Adenocarcinoma simulating mesothelioma: a clinicopathologic and immunohistochemical study of 29 cases

Our plain-English summary of Adenocarcinoma simulating mesothelioma: a clinicopathologic and immunohistochemical study of 29 cases, by M.N. Koss, M. Fleming, R.M. Przygodzki, et al (Annals of Diagnostic Pathology, 1998).

The study

• Authors: M.N. Koss, M. Fleming, R.M. Przygodzki, A. Sherrod, W. Travis, L. Hochholzer
• Journal: Annals of Diagnostic Pathology
• Published: 1998;2(2):93-102
• Type of article: Case report
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report 29 cases of adenocarcinomas whose clinical, gross, and microscopic appearance resembled diffuse malignant pleural mesothelioma. Initial criteria for inclusion in the study included availability of an open pleural biopsy or decortication specimen and microscopic evidence of neutral (periodic acid-Schiff positive) mucin in the tumor. The median age of the patients was 63 years (range, 31 to 78 years), with a peak age in the seventh decade. There were 24 men and five women. Thirteen of them had a history of smoking; six (21%) had possible or definite occupational exposure to asbestos. Three (21%) of 14 lung specimens showed ferruginous bodies and two (14%) showed microscopic evidence of asbestosis. At least 25 patients had pleural effusion, most typically unilateral. Needle biopsy of pleura showed malignancy in 10 (77%) of 13 cases. Most (20 of 29) patients underwent pleural stripping. Radiotherapy and chemotherapy was each given to three patients without effect. Median survival by Kaplan-Meier estimate was 8 months, with an 18-month survival of 13%. Histologically, glands (23 cases), nests (13 cases), tubulopapillary arrays (12 cases), or sheets (eight cases) of tumor cells were found. Spindling of neoplastic cells was seen in 10% of cases. Three (21%) of 14 lung specimens showed a subpleural adenocarcinoma. Antibodies to polyclonal CEA, Ber-EP4, Leu-M1, and B72.3 were positive in 94%, 56%, 50%, and 44% of cases, respectively. All but one of the cases stained with two or more of the antibodies CEA, Ber-EP4, Leu-M1, or B72.3. This study indicates that adenocarcinomas simulating mesothelioma are aggressive variants of peripheral adenocarcinomas with a poor prognosis, that they can show pathological evidence of asbestos exposure in a subset of cases, and that immunohistochemical and histochemical stains are useful in their differential diagnosis with diffuse malignant mesotheliomas.

In plain English

This study described 29 patients with adenocarcinomas resembling diffuse malignant pleural mesothelioma. The cases came from Armed Forces Institute of Pathology files. Each case needed an open pleural biopsy or decortication specimen and microscopic neutral, periodic acid-Schiff-positive mucin in the tumor. There were 24 men and five women; six (21%) had possible or definite occupational exposure to asbestos. Of 14 cases with lung tissue, three showed ferruginous bodies and two showed asbestosis. By comparison, ferruginous bodies were found in 12 of 29 mesotheliomas and none of 17 peripheral adenocarcinomas and bronchioloalveolar carcinomas. Among 22 patients with survival data, median survival was 8 months; 18-month survival was 13%. All 15 tumors tested stained for polyclonal CEA; all but one stained for at least two of four carcinoma markers. The authors concluded that these tumors are aggressive, with a poor prognosis, that they can show pathological evidence of asbestos exposure in a subset of cases, and that special stains help distinguish them from mesothelioma. They noted that clinical-record exposure histories may be skewed and called for asbestos fiber counts to confirm their results.

