Deciduoid mesothelioma: a report of 5 cases and literature review

Our plain-English summary of Deciduoid mesothelioma: a report of 5 cases and literature review, by J. Shia, R.A. Erlandson, D.S. Klimstra (Ultrastructural Pathology, 2002).

The study

• Authors: J. Shia, R.A. Erlandson, D.S. Klimstra
• Journal: Ultrastructural Pathology
• Published: 2002;26(6):355-63
• Type of article: Review
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Deciduoid mesothelioma was first described in young females and in the peritoneum, which led to the suggestion that deciduoid mesothelioma was a distinct subtype with specific clinical and pathologic features. Later reports, however, have shown that this type of mesothelioma may also occur in elderly people and in the pleura. Cases reported in the literature so far are limited, and the disease is not well defined. The authors report the histologic, immunohistochemical, ultrastructural, and clinical findings of 5 cases of deciduoid mesothelioma, and review the literature reports. The results demonstrate that the presence of numerous cytoplasmic intermediate filaments, either dispersed or bundled, appear to be the likely ultrastructural basis for the deciduoid histologic appearance. Twenty-one cases of deciduoid mesothelioma were identified in the literature. Analyses of these 21 cases and the authors' 5 cases showed an age range of 13-78 years (median 53 years) and a slight female predominance (female to male ratio of 1.4:1). Fourteen of 26 cases (54%) occurred in the peritoneum. Seven of 20 patients (35%) had a documented history of asbestos exposure. Fifteen of 20 patients died, with a mean survival time of 7.33 months (range 1-21 months). Five of 20 patients were alive at a follow-up time of 8 months to 5 years. These findings suggest that the so-called deciduoid mesothelioma has some clinical and pathologic features that are dissimilar to mesothelioma in general. Whether it truly represents a pathogenetically distinct variant or merely an expansion of the morphologic spectrum awaits further studies.

In plain English

This article reported 5 cases of deciduoid mesothelioma, a variant of epithelial mesothelioma that resembles decidua, and reviewed 21 published cases. The authors found them among 109 mesothelioma cases with slides in the electron microscopy files of Memorial Sloan-Kettering Cancer Center, 1982 to May 2001. The patients were 3 women and 2 men aged 51 to 71. Three tumors were pleural and 2 peritoneal. Four died (mean survival 6.5 months); one was alive without disease at 12 months. One man had occupational asbestos exposure through plumbing work and another had possible exposure as a roofer. Under the electron microscope, all 5 showed mesothelial-type microvilli and intermediate filaments, which the authors suggested were the likely basis for the deciduoid appearance. Across the 26 cases, 14 were peritoneal. Of 20 patients whose asbestos history was sought, 7 (35%) had exposure, 11 did not, and 2 had possible exposure. Of 20 with follow-up, 15 died, with a mean survival of 7.33 months. The authors concluded the variant may be distinct, but the differences could equally reflect selection bias in reported cases.

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 series of 5 cases (histology, immunohistochemistry, electron microscopy, clinical data) plus a review of cases published in the literature
• Who was studied: 148 mesothelioma cases from the electron microscopy files of Memorial Sloan-Kettering Cancer Center, New York, 1982 to May 2001. Slides were available for 109, and 5 of these (4.6%) were deciduoid: 3 females and 2 males aged 51 to 71 (median 65), 3 pleural and 2 peritoneal. A further 21 cases came from the world literature, for 26 cases in total.
• Exposure: Asbestos exposure history only, recorded as yes, no or possible. No fiber types were reported. In the authors' 5 cases: occupational exposure through plumbing work (case 4), possible exposure 30 years earlier as a roofer (case 5), no known exposure (case 3), and not documented or not available (cases 1 and 2).
• Main results:
  • In the authors' 5 cases, 4 patients died of disease with a mean survival of 6.5 months (range 1 to 17 months). One patient with a pleural tumor was alive without disease at 12 months.
  • Under electron microscopy, all 5 cases showed long, slender mesothelial-type microvilli and intermediate filaments. The authors suggested that abundant intermediate filaments, either bundled or dispersed, are the likely basis for the deciduoid appearance.
  • All 5 cases stained for keratins (AE1:AE3 and CAM 5.2) and for vimentin. Two of 2 cases tested were positive for calretinin. BerEP4, CEA and LeuM1 (CD15) were negative in all cases, and none stained for b-hCG.
  • Of the 26 combined cases (21 from the literature plus the authors' 5), 14 (54%) were peritoneal, 11 pleural and 1 in the extraperitoneal abdominal wall. The female to male ratio was 1.4:1, the median age was 53 and the mean age 49.4.
  • Of the 20 combined patients in whom asbestos history was sought, 7 (35%) were positive for exposure, 11 negative and 2 possible.
  • Of the 20 combined patients with follow-up, 15 died, with a mean survival of 7.33 months (range 1 to 21 months). Five were alive at 8 months to 5 years. The authors' review did not show significantly worse survival for deciduoid mesothelioma.
  • Seven of the 26 combined cases occurred in patients aged 40 or younger.
• The authors' conclusion: The authors concluded that differences from mesothelioma in general (more often peritoneal, more often female, younger patients, a lower asbestos exposure rate) suggest that deciduoid mesothelioma may be a distinct variant. They considered it equally possible that these differences reflect selection bias in which cases are reported, and said larger systematic studies are needed.
• Limitations the authors state:
  • The number of cases described so far is small.
  • The series was too small to draw conclusions about whether ultrastructural features relate to invasiveness or prognosis.
  • Published cases may be biased, because deciduoid tumors that are otherwise typical may not have been reported.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Peritoneum, Pleura, Asbestos Exposure.

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