Cases Of Malignant Mesothelioma Research Articles

Primary Malignant Mesothelioma of the Appendix

We report a case of primary malignant mesothelioma of the appendix. A 35-year-old man without any history of asbestos exposure was admitted to our hospital for further examination following the discovery of multiple liver tumors, an ileocecal tumor, and abdominal lymph node swelling. An ultrasound-guided liver tumor biopsy revealed malignant mesothelioma. Despite receiving systemic chemotherapy, he died 3 months after the initial diagnosis. At autopsy, a diagnosis of multiple organ metastases from a malignant biphasic mesothelioma of the appendix was made. To our knowledge, this is only the second reported case of primary malignant mesothelioma of the appendix.

A Case of Peritoneal Malignant Mesothelioma Diagnosed by Laparoscopy

症例は52歳, 男性. 腹部膨満感, 体重減少, 易疲労感, 食思不振を主訴に石井病院内科を受診した. 初診時腹部は著明に膨満していた. CT検査で腹腔内に多量の腹水を認めたが, はっきりした腫瘤性病変などはなかった. PET-CTでは右腹腔内の壁側腹膜に沿った部位と下行結腸付近にFDGの集積がみられた. 腹腔穿刺細胞診では, 出血炎症性の背景に中皮細胞が孤立性～集塊状に多数出現していて, 中皮由来の細胞集塊と考えられたが, 確定診断にはいたらなかった. 生検を目的に, 内科から外科に転科し, 腹腔鏡手術を施行した. 腹腔鏡で観察すると, 腹腔内には多量の腹水が貯留しており, PET-CTで集積を認めた右側腹部腹壁に白色調のうずら卵大の腫瘤があったが, 下行結腸付近にははっきりした腫瘤はなかった. うずら卵大の腫瘤を切除し, 病理検査に供したところ腫瘤は悪性腹膜中皮腫と診断された. 化学療法を目的として群馬大学第2外科に紹介され, GemcitabineとCarboplatinによる化学療法を開始した.

Malignant peritoneal mesothelioma with nonspecific history: a case report

In the United States, mesothelioma, a rare cancer, is estimated to occur in approximately 2,500 people annually [1]. Sporadic cases have been reported in Korea. Although, malignant pleural mesothelioma is the most common type of mesothelioma, mesothelioma has also observed in the peritoneum and pericardium. Malignant pleural mesothelioma is observed mainly in older men (median age, 72 years) who have been exposed to asbestos, although it occurs decades after exposure (20 to 40 years later) [2]. Most cases of mesothelioma have been linked to asbestos exposure, however, some reports have suggested that radiotherapy may also be a cause of mesothelioma [3,4]. Reports of malignant peritoneal mesotheliomas in women are rare. The significant variation in incidence may reflect erroneous diagnosis of peritoneal serous carcinomas or well-differentiated papillary mesotheliomas as malignant peritoneal mesothelioma. Frequency of exposure of asbestos in patients with malignant peritoneal mesothelioma ranges from 0 to 50% [5]. Malignant peritoneal mesotheliomas are most commonly diagnosed during the fifth to seventh decades of life [6]. We report on a case of malignant peritoneal mesothelioma in a 53-year-old woman with no history of exposure to asbestos or previous radiotherapy, along with a brief review of the literature.

A case of malignant peritoneal mesothelioma successfully treated with systemic chemothrapy

A case of malignant peritoneal mesothelioma successfully treated with systemic chemothrapy