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: Retrospective clinicopathologic and immunohistochemical case series drawn from pathology files. It included a parallel comparison of ferruginous bodies in lung tissue from mesotheliomas and from ordinary peripheral lung adenocarcinomas.
• Who was studied: 29 patients with adenocarcinoma simulating mesothelioma, with cases submitted to the Armed Forces Institute of Pathology by institutions in 16 US states. There were 24 men and 5 women, with a median age of 63 years (range 31 to 78). The comparison groups were 29 diffuse malignant mesotheliomas and 17 peripheral adenocarcinomas and bronchioloalveolar carcinomas. Study dates were not given, but many cases dated back more than 15 years.
• Exposure: Asbestos exposure histories came from clinical records. Six patients had possible or definite occupational exposure. Two had worked in asbestos plants: one for 15 years, who developed asbestosis, and one for only several months. One had been exposed to 'transite' 30 years before admission, one had worked with asbestos for 20 years, one had been exposed 30 years before admission, and one sold asbestos-containing materials. No fiber types were named. Thirteen patients had a history of smoking.
• Main results:
  • Six of the 29 patients (21%) had possible or definite occupational exposure to asbestos.
  • Ferruginous bodies were found in lung tissue in 3 (21%) of the 14 adenocarcinoma-simulating-mesothelioma cases that had lung tissue.
  • In the comparison series, ferruginous bodies were found in 12 of 29 diffuse malignant mesotheliomas (41%).
  • In the comparison series, ferruginous bodies were found in none (0%) of 17 peripheral adenocarcinomas and bronchioloalveolar carcinomas.
  • Two (14%) of the patients with adenocarcinoma simulating mesothelioma had microscopic evidence of asbestosis.
  • Hyaline pleural plaques were seen in the pleural tissue in three cases (10%), and one of these also had asbestosis.
  • Survival data were available for 22 patients. Median survival by Kaplan-Meier estimate was 8 months (range 1 to 23 months), 1-year survival was 39%, and 18-month survival was 13%.
  • Of the 14 cases with lung tissue, 3 (21%) showed an area of subpleural adenocarcinoma.
  • In the 15 cases with enough tissue for immunostaining, polyclonal CEA stained 100%, Ber-EP4 60%, Leu-M1 53% and B72.3 47%.
  • All but one of the 15 cases expressed two or more of these carcinoma markers, most often three.
  • Mucin staining with acid mucopolysaccharide or alcian blue stains resisted hyaluronidase predigestion in all 23 of 23 cases tested.
  • A pleural effusion was reported on chest radiograph in 25 cases. Pleural biopsy showed malignancy in 10 (77%) of 13 cases.
• The authors' conclusion: The authors concluded that adenocarcinomas simulating mesothelioma are aggressive variants of peripheral adenocarcinomas with a poor prognosis. They concluded that these tumors can show pathological evidence of asbestos exposure in a subset of cases, and that immunohistochemical and histochemical stains are useful in distinguishing them from diffuse malignant mesotheliomas.
• Limitations the authors state:
  • Many cases dated back more than 15 years, so clinical information was often incomplete.
  • Smoking was probably under-reported because of incomplete records.
  • Exposure histories came from clinical records rather than comprehensive employment or exposure histories, which may produce skewed data.
  • Autopsies were often unavailable, so the authors could not rule out that some pleural tumors were spread from a hidden primary cancer outside the lung.
  • The authors stated that asbestos fiber counts on ashed lung tissue from a large number of patients are needed to confirm the ferruginous body findings.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Adenocarcinoma, Mesothelioma, Pleural Mesothelioma, Pleural Biopsy, Occupational Exposure, Ferruginous Bodies, Pleural Effusion, Needle Biopsy.

Related studies

• Adenocarcinoma simulating mesothelioma — B. Corrin, A. Dewar (1996)
• Immunohistochemical panels for differentiating epithelial malignant mesothelioma from lung adenocarcinoma: a study with logistic regression analysis — R. Carella, G. Deleonardi, et al. (2001)
• Calretinin, thrombomodulin, CEA, and CD15: a useful combination of immunohistochemical markers for differentiating pleural epithelial mesothelioma from peripheral pulmonary adenocarcinoma — C.E. Comin, L. Novelli, et al. (2001)
• Immunohistochemical distinction of malignant mesothelioma from pulmonary adenocarcinoma with anti-surfactant apoprotein, anti-Lewisa, and anti-Tn antibodies — M. Noguchi, T. Nakajima, et al. (1989)
• E-cadherin, E-selectin and vascular cell adhesion molecule: immunohistochemical markers for differentiation between mesothelioma and metastatic pulmonary adenocarcinoma? — A.M. Müller, A. Weichert, et al. (2002)
• Immunohistochemical reactivity in mesothelioma and adenocarcinoma: a stepwise logistic regression analysis — A. Dejmek, A. Hjerpe (1994)

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