Cutaneous Presentation of Mesothelioma With a Sarcomatoid Transformation

Our plain-English summary of Cutaneous Presentation of Mesothelioma With a Sarcomatoid Transformation, by N. Klebanov, B.Y. Reddy, S. Husain, et al (The American Journal of Dermatopathology, 2018).

The study

• Authors: N. Klebanov, B.Y. Reddy, S. Husain, D.N. Silvers, M.E. Grossman, H. Tsao
• Journal: The American Journal of Dermatopathology
• Published: 2018;40(5):378-382
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is a rare neoplasm of mesodermal origin. Cutaneous involvement of malignant pleural mesothelioma is a very rare entity, with only 11 cases reported in the literature. Here, we describe the case of a 75-year-old man with stage IV epithelioid pleural mesothelioma, presenting with a cutaneous eruption 5 months after initial diagnosis, which revealed sarcomatoid features on skin biopsy. Histological analysis of malignancy progression through immunohistochemical staining of the pleural, lymph node, and skin tissue revealed gradual loss of calretinin and gain of desmin, supporting a transformation from epithelioid to sarcomatoid tissue. To our knowledge, this is the first reported case of an epithelioid to sarcomatoid transformation of malignant pleural mesothelioma manifesting in a cutaneous presentation.

In plain English

This is a case report of one patient: a 75-year-old man, a retired construction worker, with stage IV epithelioid pleural mesothelioma diagnosed by pleural biopsy. The report does not describe any asbestos exposure history for this patient. The patient received four cycles of pemetrexed/carboplatin chemotherapy, and a lymph node biopsy then confirmed spread. About five months after diagnosis, red nodules and firm plaques appeared on the left chest wall. These were first treated as presumed shingles, without improvement. A skin biopsy showed spindle cells with sarcomatoid (sarcoma-like) features, staining strongly for desmin and negative for calretinin. The authors re-examined the earlier tissue. The original pleural biopsy was positive for calretinin and negative for desmin. The lymph node biopsy showed mixed epithelioid and spindle cells, weaker calretinin and new focal desmin. They interpreted this gradient as supporting a transformation from epithelioid to sarcomatoid mesothelioma. They noted that the skin tumor could instead be a new primary cancer. The patient chose comfort measures and died 8 days after dermatology consultation. The authors described this as, to their knowledge, the first reported case of its kind.

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 75-year-old man, a retired construction worker, with stage IV epithelioid pleural mesothelioma diagnosed by pleural biopsy 5 months before presenting with a chest wall skin eruption
• Exposure: The article does not report this patient's asbestos exposure; it states only that he was a retired construction worker. Asbestos is discussed only in general terms, citing other literature.
• Main results:
  • Skin biopsy of a chest nodule showed atypical spindle cells in a storiform pattern, strongly positive for desmin, focally positive for WT1, and negative for calretinin, CK7 and CEA
  • On reanalysis, the original pleural biopsy showed epithelioid cells and no atypical spindle cells. It was positive for calretinin, WT1 and CK7 and negative for CEA and desmin.
  • The left lymph node biopsy, taken about 4 months after the pleural biopsy, showed a mix of epithelioid and spindle cells, new focal desmin positivity, and weaker calretinin staining than the pleural biopsy
  • CT imaging at the time of the skin biopsy showed malignant infiltration of the entire left intrathoracic cavity
  • The skin eruption was initially treated as presumed herpes zoster with valacyclovir, without improvement
  • The patient elected comfort measures only and died 8 days after dermatology consultation
• The authors' conclusion: The authors concluded that, to their knowledge, this is the first reported case of an epithelioid to sarcomatoid transformation of malignant pleural mesothelioma presenting in the skin. They also concluded that clinicians should be aware that such a transformation can occur and carries a more aggressive course.
• Limitations the authors state:
  • The authors stated that the skin malignancy could instead be a new primary neoplasm, such as a high-grade primary pleural sarcoma growing through the chest wall to the skin. They noted that some such tumors are often indistinguishable on immunohistochemistry.

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: Mesothelioma, Sarcomatoid, Pleural Mesothelioma, Neoplasm, Epithelioid, Biopsy, Immunohistochemistry, Calretinin.

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