Malignant Pleural Mesothelioma

malignant pleural mesothelioma is a relatively uncommon disease associated with asbestos exposure. its incidence increased markedly following the widespread mining and use of asbestos in many industries. the legal aspects regarding compensation cases for those who have developed this disease has raised its profile in the media, but also compounds the stress of diagnosis for patients. it has an insidious onset and may clinically and pathologically mimic other benign or malignant processes, complicating diagnosis. radical surgery may be used for a highly selected population of malignant pleural mesothelioma patients in the context of multimodality treatment in an experienced thoracic surgical centre, but there is no randomised evidence to support its benefit. in most cases surgery is used to treat symptoms or obtain tissue for diagnosis. Combination of a platinum agent and pemetrexed is now widely used and shown to prolong life. other treatments including radiotherapy, analgesics and supportive interventions are an integral part of the treatment of this disease. Further research is being undertaken on promising novel therapies for use in this disease, which will be discussed in this review. malignant pleural mesothelioma (mpm) is a neoplasm originating from mesothelial cells, which form the membranes surrounding the lung cavities. it is currently a disease mainly of the industrialised world, closely linked to asbestos exposure.1 seldom diagnosed prior to the advent of widespread asbestos mining in the early to mid twentieth century, it has risen in incidence over the last five decades.2, 3 according to the most recent australian institute of health and Welfare data, in 2009 there were 666 cases of malignant mesothelioma diagnosed in australia.4 this review will provide a brief overview of the diagnosis, current treatment modalities and some novel systemic treatment strategies that have been explored in mpm. Asbestos and malignant mesothelioma mpm is a disease with particular relevance to australia. Asbestos was first mined in Australia in the 1880s near Jones Creek, a town in nsW.5 it was not until the late 1940s when the insulating properties of asbestos rendered it a useful product in the building industry during the post war building boom, and subsequent demand for asbestos saw mining production rise exponentially in mines in nsW, tasmania, south australia and Western australia.5 there has also been widespread exposure within the building and transport industries in which asbestos was broadly utilised.6 Asbestos mining ended in Australia in 1983, and it is expected that malignant mesothelioma related to occupational exposure will plateau in the coming decade. in a Western Australian study, however, a significant increase was noted in the number of people being diagnosed with malignant meosthelioma whose only exposure to asbestos must have occurred in a non-occupational setting (most likely during home maintenance and renovation). Between 2005 and 2008, 8% of males and 5% of females diagnosed with malignant mesothelioma in this series reported non-occupational exposure as their only exposure to asbestos.6 these observations ask for confirmation in a case-controlled epidemiological study.

Malignant mesothelioma in Metsovo, Greece, from domestic use of asbestos: 30 years later

To the Editors: Malignant mesothelioma (MM) is a devastating disease, almost exclusively due to inhalation of asbestos fibres, and with higher risk for amphiboles [1]. Mediterranean regions, such as Turkey, Cyprus and Corsica, and others, such as New Caledonia [2], have experienced epidemics of MM as a result of nonoccupational, “domestic” exposure to tremolite asbestos and fibrous erionite [3]. In 1987, we reported on the very high incidence, 300 times higher than expected, of MM in the area of Metsovo, a complex of small villages in the prefecture of Ioannina in north-west Greece [4]. This, in conjunction with the previously noted very frequent pleural calcifications among Metsovites [5], led to the discovery of the culprit, a tremolite asbestos-containing whitewash (“luto” in the local dialect) [6]. The material was used by practically all households until 1940–1950. After that, it was gradually substituted by modern materials that did not contain asbestos. In 1980, luto was used by only 18% of builders and by 1990 it had been abandoned altogether (fig. 1) [7]. In 1996, we reported that the incidence of MM in the period 1985–1994 declined to one-third compared with the period 1980–1984, and we attributed the reduction to the abandonment of the use of luto. As a result, we concluded that the “Metsovo mesothelioma epidemic” would decline by 2020–2030 [8]. Figure 1– Percentage of Metsovo (Greece) households using luto from 1940–1990 (•) and the decline in Metsovo malignant mesothelioma (MM) cases between 1980 and 2009 in 5-yr (white bars) and 10-yr intervals (grey bars). In the …

Lung cancer a hot topic at AACR meeting

Lung cancer a hot topic at AACR meeting

Malignant mesothelioma of the peritoneum invading the liver and mimicking metastatic carcinoma: A case report

