Desmoplastic malignant mesothelioma of the pleura: autopsy reveals asbestos exposure

Our plain-English summary of Desmoplastic malignant mesothelioma of the pleura: autopsy reveals asbestos exposure, by R. Ishikawa, E. Kikuchi, M. Jin, et al (Pathology International, 2003).

The study

• Authors: R. Ishikawa, E. Kikuchi, M. Jin, M. Fujita, T. Itoh, H. Sawa, K. Nagashima
• Journal: Pathology International
• Published: 2003;53(6):401-6
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Desmoplastic mesothelioma is a rare subtype of diffuse malignant mesothelioma, and is often difficult to distinguish from reactive pleural fibrosis because of associated extensive collagen fibrosis. An 82-year-old woman with a severe cough was revealed to have pleural effusion and diffuse pleural thickening on the right side. Antibiotics were ineffective, and a compression fracture of the ninth and tenth thoracic vertebral bodies was recognized on X-ray. Autopsy revealed a diffuse pleural thickening with hyalinized collagen tissue in the central part of the pleura. However, the peripheral part of the fibrous tissue was composed of spindle and polygonal cell proliferation that were immunohistochemically positive for antibodies against cytokeratin and vimentin. In addition, the ninth and tenth thoracic spines were infiltrated by similar cells. The condition was diagnosed as desmoplastic mesothelioma with bone metastases. Asbestos bodies were detected in the thickened pleura and fibrosed alveolar septa, and it was suggested retrospectively that the patient had been exposed to asbestos. Thus, autopsy analyses of fibrous pleurisy are necessary to detect a desmoplastic variant of mesothelioma of the pleura and its association with asbestos exposure.

In plain English

This was a case report from Japan describing one patient. An 82-year-old woman developed a severe cough, with fluid around the right lung (pleural effusion) and diffuse thickening of the pleura. Antibiotics and diuretics did not help. A needle biopsy of the pleura found no tumor cells, and she died 6 months after her cough began. At autopsy, more than 90% of the thickened pleura was dense collagen (scar-like) tissue. Cells at its outer edge, however, invaded the surrounding fat and stained positive for cytokeratin and vimentin. Similar cells were found in the thoracic spine. The authors diagnosed desmoplastic malignant mesothelioma of the pleura, an unusual, mostly fibrous subtype, with bone metastases. Asbestos bodies were found in both lungs, about 120 bodies per 5 g of lung, which the authors placed at second grade exposure on a four-tier system. Only afterwards was it learned that she had worked as an industrial sweeper for 10 years from age 50. No fiber type was named. The authors concluded that the autopsy was critical in identifying her asbestos exposure.

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 autopsy case)
• Who was studied: One 82-year-old woman in Japan who had attended hospital for high blood pressure. She developed a severe cough and right-sided pleural effusion and was admitted to National Sapporo South Hospital.
• Exposure: Asbestos exposure was inferred from asbestos bodies found at autopsy. The patient's history, learned only afterwards, showed she had worked as an industrial sweeper for 10 years from age 50. The article does not name a fiber type or a specific asbestos source.
• Main results:
  • The patient died 6 months after her cough began. Bronchopneumonia, renal failure and heart failure developed before death.
  • At autopsy, more than 90% of the thickened right pleura consisted of hyalinized collagen tissue.
  • The infiltrating cells, including those in the bone marrow, stained positive for vimentin and CAM 5.2 (low molecular weight keratin). They were negative for CD34, Bcl2, HHF35, ERA, Calretinin and HBME-1.
  • The fibrous tissue extended to the ninth and tenth thoracic vertebral bodies, which showed compression fracture. Tumor cells were found in the vertebral bone, which the authors took as confirming the disease was cancer.
  • The tumor was diagnosed as pleural mesothelioma, desmoplastic variant.
  • Asbestos bodies were seen near the thickened pleura on the right side and in peribronchial fibrous tissue on the left side.
  • Quantitative analysis found about 120 asbestos bodies per 5 g of lung. The authors placed this at second grade exposure in a four-tier system.
  • When the earlier pleural biopsy was re-examined after diagnosis, no keratin-positive (tumor) cells were found in it.
  • SV40 large T antigen staining was positive in the tumor spindle cells. It also stained some normal and reactive cells.
• The authors' conclusion: The authors concluded that the autopsy was a critical factor in revealing the patient's past history and identifying her exposure to asbestos. They described the case as asbestos-associated desmoplastic mesothelioma.
• Limitations the authors state:
  • The SV40 large T antigen staining also labeled normal and reactive cells. The authors said further studies with more specific antibodies might be needed.

Topics

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

Medical terms in this study, explained in our Lexicon: Desmoplastic Mesothelioma, Mesothelioma, Pleura, Autopsy, Asbestos Exposure, Fibrosis, Collagen, Pleural Effusion.

Related studies

• Collision tumour of the pleura composed of small cell carcinoma and malignant mesothelioma — A.H. Lee, I.N. Soomro (2004)
• Pseudomesotheliomatous carcinoma of the pleura: an autopsy case of metastasis from a G-CSF-producing anaplastic carcinoma of the pancreas — Y. Hattori, K. Sentani, et al. (2018)
• Focused X-Ray Histological Analyses to Reveal Asbestos Fibers and Bodies in Lungs and Pleura of Asbestos-Exposed Subjects — L. Pascolo, A. Gianoncelli, et al. (2016)
• Malignant mesothelioma of the pleura with desmoplastic histology: a case series and literature review — K. Hashimoto, Y. Okuma, et al. (2016)
• An autopsy case of a malignant pericardial mesothelioma in a Japanese young man — M. Watanabe, H. Suzuki, et al. (1999)
• Novel functional view of the crocidolite asbestos-treated A549 human lung epithelial transcriptome reveals an intricate network of pathways with opposing functions — J.M. Hevel, L.C. Olson-Buelow, et al. (2008)

Browse more research in Pathology International, or return to medical research.