Biphasic malignant mesothelioma cases with osseous differentiation and long survival: a review of the literature

Our plain-English summary of Biphasic malignant mesothelioma cases with osseous differentiation and long survival: a review of the literature, by F. Demirag, E. Unsal, I. Tastepe (Lung Cancer, 2007).

The study

• Authors: F. Demirag, E. Unsal, I. Tastepe
• Journal: Lung Cancer
• Published: 2007;57(2):233-6
• Type of article: Case report, Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This report describes two cases of diffuse biphasic malignant mesothelioma with osseous differentiation and long survival. Two male patients aged 66 and 54 years presented with chest pain, bloody pleural effusions, and diffuse and nodular pleural thickening. They both had a history of prolonged asbestos exposure. Sarcomatoid and epithelioid areas were identified on histopathological examination. In addition, there were foci of ossification. Epithelioid tumor cells as well as benign osteoclasts within the ossification reacted positively for cytokeratin 5/6, whereas sarcomatoid areas were negative. Both patients survived 39 and 69 months, respectively. To our knowledge, these two cases with biphasic malignant mesothelioma and osseous differentiation with long survival are the first to be described from Central Anatolia.

In plain English

This short communication described two men from Central Anatolia, Turkey, with biphasic malignant pleural mesothelioma. Biphasic means the tumor contains both epithelioid and sarcomatoid areas. Both tumors also contained foci of bone formation. The authors compared them with earlier published cases. Both men were farmers with a history of asbestos exposure: about 50 years in the first patient, aged 65, and 30 years in the second, aged 54. The article did not name a fiber type. Both had chest pain and left-sided pleural effusion with pleural thickening. In the first patient, ferruginous bodies were found in the lung beneath the pleura. Epithelioid tumor cells and osteoclasts (bone cells) stained for cytokeratin 5/6, while sarcomatoid areas did not. In the second patient, a first pleural biopsy was negative. A later thoracoscopic biopsy was diagnosed as sarcomatoid mesothelioma, and surgery five years later found scant epithelioid areas. The first patient survived 39 months. The second survived 69 months after the thoracoscopy and died 7 months after the later surgery. The authors suggested that markers linked to bone formation might predict survival.

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 of two patients, with a table of previously reported cases of malignant mesothelioma with osseous differentiation
• Who was studied: two male farmers from Central Anatolia, Turkey, aged 65 (case 1) and 54 (case 2), treated at a chest diseases hospital in Ankara
• Exposure: history of asbestos exposure for approximately 50 years (case 1) and 30 years (case 2); fiber type and source not reported; case 1 also had a 30 pack-year smoking history, case 2 no smoking history
• Main results:
  • Case 1: ferruginous bodies were found beneath the pleura in the lung tissue
  • In both cases, epithelioid tumor cells stained for cytokeratin 5/6, sarcomatoid (spindle cell) areas were negative, and osteoclasts within the ossification were positive for cytokeratin 5/6
  • Case 1 (stage III, T3 N0 M0) survived 39 months
  • Case 2: thoracocentesis and pleural biopsy were negative for malignancy
  • Case 2: a later video-assisted thoracoscopy biopsy was diagnosed as sarcomatoid malignant mesothelioma, stage II
  • Case 2: at decortication five years later, the tumor was mainly spindle cells with ossification and cartilage, with scant epithelioid areas and no necrosis
  • Case 2 survived 69 months after video-assisted thoracoscopy and died 7 months after decortication
  • The authors stated that only 15 cases of malignant mesothelioma with osseous differentiation had been reported. In their table, the earlier cases with known survival survived 2 to 10 months, and the others were listed as necropsy or not available. The authors said their cases were clinically and morphologically similar to those earlier cases but survived longer
• The authors' conclusion: The authors stated that, to their knowledge, these were the first reported biphasic malignant mesothelioma cases with osseous differentiation and long survival. They suggested that markers associated with osseous differentiation might be predictive for survival, which future immunohistochemical and genetic studies might explain

Topics

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

Medical terms in this study, explained in our Lexicon: Biphasic Mesothelioma, Malignant Mesothelioma, Pleural Effusion, Pleural Thickening, Asbestos Exposure, Sarcomatoid, Epithelioid, Cytokeratin 5/6.

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