We present a case of malignant mesothelioma of the peritoneum with massive direct invasion to the liver in a 58-year-old Japanese woman. She had no history of asbestos exposure or other malignancies. Abdominal computed tomography revealed one 8-cm intrahepatic mass adjacent to the abdominal wall with peritoneal thickening, multiple smaller nodules in the peritoneal cavity, and intra-abdominal lymphadenopathy. Liver biopsy showed a small cluster of atypical cells similar to epithelial neoplasm, which formed a tubulopapillary structure. The tumor cells were positive for calretinin with strong nuclear and cytoplasmic expression together with podoplanin (D2-40) and some cytokeratins, but were negative for hepatocyte paraffin 1 and other adenocarcinoma markers. We confirmed a diffuse peritoneal mesothelioma with direct invasion to the liver. Liver masses with other peritoneal nodules are mostly encountered as metastatic diseases. However, the possibility of mesothelioma should be considered, even in women without an apparent history of asbestos exposure.

Malignant biphasic peritoneal mesothelioma in a child: Fine‐needle aspiration cytology, Histopathology, and immunohistochemical features along with review of literature

Peritoneal mesotheliomas in children are of rare occurrance. We herein report the clinical, radiological, and pathological findings of a rare case of malignant peritoneal mesothelioma occurring in nine-year-old female child. The child presented with abdominal distension and awareness of a painless mass in the abdomen which on radiology appeared as a large heterogeneous pelvic mass with peritoneal deposits at multiple sites. To the best of our knowledge, this is the first case of a peritoneal malignant mesothelioma on which fine needle aspiration (FNA) was performed as first line investigation of the primary tumor. The cytological features, major differential diagnoses, and the pitfalls therein are discussed. Histopathology revealed biphasic pattern of mesothelioma which is again a rare pattern. Immunochemistry was carried out on the cell block made from the FNA as well as the biopsy specimen essentially showed the same features. There was positivity for vimentin, EMA, and cytokeratin 5/6 while WT1, calretinin, and CEA were negative; however, D2-40 showed diffuse membranous positivity in the epithelial areas and cytoplasmic positivity in the spindle areas confirming a mesothelioma. We emphasize the use of immunochemistry on cell block material for a confident diagnosis of mesothelioma in such cases.

Usefulness of Claudin 4 in the cytological diagnosis of serosal effusions

The identification of metastatic cells in serous effusions has prognostic and therapeutic implications, thus leading to a continuous search for improvement of the existing diagnostic procedures, including immunocytochemistry. To evaluate the usefulness of an antibody recognizing the tight junction-associated protein Claudin 4 in detecting metastatic tumor cells and in the differential with reactive and neoplastic mesothelium, we stained 345 cases of benign and neoplastic serous effusions obtained from pleura, peritoneum, and pericardium. Two-hundred and twenty-eight of 230 cases (99.1%) of epithelial metastasis of different origin were strongly stained by anti-Claudin 4, whereas all cases of reactive mesothelitis (78) and malignant mesothelioma (37) were negative. With the exception of a single case of ovarian carcinoma hypercalcemic-type, all tumors originating from the anatomical sites that most frequently metastasize to the serosae, including lung (61), breast (23), female genital tract (67), gastrointestinal tract (27), and peritoneum (6), were found to be positive. Claudin 4 was also extremely useful in detecting single-tumor cells dispersed among heavy inflammatory reaction. Because of its high sensitivity (99.1%) and specificity (100%), Claudin 4 might be used as an ideal "single-shot" marker for the identification of metastatic epithelial cells in serous effusions.

Rarity of malignant mesothelioma prior to the widespread commercial introduction of asbestos: The Mount Sinai autopsy experience 1883-1910

Most malignant mesotheliomas are related to asbestos exposure. Whether malignant mesothelioma occurs in the absence of asbestos exposure remains unsettled. To address this question we reviewed a series of 2,025 autopsies performed at the Mount Sinai Hospital between 1883 and 1910, prior to the widespread commercial introduction of asbestos. Retrospective autopsy review. No cases of malignant mesothelioma were identified in 2,025 autopsies performed between 1883 and 1910. Malignant mesothelioma was rare prior to the widespread commercial introduction of asbestos.

