A patient with epithelioid pleural mesothelioma (Myxoid variant) who survived for a long period without treatment

Our plain-English summary of A patient with epithelioid pleural mesothelioma (Myxoid variant) who survived for a long period without treatment, by K. Mizuhashi, K. Okamoto, T. Kishimoto (Respiratory Medicine Case Reports, 2021).

The study

• Authors: K. Mizuhashi, K. Okamoto, T. Kishimoto
• Journal: Respiratory Medicine Case Reports
• Published: 2021;33:101381
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pleural mesothelioma is a disease with a very poor prognosis. Here, we report a mesothelioma patient who survived for 5 years and a half. As a result of the autopsy, the tumor was diagnosed as a myxoid variant, which is internationally proposed as a histological subtype of epithelioid mesothelioma with a relatively favorable prognosis. Since patients with this disease are expected to survive for a long period even without treatment, careful determination of the therapeutic approach is considered necessary. This report is considered to be the first of a myxoid variant epithelioid pleural mesothelioma in Japan.

© 2021 The Author(s).

In plain English

This case report described a woman in Japan with pleural mesothelioma who lived five years and six months after the estimated onset (three years and six months after diagnosis) without anticancer treatment. A former nurse, she had no history of occupational asbestos exposure and had not lived in an asbestos-contaminated environment. Abnormal chest X-rays were found at community health screenings, and a 2007 needle biopsy showed epithelioid mesothelioma. She declined aggressive treatment. The authors judged that the disease progressed slowly at first and rapidly later. She received opioids and home oxygen and died of respiratory insufficiency in January 2011. At autopsy the tumor was diagnosed as epithelioid pleural mesothelioma, myxoid variant, without lymph node or distant spread. Her lungs held 627 asbestos bodies per gram of dry lung, which the authors said did not differ from the population average. They concluded that patients with this variant may live relatively long even without treatment, and that treatment should suit the tumor type, based on accurate diagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient, with autopsy), plus a search of a Japanese medical literature database for other long-term survivors
• Who was studied: one 82-year-old woman, a former nurse, with pleural mesothelioma, followed from abnormal screening X-rays (2005 to 2007) until her death in January 2011, admitted to Toyama Rosai Hospital, Japan
• Exposure: no known asbestos exposure: no occupational exposure (she worked as a nurse until age 72) and no residence in an asbestos-contaminated environment; lung asbestos body count at autopsy was 627 per gram dry lung, which the authors said did not differ from the population average
• Main results:
  • The patient survived an estimated five years and six months after onset (three years and six months after diagnosis) without treatment
  • She declined aggressive treatment and was followed without treatment
  • After admission in 2010 she received opioids and home oxygen; she died of respiratory insufficiency at the end of January 2011
  • The authors judged that the disease progressed slowly at first, then rapidly after about April 2008
  • At autopsy the tumor was diagnosed as epithelioid pleural mesothelioma (myxoid variant); no lymph node or distant metastasis was found
  • Ki-67 index (a measure of how fast tumor cells divide) at autopsy was 12.2% in stroma-rich areas and 17.2% in stroma-deficient areas, higher than 3.3% in the 2007 needle biopsy
  • Asbestos bodies in the autopsied lungs numbered 627 per gram of dry lung, which the authors said did not differ from the population average
  • The authors' search of the Japanese database ICHUSHI found 7 case reports, all conference proceedings, of pleural mesothelioma patients surviving five years or longer with non-surgical treatment
• The authors' conclusion: The authors concluded that patients with the myxoid variant of epithelioid pleural mesothelioma may live relatively long even without treatment, and that treatment should be chosen to suit the histological type based on accurate diagnosis
• Limitations the authors state:
  • Loss of BAP1 (a tumor marker) could not be assessed because the control cells did not stain, which the authors attributed to more than eight years having passed since the autopsy

Topics

Medical terms in this study, explained in our Lexicon: Epithelioid, Pleural Mesothelioma, Prognosis, Mesothelioma, Autopsy, Histological Subtype.

Related studies

• Myxoid variant epithelioid pleural mesothelioma defines a favourable prognosis group: an analysis of 191 patients with pleural malignant mesothelioma — F.S. Alchami, R.L. Attanoos, et al. (2017)
• A Rare Case of Pleural Epithelioid Mesothelioma With a Prominent Myxoid Stroma Reported With Morphology, Fluorescent In Situ Hybridization, and Ultrastructural Findings — H. Sonobe, R. Omote, et al. (2024)
• Malignant deciduoid mesothelioma: a rare variant of epithelioid mesothelioma — L. Taylor, D. Cooper, et al. (2019)
• Detailed clinical course of a patient with rapidly progressing sarcomatoid pleural mesothelioma without p16 deletion with systemic haematogenous metastasis to soft tissues — K. Mizuhashi, K. Okamoto, et al. (2024)
• Long-lasting production of TGF-beta1 by alveolar macrophages exposed to low doses of asbestos without apoptosis — Y. Nishimura, T. Nishiike-Wada, et al. (2007)
• Consequences of long-lasting asbestos-exposure: peripheral blood parameters in shipyard workers with and without asbestosis — I. Trosić, Z. Pisl (1995)

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