominal distension. CT scan showed abdominal mass with a large amount of ascites. A diagnostic laparoscopy revealed multiple peritoneal nodules. She underwent several regimens of chemotherapy over a period of 69 months and is still alive to date. In both cases, features of mesothelial origin were subtle and the smears showed predominantly single cells with marked nuclear atypia. The second case also contained few two-dimensional loose cell clusters with scalloped or hobnail borders. The clusters often exhibited a pseudoacinar structure surrounding a globular extracellular material. Groups of three to four cells often formed doublets and triplets with cell-to-cell windows. Our results show that MDM may not present with the traditional cytological features described in MM and can manifest with more nuclear pleomorphism resulting in erroneous diagnosis. Recognition of the subtle mesothelial features along with the appropriate ancillary tests is essential for accurate diagnosis.

La déciduose ectopique : variabilités de présentation pendant la grossesse et diagnostics différentiels

The ectopic decidua is a common occurrence during pregnancy, corresponding to the presence of decidual tissue outside the endometrium. The pathophysiology of these lesions is not yet fully elucidated. The phenomenon is most often benign, with a favourable outcome in the post-partum and without follow-up. Because of the wide range of clinical presentations, from localized peritoneal granulation to large pelvic mass, the clinical diagnosis of ectopic decidua is difficult. Furthermore, imaging is not specific. The discovery of such lesions should lead to the realization of systematic biopsies for histological examination and rule out other causes such as lesions of tuberculosis or carcinomatosis. Immunohistochemical studies are helpful in differentiating deciduosis from malignant deciduoid mesothelioma, its main differential diagnosis with a catastrophic prognosis.

Mesotelioma deciduóide pleural – uma entidade rara numa mulher jovem

Deciduoid Mesothelioma is a rare variant of epithelioid mesothelioma; it was initially thought that it only occurred in the peritoneum of young women and had nothing to do with asbestos exposure. However, since these early findings it has also been observed in the pleura and the pericardium, with possible association to asbestos. In general the prognosis is poor compared to epithelioid mesothelioma. 45 cases have been reported in the literature up to now, 22 of these were located in the pleural cavity. The authors describe a case of deciduoid pleural mesothelioma in a 40-year-old-woman who presented with right pleuritic chest pain, with no history of asbestos exposure, treated with chemotherapy followed by surgery and who died postoperatively.

Epithelioid malignant mesothelioma of tunica vaginalis with deciduoid features: An unusual malignancy clinically masquerading an inguinal hernia

Paratesticular/scrotal and inguinal canal mass lesions in elderly patients may pose a diagnostic challenge to both the surgeon as well as the pathologist. In most cases, these represent hernial sacs with their contents, and true neoplasms like lipomas, rhabdomyosarcomas, and fibrous pseudotumors are infrequent. Malignant mesotheliomas arising from the tunica layers are rare cause of inguinal and paratesticular tumors. Herein, we report a case of an elderly patient who presented with an inguinal hernia which pathologically had features of deciduoid malignant mesothelioma.

Metastasis of a pleural mesothelioma to a hyperplastic stomach polyp: an increase of vimentin expression is seen during a gain in deciduoid morphology

Deciduoid mesothelioma is a rare variant of the epithelioid histotype spectrum, resembling decidua of gravid uterus. It is found in the peritoneum of young women, but also in the pleura of elderly people. Histotype plasticity from epithelioid to sarcomatoid mesothelioma may be considered as epithelial-mesenchymal transition (EMT). A full autopsy was performed and mesothelioma infiltrates were analysed by immunohistochemistry. The metastasis of an epithelioid pleural mesothelioma to a hyperplastic polyp of the stomach is presented in this autopsy case. Deciduoid morphology increased during tumour progression and metastasis. The increase in eosinophilic cytoplasm correlated with the upregulation of the intermediate filament vimentin. High expression of vimentin was found in both central and superficial periglandular regions of the polyp. High vimentin expression also can occur in epithelioid rather than sarcomatoid differentiation. Thus, although vimentin is considered to be the major EMT marker, additional pathways must regulate its expression.

Hypodermal Decidualized Endometrioma With Aberrant Cytokeratin Expression. A Lesion Mimicking Malignancy

Decidualized endometrioma is a pseudoneoplastic lesion that may appear as a solitary nodule in the hypodermis, simulate a malignant epithelioid tumor, and can represent a diagnostic challenge. A 36-year-old woman delivered a full-term baby by cesarean. At the immediate puerperium, she complained of a subcutaneous nodule measuring 2.5 cm, underneath a previous caesarean scar from the former full-term delivery 3 years earlier. Histologic features included a nodular growth pattern of large monomorphic epithelioid cells showing diffuse positivity for cytokeratin (AE1/AE3, 18), human placental lactogen, and CD10 and focal positivity for inhibin alpha. The main differential diagnoses include trophoblastic neoplasia and deciduoid mesothelioma. Good clinicopathological correlation is essential for the correct diagnosis. Immunohistochemical stains can be misleading. An important clue is the combination of large decidualized cells and lumens lined by flat or low cuboidal cells that are atrophic endometrial glands. This lesion has a benign behavior.

Primary malignant deciduoid peritoneal mesothelioma: A report of the cytohistological and immunohistochemical appearances

Malignant deciduoid mesothelioma (MDM) is a rare variant of epithelioid mesothelioma. This type of tumor might be associated with the asbestos exposure and carries a poor prognosis in general. MDM was first described by Nascimento et al. in 1994 in a peritoneal lesion of a young woman. And its diagnosis is frequently mistaken with florid mesothelial hyperplasia and peritoneal deciduosis. There are 44 MDM cases reported in the literature up today. A 59-year-old woman patient referred to our clinic was identified with an abdominal mass. Computed tomography of whole abdomen of the patient showed a mass with the widest transverse dimension of 65 × 60 mm at abdominal bifurcation in the mesenteric region. The patient was diagnosed with MDM after the cytopathological examination of the fine needle aspiration biopsy performed from the mass. Consequently, she received a total mass excision and right hemicolectomy under general anesthesia. The cytomorphological appearance of the ascitic fluid is detailed for the first time by Gillespie et al. and is described only in two manuscripts. In the present study, we aimed to report a case of a 59-year-old woman since she was diagnosed with MDM and because her cytological findings were further supported by histomorphological and immunohistochemical evaluations of the operation material obtained from the patient.

DECIDUOID MESOTHELIOMA OF THE PLEURA IN AN ADOLESCENT BOY

Deciduoid mesothelioma is an extremely rare variant of malignant epithelioid mesothelioma. This report presents the case of a 13-year-old boy with this type of tumor in his pleura, whose initial main symptoms were chest pains and progressive scoliosis. Ensuing chemotherapy, which comprised pemetrexed and cisplatin, yielded good response after 5 cycles. Subsequent radical surgery was carried out and another 3 cycles of chemotherapy were given. The patient has been doing well 2 years after completion of this regime of treatment.