A Case of Malignant Pleural Mesothelioma With Osseous and Cartilaginous Differentiation

A 69-year-old man with a history of exposure to asbestos was admitted because of a chest radiographic abnormality. Subsequent findings from computed tomography and a thoracoscopic biopsy suggested malignant mesothelioma. Punctate calcification was observed in the pleural tumor on computed tomography scanning. The patient underwent pleuropneumonectomy, and the tumor was pathologically diagnosed as malignant mesothelioma, sarcomatoid type with osseous and cartilaginous differentiation. Malignant mesothelioma with osseous and cartilaginous differentiation is a rare condition. Punctate calcification in the pleural mass as a lesion distinct from the pleural plaque may indicate osseous or osteosarcomatous differentiation in malignant mesothelioma.

A Case of Malignant Pericardial Mesothelioma With Constrictive Pericarditis Physiology Misdiagnosed as Pericardial Metastatic Cancer

Malignant pericardial mesothelioma is a rare and progressive cardiac tumor. There is no established standard treatment and the prognosis is poor. Most patients were retrospectively diagnosed from surgery or autopsy due to absence of specific clinical manifestation. Most patients with pericardial mesothelioma have demonstrated constrictive physiology on echocardiography or cardiac catheterization. Therefore, pericardial mesothelioma was often misdiagnosed as other causes of constrictive pericarditis. We report a case of primary pericardial mesothelioma misdiagnosed as pericardial metastasis of unknown origin.

Peritoneal malignant psammomatous mesothelioma

Psammoma bodies (PBs) are observed most commonly in papillary thyroid carcinoma, meningioma, and papillary serous cystadenocarcinoma of the ovary. We report one case of peritoneal malignant mesothelioma (PMM) with massive deposition of PBs. A 72-years-old man presented with abdominal swelling and marked weight loss. Contrast enhanced computed tomography showed fluid diffuse in peritoneal recesses, thick septa with micronodules in the greater omentum and adjacent enhancement of the thickened peritoneum. The explorative laparoscopy showed diffuse minute parietal peritoneal nodules. The peritoneal biopsy revealed a superficial papillary growth of malignant epithelial-like cells with diffuse involvement of submesothelial tissues. Massive deposition of PBs was observed. Nuclear and cytoplasmic calretinin immunoreactivity was present in neoplastic cells along with membranous D2-40 and membranous/cytoplasmic cytokeratin 5 staining. The patient was treated with chemotherapy (gemcitabine, vinorelbine, cisplatin). PBs may represent an active biologic process ultimately leading to degeneration/death of tumor cells and retardation of growth of the neoplasm. It may also serve as a barrier against the spread of tumor. Psammomatous malignant mesothelioma may simulate serous psammocarcinoma of the peritoneum. The behavior of serous psammocarcinoma is more closely similar to borderline serous tumor than to serous carcinoma. Further studies are necessary to establish if massive deposition of PBs may define a new variant of psammomatous malignant mesothelioma with a favorable impact to the prognosis of usual psammomatous malignant mesothelioma, as well as in serous psammocarcinoma of the peritoneum.

Archives of "Comprehensive Approach on Asbestos-Related Diseases" Supported by the "Special Coordination funds for Promoting Science and Technology (H18-1-3-3-1)" -Overview of Group Research Project, Case and Specimen Registration, Cellular Characteristics of Mesothelioma and Immunological Effects of Asbestos-

