Desmoplastic malignant mesothelioma: a review of 17 cases

Our plain-English summary of Desmoplastic malignant mesothelioma: a review of 17 cases, by G.E. Wilson, P.S. Hasleton, A.K. Chatterjee (Journal of Clinical Pathology, 1992).

The study

• Authors: G.E. Wilson, P.S. Hasleton, A.K. Chatterjee
• Journal: Journal of Clinical Pathology
• Published: 1992;45(4):295-8
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004920).

Abstract

Aims: To identify the histological features of desmoplastic mesothelioma, and to determine its incidence and prognosis.

Methods: Two hundred and fifty five cases of malignant mesothelioma were examined over seven years (1982-9) to identify the desmoplastic variant. Sections were cut at 5 microns and stained with haemotoxylin and eosin and with CAM 5.2 (Dakopatts). Asbestos fibre counts were carried out by light microscopy in 14 cases using the potash digestion method.

Results: Seventeen cases were identified as desmoplastic mesothelioma giving an incidence of 6.6%. In 11 cases the cell type in more cellular areas was sarcomatous and in six others it was biphasic. The mean survival time from onset of symptoms to death was 5.8 months for the sarcomatous variant and 6.8 months for the biphasic variant. Twelve of 16 patients had had previous occupational exposure to asbestos, ranging from five months to 43 years. The diagnosis of desmoplastic mesothelioma was only accepted if acellular connective tissue comprised 50% or more of the tumour bulk. Also seen was collagen necrosis, anastomosing bands of often hyalinised collagen with a prominent storiform pattern, and where cellular detail was present there were hyperchromatic nuclei.

Conclusions: Desmoplastic mesothelioma is a rare variant of malignant mesothelioma with a storiform collagen pattern, collagen necrosis, bland acellular collagen and focal cytological features of malignancy. Though rare, it is important to recognise this variant and distinguish it from a pleural plaque, nonspecific reactive pleural fibrosis, pleurisy, rheumatoid disease, or, rarely, spindle cell sarcomas.

In plain English

This was a case series. The authors reviewed 255 cases of malignant mesothelioma seen at or referred to a regional cardiothoracic centre between 1982 and 1989. They classed 17 (6.6%) as desmoplastic malignant mesothelioma, meaning more than half of the tumour was dense fibrous tissue with few cells. Fifteen of the 17 patients were male. Known ages ranged from 41 to 79 years. Twelve of 16 patients had past occupational asbestos exposure, lasting from five months to 43 years where known. The article did not name fibre types. In 11 of 17 cases the cellular parts of the tumour were sarcomatous. The rest were biphasic. Mean survival from first symptoms was 5.8 months in eight sarcomatous cases and 6.8 months in four mixed cases. At post mortem, 14 of 16 showed spread of the cancer. Collagen necrosis was found in 12 of 17 cases. In 12 of 14 cases tested, lung fibre counts were above 50,000 per gram of dried lung. No case showed frank asbestosis. The authors concluded that this rare variant should be recognised and told apart from pleural plaques, reactive pleural fibrosis, pleurisy, rheumatoid disease and, rarely, spindle cell sarcomas.

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: Retrospective case series: review of pathology material from mesothelioma cases at one centre
• Who was studied: 17 patients with desmoplastic malignant mesothelioma, identified from 255 malignant mesothelioma cases at a regional cardiothoracic centre, 1982 to 1989. Fifteen were male and two female. For the 16 with known age, ages were 41 to 79 years (mean 60.1).
• Exposure: Previous occupational asbestos exposure in 12 of 16 patients, lasting from five months to 43 years where known. Fibre types and jobs were not specified. Lung asbestos fibre counts were done by light microscopy in 14 cases.
• Main results:
  • 17 of the 255 malignant mesothelioma cases (6.6%) were classed as desmoplastic malignant mesothelioma.
  • In 11 of the 17 cases (64.7%) the cellular areas were sarcomatous. In the remaining 35.3% both sarcomatous and epithelial components were present.
  • Survival from onset of symptoms was known in 12 cases. Mean survival was 5.8 months in eight patients with sarcomatous tumours and 6.8 months in four patients with mixed tumours.
  • The authors reported no real difference in survival between the sarcomatous and biphasic desmoplastic cases.
  • Of the 16 patients examined after death, 14 (87.5%) showed metastatic disease.
  • The most common collagen arrangement was a network of anastomosing bands of often hyalinised collagen with a prominent storiform pattern.
  • Collagen necrosis was present within desmoplastic areas in 12 of 17 cases.
  • In all but one case, cells in the desmoplastic component stained positive for low molecular weight cytokeratin CAM 5.2.
  • In 12 of 14 cases tested (85.7%), the light microscopy asbestos fibre count was more than 50,000 per gram of dried lung tissue. The authors took this as indicating previous asbestos exposure.
  • No case showed frank asbestosis.
• The authors' conclusion: The authors concluded that desmoplastic mesothelioma is a rare variant. They said it should be recognised and distinguished from a pleural plaque, non-specific reactive pleural fibrosis, pleurisy, rheumatoid disease or, rarely, spindle cell sarcomas.

Topics

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

Medical terms in this study, explained in our Lexicon: Desmoplastic Mesothelioma, Malignant Mesothelioma, Prognosis, Biphasic Mesothelioma, Occupational Exposure, Collagen, Necrosis, Pleural Plaques.

Related studies

• The diagnosis of desmoplastic malignant mesothelioma and its distinction from fibrous pleurisy: a histologic and immunohistochemical analysis of 31 cases including p53 immunostaining — W.E. Mangano, P.T. Cagle, et al. (1998)
• The diagnosis of desmoplastic malignant mesothelioma — T.V. Colby (1998)
• BAP1 Immunohistochemistry and p16 FISH in the Diagnosis of Sarcomatous and Desmoplastic Mesotheliomas — H.C. Hwang, S. Pyott, et al. (2016)
• GATA3 Immunohistochemistry for Distinguishing Sarcomatoid and Desmoplastic Mesothelioma From Sarcomatoid Carcinoma of the Lung — K.B. Berg, A. Churg (2017)
• Keratin and epithelial membrane antigen immunoreactivity in nonneoplastic fibrous pleural lesions: implications for the diagnosis of desmoplastic mesothelioma — J.I. Epstein, R.E. Budin (1986)
• The fake fat phenomenon in organizing pleuritis: a source of confusion with desmoplastic malignant mesotheliomas — A. Churg, P. Cagle, et al. (2011)

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