Deciduoid mesothelioma: report of 21 cases with review of the literature

Our plain-English summary of Deciduoid mesothelioma: report of 21 cases with review of the literature, by N.G. Ordóñez (Modern Pathology, 2012).

The study

• Author: N.G. Ordóñez
• Journal: Modern Pathology
• Published: 2012;25(11):1481-95
• Type of article: Review
• Cited by: 48 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma that was initially considered to occur exclusively in the peritoneum of young women who had no history of asbestos exposure and to be characterized by an aggressive clinical course, but it was later demonstrated that this tumor could also occur in the pleura of older men and women who had been exposed to asbestos. Some subsequent studies have also indicated that the clinical course is no different from that of conventional epithelioid mesothelioma. Herein are reported 21 cases of deciduoid mesothelioma that were investigated using a large panel of immunohistochemical markers, 9 of which were also studied by electron microscopy. Fifteen of the patients were male and 6 were female (mean age, 60 years). Seventeen of the cases originated in the pleura and four in the peritoneum. Histologically, all of the cases were composed of large, polygonal or ovoid cells with well-defined cell borders, dense eosinophilic cytoplasm, and single or multiple nuclei. In some cases, the cells exhibited a wide variation in their size and shape, frequent loss of cell cohesion, marked nuclear atypia, and high mitotic activity (>5 per 10 HPF); whereas, in others, the cells were more cohesive, less pleomorphic, and the mitotic activity low. As the survival of patients in the first group of cases was shorter (mean, 7 months), when compared with that of the latter (mean, 23 months), it is concluded that the differences in prognosis reported in deciduoid mesothelioma are due to the existence of a high-grade subgroup that presents highly aggressive clinical behavior. Therefore, when a high-grade deciduoid mesothelioma is present, it should be reported as it can significantly affect prognosis and treatment. The use of immunohistochemistry and electron microscopy in assisting in the differential diagnosis of deciduoid mesothelioma is also discussed.

In plain English

This article reported 21 cases of deciduoid mesothelioma, a rare form of epithelioid mesothelioma, drawn from the pathology files of the University of Texas MD Anderson Cancer Center. The author also reviewed 43 previously published cases. Fifteen patients were men and 6 were women, aged 39 to 78 years (mean 60). The tumor began in the pleura in 17 cases and in the peritoneum in 4. Eleven patients had a history of asbestos exposure; no fiber types were named. Of 17 patients with follow-up, 16 died of disease 4 to 62 months after diagnosis (mean 15 months). The author sorted the tumors by how they looked under the microscope. In 7 tumors with marked variation in cell size and shape, loss of cell cohesion and more than 5 mitoses per 10 high-power fields, patients died at a mean of 7 months. In a second, less atypical group of 10, 9 patients died at a mean of 22 months and 1 was alive with recurrent disease at 25 months. All 21 tumors stained for calretinin. The author concluded that this high-grade subgroup explains the reported differences in prognosis and should be noted in pathology reports.

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 21 cases from one pathology department, with a review of previously published cases
• Who was studied: 21 patients with deciduoid mesothelioma from the files of the Department of Pathology, University of Texas MD Anderson Cancer Center (Houston, TX, USA): 15 men and 6 women aged 39 to 78 years (mean 60); 17 pleural and 4 peritoneal tumors; study years not given
• Exposure: History of asbestos exposure in 11 of 21 patients and smoking in 10; no fiber types, products, jobs or doses given
• Main results:
  • Tumor site in the 21 cases: pleura in 17, peritoneum in 4
  • Of 17 patients with follow-up, 16 died of disease 4 to 62 months after diagnosis (mean 15 months); 1 was alive with recurrent disease 25 months after extrapleural pneumonectomy
  • First (high-grade) group: 7 cases with more than 5 mitoses per 10 high-power fields, decreased cell cohesion and highly atypical nuclei; all died of disease 4 to 17 months after diagnosis (mean 7 months)
  • Second group: of 10 cases with lower mitotic activity and more uniform, cohesive cells, 9 died of disease 6 to 62 months after diagnosis (mean 22 months); the remaining patient (Case 4) was alive with recurrent disease at 25 months
  • Immunohistochemistry in this series: all 21 cases were positive for calretinin. Podoplanin was positive in 13 of 14 cases (93%) and WT1 in 11 of 13 (85%). All cases stained for MOC-31, CEA, TAG-72, CD15, TTF-1 or HCG were negative.
  • Electron microscopy of 9 cases showed similar features, including cell membranes covered by many slender microvilli
  • Across all 64 cases (43 published plus these 21), 39 arose in the pleura, 22 in the peritoneum, 1 in the pericardium and 2 in the paratesticular region. Of the 27 patients with a history of asbestos exposure, 23 had pleural and 4 had peritoneal tumors.
• The authors' conclusion: The author concluded that the differences in prognosis reported for deciduoid mesothelioma are explained by a high-grade subgroup with highly aggressive behavior. The author recommended that this subtype be indicated in the pathology report, because it can affect prognosis and treatment.
• Limitations the authors state:
  • For the comparison with published cases, few published reports with follow-up gave detailed microscopic descriptions of the tumors

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Epithelioid, Peritoneum, Asbestos Exposure, Pleura, Eosinophilic, Nuclear Atypia, Pleomorphic.

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