The research project entitled "Comprehensive approach on asbestos-related diseases" supported by the "Special Coordination Funds for Promoting Science and Technology (H18-1-3-3-1)" began in 2006 and was completed at the end of the Japanese fiscal year of 2010. This project included four parts; (1) malignant mesothelioma (MM) cases and specimen registration, (2) development of procedures for the early diagnosis of MM, (3) commencement of clinical investigations including multimodal approaches, and (4) basic research comprising three components; (i) cellular and molecular characterization of mesothelioma cells, (ii) immunological effects of asbestos, and (iii) elucidation of asbestos-induced carcinogenesis using animal models. In this special issue of the Japanese Journal of Hygiene, we briefly introduce the achievements of our project. The second and third parts and the third component of the fourth part are described in other manuscripts written by Professors Fukuoka, Hasegawa, and Toyokuni. In this manuscript, we introduce a brief summary of the first part "MM cases and specimen registration", the first component of the fourth part "Cellular and molecular characterization of mesothelioma cells" and the second component of the fourth part "Immunological effects of asbestos". In addition, a previous special issue presented by the Study Group of Fibrous and Particulate Substances (SGFPS) (chaired by Professor Otsuki, Kawasaki Medical School, Japan) for the Japanese Society of Hygiene and published in Environmental Health and Preventive Medicine Volume 13, 2008, included reviews of the aforementioned first component of the fourth part of the project. Taken together, our project led medical investigations regarding asbestos and MM progress and contributed towards the care and examination of patients with asbestos-related diseases during these five years. Further investigations are required to facilitate the development of preventive measures and the cure of asbestos-related diseases, particularly in Japan, where asbestos-related diseases are predicted to increase in the next 10 to 20 years.

Clinical characteristics and treatment outcomes in 132 patients with malignant mesothelioma

Purpose:Our objective is to scrutinize clinical, laboratory, radiological characteristics, treatment regimens, and treatment outcomes of malignant mesothelioma (MM) cases in our hospital.Materials and Methods:We investigated, retrospectively, the clinical characteristics and treatment outcomes of all 132 MM patients at Dicle University Hospital between January 2006 and April 2010.Results:A total of 82 (62.1%) patients were male, and 50 (37.9%) female. Median age was 56.0 years. Mean survival time was 9.6±6.9 months. Mean survival time of patients who had received best supportive care was 7.5 months, chemotherapy 10.4 months, and multimodality treatment regimen 12.6 months. Patients in the multimodality treatment group survived longer than did those in the other two groups (P=0.042). A total of 76 patients received chemotherapy, of whom 17 (22.3%) were administered Cisplatin/Carboplatin and Gemcitabine, 58 (76.4%) Cisplatin/Carboplatin and Pemetrexed, and one (1.3%) Cisplatin + Docetaxel. Complete and partial response to treatment in patients receiving Cisplatin/Carboplatin and Gemcitabine was found 47.1% and Cisplatin/Carboplatin and Pemetrexed was found 50.0% (P>0.05).Conclusions:MM related to asbestos exposure is seen frequently in Turkey. Patients present with the typical clinical features of dyspnea, weight loss, and chest pain. Survival analysis shows that patients receiving multimodality treatment may be better.

Malignant Mesothelioma: A Clinical Study of 238 Cases

Malignant mesothelioma is a diffuse tumor arising in the pleura, peritoneum, or other serosal surface and is closely associated with asbestos exposure. An estimated 2,500 to 3,000 cases are diagnosed each year in the United States. Although there are individual case reports and small series detailing the clinical aspects of mesothelioma, few studies examine a large series of patients with malignant mesothelioma from the clinical perspective. This study reports on the findings of 238 cases of malignant mesothelioma from a private consultative medical practice. Most cases had a history of occupational asbestos exposure. The mean latency was 48.5 yr, with women having a longer latency than men. The mean age at diagnosis was 70. Survival overall was poor (mean 8.8 months), but treatment was beneficial (mean 11.3 versus 6.4 months). Epithelioid histology conferred a survival advantage over sarcomatoid and responded better to treatment. Our data support an inverse relationship between asbestos dose and latency.

Malignant mesothelioma with prominent adenomatoid features: a clinicopathologic and immunohistochemical study of 10 cases

