Adenomatoid mesothelioma with intranuclear inclusion bodies: a case report with cytological and histological findings

Our plain-English summary of Adenomatoid mesothelioma with intranuclear inclusion bodies: a case report with cytological and histological findings, by T. Kawai, K. Kawashima, H. Serizawa, et al (Diagnostic Cytopathology, 2014).

The study

• Authors: T. Kawai, K. Kawashima, H. Serizawa, H. Miura, K. Kyeongil
• Journal: Diagnostic Cytopathology
• Published: 2014;42(5):436-40
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a very unusual cytologic feature, intranuclear inclusion bodies, in mesothelioma of a predominantly adenomatoid type. The patient, a 57-year-old woman, was presented with dyspnea and right pleural effusion. Pleural aspiration cytology revealed many cohesive ball-like clusters, with a tubular pattern, composed of small atypical cells displaying a high-nuclear-cytoplasmic ratio. They had a nuclear groove and irregular intranuclear inclusion bodies. Right lung partial resection with thoracoscopy revealed that a white tumor had proliferated along the pleural surface at S(8) . Histology revealed nodular tumor cells forming dilated structures mixed with small tubular or glandular structures similar to those seen in benign adenomatoid tumors. These tumor cells had invaded peripheral lung tissues. Such inclusion bodies have not been reported earlier in mesothelioma. On the basis of this observation, we propose that the adenomatoid type of malignant mesothelioma be added to the differential diagnosis of malignant effusions when tumor cells with nuclear grooves and intranuclear inclusions are found in pleural aspiration cytology.

Copyright © 2012 Wiley Periodicals, Inc., a Wiley company.

In plain English

This case report described a 57-year-old woman with breathlessness and fluid around the right lung (pleural effusion). She had no occupational history of asbestos exposure. Chest fluid contained clusters of small abnormal cells with nuclear grooves and irregular or oval inclusions inside the nucleus. Partial removal of the right lung found a white tumor along the pleural surface. Over 95% of it was adenomatoid type, and it had invaded lung tissue. Staining was positive for mesothelial markers and negative for adenocarcinoma markers CEA, MOC31 and TTF-1; the carcinoma marker BerEP4 was negative at the first biopsy but positive at the second. The diagnosis was adenomatoid malignant mesothelioma. MIB-1, a cell-growth index, was 7 to 8% at the first biopsy and 30% at the second, a chest wall biopsy. Three years later the tumor recurred in the right chest wall, including the skin. Mesothelioma cells appeared in abdominal fluid; she died 3 years 5 months after the first operation. The authors proposed adding this tumor type to the differential diagnosis when a malignant pleural effusion shows tumor cells with intranuclear inclusions.

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 cytological, histological and immunohistochemical findings
• Who was studied: One 57-year-old woman with dyspnea and a history of fibroadenoma of the left breast; the authors are at institutions in Japan
• Exposure: No asbestos exposure was studied; the article states the patient had no occupational history of asbestos exposure
• Main results:
  • Pleural aspiration cytology showed cohesive ball-like clusters with a tubular pattern made up of small atypical cells
  • The cells had a nuclear groove and irregular or oval intranuclear inclusion bodies
  • Thoracoscopic partial resection of the right lung found a white tumor proliferating along the pleural surface at S8
  • More than 95% of the tumor was adenomatoid type, with small amounts of tubular and solid types
  • The tumor cells had invaded peripheral lung tissue
  • Immunohistochemistry was done on two specimens: the first was the lung partial resection, the second a biopsy of the thoracic wall and subcutaneous tissue
  • Mesothelial markers were positive, and the adenocarcinoma markers CEA, MOC31 and TTF-1 were negative on immunohistochemistry
  • BerEP4 (spelled 'BerER4' in the case text), which the article elsewhere lists among carcinoma markers, was negative at the first biopsy and positive at the second
  • The MIB-1 index was 7 to 8% in the first specimen and 30% in the second (chest wall) biopsy; the discussion calls these the first and second operations
  • Three years later the tumor recurred in the right thoracic wall, including the skin
  • Ascites later contained mesothelioma cells, and the patient died 3 years 5 months after the first operation
  • The final diagnosis was adenomatoid malignant mesothelioma
• The authors' conclusion: The authors concluded that, to their knowledge, this was the first report of nuclear grooves and irregular intranuclear inclusion bodies in adenomatoid pleural mesothelioma. They proposed that adenomatoid malignant mesothelioma be added to the differential diagnosis when a malignant pleural effusion shows tumor cells with intranuclear inclusions.

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: Adenomatoid Tumor, Mesothelioma, Dyspnea, Pleural Effusion, Cytology, Thoracoscopy, Histology, Malignant Mesothelioma.

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