Diffuse pleural mesothelioma with epithelioid and angiosarcomatous components--a hitherto undescribed pattern of differentiation

Our plain-English summary of Diffuse pleural mesothelioma with epithelioid and angiosarcomatous components--a hitherto undescribed pattern of differentiation, by A. Klabatsa, A.G. Nicholson, K. Dulay, et al (Histopathology, 2012).

The study

• Authors: A. Klabatsa, A.G. Nicholson, K. Dulay, R.M. Rudd, M.T. Sheaff
• Journal: Histopathology
• Published: 2012;60(7):1164-6
• Type of article: Case report, Letter
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter described a case of diffuse pleural mesothelioma with a pattern of differentiation that the authors stated had not previously been published. The patient was an 82-year-old man with occupational exposure to asbestos who presented with left-sided chest pain and breathlessness of gradual onset over several weeks. CT showed a large left pleural effusion, a collapsed left lung, thickened pleura in the left basal region and pleural plaques. He had never received thoracic irradiation and was anaemic, requiring blood transfusion. Video-assisted thoracoscopy found a 900 ml haemorrhagic effusion with clots of blood, and pleural biopsies were taken before talc pleurodesis. Microscopy showed two components. The larger was an infiltrative tumour of malignant epithelioid and spindle-shaped cells that stained positive for calretinin, WT1 and CK5/6 and negative for CD31, CD34, factor VIIIrAg and TTF-1. A lesser, superficial component of irregular vascular channels lined by atypical endothelial cells stained positive for factor VIIIrAg, CD34 and CD31 and negative for pancytokeratin and mesothelial markers. In areas the two components blended. The tumour was classified as epithelioid mesothelioma with angiosarcomatous de-differentiation. Two separate co-located tumours were considered less likely. The authors concluded that positive vascular marker staining should no longer exclude mesothelioma, and that angiosarcomatous de-differentiation should be added to the recognised variations of pleural mesothelioma.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This letter to the journal was a case report about one patient: an 82-year-old man with occupational exposure to asbestos. The article did not say what fiber type or job was involved. He had left-sided chest pain and breathlessness that came on gradually over several weeks. A CT scan showed a large left pleural effusion (fluid around the lung), a collapsed left lung, thickened pleura and pleural plaques. He had never had radiation to the chest. During keyhole chest surgery (VATS), 900 ml of bloody fluid was found and pleural biopsies were taken. Most of the tumour was made of malignant epithelioid and spindle-shaped cells that stained positive for mesothelial markers. A smaller surface part was made of abnormal blood-vessel channels whose cells stained positive for vascular markers and negative for cytokeratin and mesothelial markers. The authors classified the tumour as an epithelioid pleural mesothelioma with angiosarcomatous de-differentiation. They judged two separate tumours to be less likely. They stated that no such cases had been published before. The authors concluded that this pattern should be added to the known variations of pleural mesothelioma.

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 (letter/correspondence)
• Who was studied: one 82-year-old man with occupational exposure to asbestos; place and date of treatment not stated (the authors are based at London hospitals)
• Exposure: occupational exposure to asbestos; fiber type, job and dose not stated. The patient had never received thoracic irradiation
• Main results:
  • CT showed a large left pleural effusion, a uniformly collapsed left lung, thickened pleura in the left basal region and pleural plaques
  • At VATS a haemorrhagic (bloody) effusion of 900 ml with blood clots was found in the pleural cavity
  • The main component was an infiltrative tumour of malignant epithelioid and spindle-shaped cells, positive for calretinin, WT1 and cytokeratin 5/6, and negative for CD31, CD34, factor VIIIrAg and TTF-1
  • A lesser, superficial component of irregular vascular channels lined by atypical endothelial cells was positive for factor VIIIrAg, CD34 and CD31, and negative for pan-cytokeratin and mesothelial markers
  • The tumour was classified as an epithelioid mesothelioma with angiosarcomatous de-differentiation; two synchronous tumours (mesothelioma plus primary pleural angiosarcoma) seemed less likely to the authors
  • The authors stated that no cases of malignant mesothelioma with angiosarcomatous de-differentiation had previously been published
• The authors' conclusion: The authors concluded that angiosarcomatous de-differentiation should be added to the variations seen in pleural mesothelioma, and should be considered for pleural tumours that stain for vascular markers

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Epithelioid, Occupational Exposure, Pleural Effusion, Pleura, Pleural Plaques, Thoracoscopy, Talc Pleurodesis.

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