An Autopsy Case Report of Malignant Pleural Mesothelioma with Deciduoid Features

Our plain-English summary of An Autopsy Case Report of Malignant Pleural Mesothelioma with Deciduoid Features, by R. Ushio, M. Yamamoto, Y. Shibata, et al (Internal Medicine, 2015).

The study

• Authors: R. Ushio, M. Yamamoto, Y. Shibata, H. Ishii, K. Watanabe, R. Takahashi, T. Sato, M. Kudo, A. Miyake, T. Kaneko, Y. Ishigatsubo
• Journal: Internal Medicine
• Published: 2015;54(22):2915-7
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma. We experienced the case of a 73-year-old man with asbestos exposure who was diagnosed with malignant pleural mesothelioma with deciduoid features. He received chemotherapy containing six cycles of cisplatin and pemetrexed and survived for twenty-five months after the diagnosis. At autopsy, the final diagnosis was biphasic pleural mesothelioma. Cells with deciduoid features had mostly disappeared, and spindle cells markedly proliferated. To the best of our knowledge, this is the first autopsy case of malignant pleural mesothelioma with deciduoid features that exhibited a response to chemotherapy.

In plain English

This case report described a 73-year-old man treated in Japan, a former shipyard worker with asbestos exposure and a former smoker. The patient arrived with breathlessness and left chest pain from a collapsed left lung. A pleural biopsy showed malignant pleural mesothelioma with deciduoid features, a rare variant of epithelioid mesothelioma, which had caused the lung collapse. After six cycles of cisplatin and pemetrexed, the tumor thinned from 11.7 mm to 7.9 mm (a partial response), then grew to 9.25 mm during pemetrexed alone. Later chemotherapy did not shrink it. The patient died of tumor progression twenty-five months after diagnosis. At autopsy the final diagnosis was biphasic pleural mesothelioma. Deciduoid-type cells remained only in a limited area, and about half of them had died. Spindle cells had markedly multiplied. The tumor had spread to the right lung, liver, left kidney, vertebra and epicardium (outer layer of the heart). The authors concluded that deciduoid mesothelioma is able to respond to cisplatin and pemetrexed, but that more cases are needed to assess this.

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 with autopsy (one patient)
• Who was studied: one 73-year-old man seen at Yokohama City University Hospital, Japan, with sudden breathlessness and left chest pain; former 40 pack-year smoker with a past pancreatoduodenectomy for adenocarcinoma of the major duodenal papilla
• Exposure: history of asbestos exposure as a shipyard worker until retirement; fiber type and dose not stated. The patient also had a 40 pack-year smoking history.
• Main results:
  • Biopsy and immunohistochemistry (positive for calretinin, D2-40, WT-1 and CK 5/6; negative for TTF-1) led to a diagnosis of secondary pneumothorax (lung collapse) caused by malignant pleural mesothelioma with deciduoid features
  • After six cycles of cisplatin and pemetrexed, the pleural tumor showed a partial response, decreasing from 11.7 mm to 7.9 mm
  • During four further cycles of pemetrexed alone, the tumor enlarged from 7.9 to 9.25 mm; later platinum plus pemetrexed and then gemcitabine did not produce tumor regression
  • Progression-free survival for first-line cisplatin and pemetrexed plus the following pemetrexed alone was approximately ten months; the patient received chemotherapy for twenty-two months and survived twenty-five months after diagnosis, dying of tumor progression
  • At autopsy the final diagnosis was biphasic pleural mesothelioma; deciduoid features were seen only in a limited area of the primary lesion, spindle cells had markedly proliferated, and approximately half of the tumor cells with deciduoid features had necrotized (histological chemotherapy effect graded Ef 1b)
  • The tumor directly invaded the left lung and mediastinum, with metastasis to the right lung, liver, left kidney, vertebra and epicardium; emphysema and anthracosis were attributed to smoking
• The authors' conclusion: The authors concluded that their findings indicate deciduoid mesothelioma is able to respond to cisplatin and pemetrexed chemotherapy, similar to the epithelioid type but not the sarcomatoid type. They described this as, to their knowledge, the first autopsy case of malignant pleural mesothelioma with deciduoid features, in which the potential efficacy of chemotherapy was confirmed.
• Limitations the authors state:
  • The authors stated that the effectiveness of chemotherapy for this rare tumor subtype must be assessed in more cases

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: Autopsy, Pleural Mesothelioma, Mesothelioma, Epithelioid, Asbestos Exposure, Chemotherapy, Cisplatin, Pemetrexed (Alimta).

Related studies

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• Epithelial mesothelioma with deciduoid features: report of four cases — N.G. Ordóñez (2000)
• Post-irradiation pericardial malignant mesothelioma: an autopsy case and review of the literature — M. Bendek, M. Ferenc, et al. (2010)
• Heterologous sarcomatoid pleural mesothelioma with osteosarcomatous differentiation: a report of autopsy case that accomplished trimodality therapy and review of the literature — H. Itano, T. Takeda, et al. (2020)
• Deciduoid mesothelioma of the pleura in an adolescent boy — L.Y. Tsai, Y.L. Yang, et al. (2010)
• Deciduoid mesothelioma: cytologic presentation and diagnostic pitfalls — C.C. Huang, C.W. Michael (2013)

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