The clinicopathologic and immunohistochemical features of 10 cases of pleural malignant mesothelioma with predominantly adenomatoid growth pattern are described to determine the clinical, histologic, and behavioral features of these tumors and to highlight the importance of separating this unusual pattern from the benign adenomatoid tumor. Seventy-seven cases of pleural biopsy and extrapleural pneumonectomy specimens for malignant mesothelioma were examined to identify the specific type of histologic growth pattern exhibited by the tumors. The 10 cases herein described were identified as an unusual histopathologic subset of these tumors. Nine patients were men and one was a woman with an age range of 56 to 82 years (mean, 68.5 years). The main presenting symptoms included cough, dyspnea, and chest pain. The typical features of pleural malignant mesothelioma were noted both radiologically and macroscopically. The tumors were characterized by diffuse pleural thickening with confluent nodular patches of tumor obliterating the pleural space. Histologically, a distinct morphology was observed composed of small tubular spaces lined by epithelioid cells, reminiscent of adenomatoid tumors of the genital tract. Immunohistochemical studies confirmed the mesothelial nature of the tumors. Clinical follow-up in 7 of 7 patients demonstrated a mean survival of 10 months from time of diagnosis. Adenomatoid mesothelioma is an unusual variant of epithelioid malignant mesothelioma that histologically may mimic a range of other tumors, including benign adenomatoid tumors and metastases of adenocarcinoma to the pleura. The clinical presentation, infiltrative growth, distinct histologic features, cytologic atypia and immunohistochemical profile all serve to differentiate adenomatoid malignant mesothelioma from other infiltrative processes involving the pleura.

Immunocytochemistry of CD146 is useful to discriminate between malignant pleural mesothelioma and reactive mesothelium

Malignant pleural mesothelioma is a refractory tumor with poor prognosis associated with asbestos exposure. Pleural effusion is frequently observed in patients with malignant pleural mesothelioma, and cytological analysis is effective to detect malignant pleural mesothelioma. However, cytological discrimination between malignant pleural mesothelioma and reactive mesothelium is often difficult. Increased expression of CD146, a cell adhesion molecule, has been reported to be closely associated with an advanced stage of malignant melanoma, prostate cancer, and ovarian cancer. In this study, to evaluate the diagnostic utility of CD146 for discrimination between malignant pleural mesothelioma and reactive mesothelium, we examined immunocytochemical expression of CD146 in malignant pleural mesothelioma and reactive mesothelium using two clones of CD146 antibody, OJ79 and EPR3208, on smear specimens of effusion fluids. Immunocytochemical stains were semiquantitatively scored on the basis of immunostaining intensity (0, negative; 1, weak positive; 2, moderate positive; and 3, strong positive). CD146 expression was detected in 15 of 16 malignant pleural mesothelioma with median immunostaining score of 3 by OJ79, and in 19 of 21 malignant pleural mesothelioma with median immunostaining score of 2 by EPR3208. Strong immunoreactivity of CD146 was observed at the apposing surfaces of cell–cell interactions on the plasma membrane of mesothelioma cells. In addition, one OJ79-negative case of malignant pleural mesothelioma was positive for CD146 by EPR3208 and two EPR3208-negative cases of malignant pleural mesothelioma were CD146 positive by OJ79, showing that all 23 malignant pleural mesothelioma cases were positive for CD146 by either OJ79 or EPR3208. On the other hand, CD146 expression was undetectable in all reactive mesothelium cases by OJ79 and EPR3208. The sensitivity of OJ79 and EPR3208 was 94 and 90%, respectively, and the specificity was 100% for both clones. We propose that CD146 is a sensitive and specific immunocytochemical marker enabling differential diagnosis of malignant pleural mesothelioma from reactive mesothelium.

A Rare Cause of Dysphagia: Malignant Pleural Mesothelioma in the Posterior Mediastinum

A 69-year-old man presented to the emergency room with dysphagia and vomiting. A computed tomographic scan revealed a posterior mediastinal mass surrounding the lower portion of the esophagus. Endoscopic examination demonstrated narrowing of the lower esophagus without malignant mucosal lesions. Thoracoscopic biopsies of the mediastinal mass failed to yield a pathologic diagnosis. The hyaluronic acid concentration in the left pleural effusion was remarkably high (755 mg/L), which is a finding strongly suggestive of malignant mesothelioma. Four months after the initial admission, a subcutaneous nodule was found in the left chest wall and a biopsy was taken. The histopathologic and immunohistochemical findings of the biopsy were consistent with the diagnosis of pleural malignant mesothelioma.