Distant cutaneous metastasis of malignant epithelioid mesothelioma

Our plain-English summary of Distant cutaneous metastasis of malignant epithelioid mesothelioma, by K. Collins, P. Nagarajan, P.P. Aung (Journal of Cutaneous Pathology, 2021).

The study

• Authors: K. Collins, P. Nagarajan, P.P. Aung
• Journal: Journal of Cutaneous Pathology
• Published: 2021;48(7):902-907
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is a locally aggressive malignancy most commonly arising from the pleural and/or peritoneal cavity. Distant cutaneous metastasis is extremely rare. Here, we describe two cases of mesothelioma metastatic to the head and neck skin. Case 1: A 64-year-old man diagnosed previously with extensive thoracic and abdominal mesothelioma, developed a rapidly growing right upper lip lesion, for which a wedge resection was performed. Case 2: A 77-year-old woman with a history of pleural mesothelioma developed a firm, mobile subcutaneous nodule on the right lateral forehead, clinically thought to represent either an epidermal inclusion cyst or a lipoma. A punch biopsy was performed. In both cases, histopathologic evaluation revealed dermal proliferation of epithelioid cells with moderate cytologic atypia and three mitotic figures per mm2 and two mitotic figures per mm2 for Cases 1 and 2, respectively. Immunohistochemical studies revealed the lesional cells to be positive for WT1, mesothelin, D2-40, CK5/6, while being negative for melanocytic and other keratinocytic markers, supporting a diagnosis of metastatic mesothelioma. Awareness of rare instances of cutaneous metastases from malignant mesothelioma is necessary to avoid possible misdiagnosis and ensure appropriate management.

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

In plain English

This case report from The University of Texas MD Anderson Cancer Center described two patients whose malignant mesothelioma spread to the skin of the head. The authors called this extremely rare. The first patient was a 64-year-old man, a commercial diver for an oil refinery company. He had mesothelioma with pleural and peritoneal-based masses and was treated with chemotherapy. Eight months later, a lump on his right upper lip grew to 15 mm. Tissue tests on it supported metastatic mesothelioma, and he died 28 months after his initial diagnosis. The second patient was a 77-year-old woman, a retired insurance agent and former smoker. A biopsy confirmed malignant epithelioid mesothelioma of the pleura. After chemotherapy, immunotherapy and radiotherapy, she developed a 23 mm nodule on her right forehead. A biopsy supported metastatic mesothelioma, and she died two weeks later, 26 months after first presenting. The authors counted 17 previously reported cases of pleural mesothelioma spreading to distant skin. The article did not discuss asbestos exposure. The authors concluded that mesothelioma should be considered among tumors that can spread to the skin.

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 (two patients), with a table of previously published cases
• Who was studied: Two patients described by pathologists at The University of Texas MD Anderson Cancer Center, Houston: a 64-year-old man (a commercial diver for an oil refinery company) and a 77-year-old woman (a retired insurance agent and former smoker)
• Exposure: Not reported. The article does not mention asbestos or any other exposure; it gives only the patients' occupations and the woman's smoking history.
• Main results:
  • Case 1 (man): eight months after starting chemotherapy, a lip lesion was found that grew to a 15 mm mass. A biopsy supported metastatic mesothelioma.
  • Case 1 (man) died of disease progression 28 months after initial diagnosis.
  • Case 2 (woman): a second pleural biopsy confirmed malignant epithelioid mesothelioma.
  • Case 2 (woman): two months after radiotherapy, a 23 mm nodule appeared on the right lateral forehead. A punch biopsy supported metastatic mesothelioma.
  • Case 2 (woman) died 2 weeks after the skin biopsy, 26 months after initial presentation.
  • In the earlier published literature, the authors found 17 reported cases of pleural mesothelioma with distant skin metastases, 14 of them to the head and neck and 3 to the trunk.
• The authors' conclusion: The authors concluded that, although uncommon, mesothelioma should be included among the possible diagnoses for tumors that may spread to the skin.

Topics

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

Medical terms in this study, explained in our Lexicon: Metastasis, Epithelioid, Mesothelioma, Malignant Mesothelioma, Peritoneal Cavity, Pleural Mesothelioma, Biopsy, Mesothelin.

Related studies

• Expression of thrombomodulin, calretinin, cytokeratin 5/6, D2-40 and WT-1 in a series of primary carcinomas of the lung: an immunohistochemical study in comparison with epithelioid pleural mesothelioma — C.E. Comin, L. Novelli, et al. (2014)
• Skin metastasis of pleural epithelioid malignant mesothelioma — T. Terada (2011)
• Glypican-1 immunohistochemistry is a novel marker to differentiate epithelioid mesothelioma from lung adenocarcinoma — V.J. Amatya, K. Kushitani, et al. (2018)
• Cutaneous Metastases From Malignant Mesothelioma of the Tunica Vaginalis Testis — P. Hispán, J.C. Pascual, et al. (2016)
• Metastasis of Sarcomatoid Malignant Mesothelioma With p16/CDKN2A Deletion Manifested as a Subcutaneous Mass in the Back: A Case Report and Review of Literature — K.B. Chen, Y.J. Huang, et al. (2021)
• The diagnostic utility of D2-40, calretinin, CK5/6, desmin and MOC-31 in the differentiation of mesothelioma from adenocarcinoma in pleural effusion cytology — T.S. Hyun, M. Barnes, et al. (2012)

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