Anaplastic lymphoma kinase (ALK) translocation in paediatric malignant peritoneal mesothelioma: a case report of novel ALK-related tumour spectrum

Our plain-English summary of Anaplastic lymphoma kinase (ALK) translocation in paediatric malignant peritoneal mesothelioma: a case report of novel ALK-related tumour spectrum, by K. Loharamtaweethong, N. Puripat, N. Aoonjai, et al (Histopathology, 2016).

The study

• Authors: K. Loharamtaweethong, N. Puripat, N. Aoonjai, A. Sutepvarnon, C. Bandidwattanawong
• Journal: Histopathology
• Published: 2016;68(4):603-7
• Type of article: Case report
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: To report a case of paediatric malignant peritoneal mesothelioma (MPM) with evidence of anaplastic lymphoma kinase (ALK) translocation.

Methods And Results: We describe a 10-year-old girl who presented with abdominal pain and progressive abdominal distension. She had no history of asbestos exposure. Histopathological, immunohistochemical and ultrastructural analyses were performed and showed a biphasic malignant mesothelioma. In addition, we also studied on a selected set of immunomarkers which may be the potential therapeutic molecular targets including ALK, c-kit (CD117), epidermal growth factor receptor (EGFR) and human epidermal growth factor 2 (HER2)/neu, as well as corresponding molecular analysis. Consequently, we identified ALK expression by immunohistochemistry, together with evidence of ALK translocation by fluorescent in-situ hybridization (FISH) analysis.

Conclusions: Paediatric MPM is associated with ALK translocation in our case. The results may open up a new avenue for the study of molecular genesis of paediatric malignant mesothelioma in the future and help to determine whether patients MMs with ALK translocation would benefit from ALK inhibitor treatment.

© 2015 John Wiley & Sons Ltd.

In plain English

This was a case report from a hospital in Bangkok, Thailand, about a 10-year-old Thai girl with malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. She had a 4-month history of abdominal pain and swelling. The article states she had no previous history of asbestos exposure. She had surgery to remove as much tumour as possible. Pathologists found a biphasic mesothelioma: about 70% epithelioid tissue and about 30% sarcomatous tissue. Standard mesothelial markers were diffusely positive. Electron microscopy showed features the authors called characteristic of mesothelioma. Testing for possible drug targets found moderate staining for the ALK protein in 30% of tumour cells. A genetic test (FISH) showed a result consistent with an ALK gene translocation in 56% of cells in epithelioid areas and 50% in sarcomatoid areas. HER2/neu was not amplified, and CD117 and EGFR showed no stained cells. Six months after diagnosis she was still alive after cisplatin and gemcitabine chemotherapy. The authors concluded that in this case the mesothelioma was associated with ALK translocation. They said larger studies are needed to find how common this is.

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)
• Who was studied: One 10-year-old Thai girl with malignant peritoneal mesothelioma, treated at Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
• Exposure: The patient had no previous history of asbestos exposure. The study examined the tumour's molecular markers (ALK, CD117, EGFR, HER2/neu), not an exposure.
• Main results:
  • The tumour grew in a biphasic pattern: epithelioid component about 70% of the tumour, sarcomatous component about 30%
  • Mesothelial markers calretinin, CK5/6, podoplanin and WT1 were diffusely positive
  • ALK immunohistochemistry: moderate (2+) cytoplasmic staining in 30% of tumour cells, in both epithelioid and sarcomatoid components
  • ALK FISH showed separated signals in 56% of tumour cells in epithelioid areas and 50% in sarcomatoid areas, consistent with a translocation involving the chromosome 2p23 region
  • HER2/neu showed weak (1+) staining in 10% of cells, but FISH was negative for HER2/neu amplification; CD117 and EGFR showed no stained cells
  • Electron microscopy showed long, slender microvilli, which the authors described as characteristic of mesothelioma
  • Six months after diagnosis the patient was still alive, having received cisplatin and gemcitabine
• The authors' conclusion: The authors concluded that in their case paediatric malignant peritoneal mesothelioma was associated with ALK translocation. They suggested it may possibly represent a disorder differing from adult disease.
• Limitations the authors state:
  • The authors stated that larger studies with in-depth molecular analyses are needed to determine the true prevalence of this translocation and its gene partner
  • The authors stated that the treatment impact of ALK translocation in this disease remains for future clinical studies

Topics

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

Medical terms in this study, explained in our Lexicon: Translocation, Peritoneal Mesothelioma, Asbestos Exposure, Biphasic Mesothelioma, Malignant Mesothelioma, EGFR, HER2, Immunohistochemistry.

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