Epithelioid malignant mesothelioma metastatic to the skin: A case report and review of the literature

Our plain-English summary of Epithelioid malignant mesothelioma metastatic to the skin: A case report and review of the literature, by R.E. Ward, S.A. Ali, M. Kuhar (Journal of Cutaneous Pathology, 2017).

The study

• Authors: R.E. Ward, S.A. Ali, M. Kuhar
• Journal: Journal of Cutaneous Pathology
• Published: 2017;44(12):1057-1063
• Type of article: Case report
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma (MM) is an aggressive and invasive neoplasm primarily affecting the pleura, peritoneum and pericardium. While mesothelioma commonly metastasizes to visceral organs, it has rarely been documented to involve the skin and subcutaneous tissue. There is a paucity of reports of cutaneous metastatic mesothelioma, and histologic examination is often challenging because the tumor closely mimics other primary and metastatic neoplasms. We report a case of a 75-year-old man presenting with a firm, hard nodule on his upper back, which on initial histologic evaluation resembled metastatic adenocarcinoma. However, upon review of his medical history and immunohistochemical evaluation of the lesion, the diagnosis of epithelioid MM metastatic to the skin was rendered. The purpose of this case report and review of the literature is to summarize the most effective available immunostains to aid in the diagnosis of this challenging entity, highlight the histologic similarities between metastatic epithelioid MM and other primary and metastatic neoplasms of the skin, and provide prognostic information for these rare tumors.

© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

In plain English

This article was a case report combined with a review of published cases of malignant mesothelioma that spread to the skin. The patient was a 75-year-old retired automobile mechanic who had specialized in brake repair. After a large fluid build-up around the left lung, biopsies led to a diagnosis of stage II pleural malignant mesothelioma. Four months later, a single firm, pink nodule measuring 6 x 8 mm appeared on the upper back. Its microscopic pattern and stains supported a diagnosis of epithelioid malignant mesothelioma that had spread to the skin. The stains were positive for calretinin, CK5/6, CK7 and D2-40. The patient died within a week of the skin biopsy. The authors found nineteen previously reported cases. Across the reported cases, the average age when skin spread appeared was 56.5 years (range 25 to 77). Of these cases, 85% came from pleural and 15% from peritoneal mesothelioma, and the face was the most common site. The authors concluded that diagnosis is challenging, but that combined microscopic, staining and molecular tests, with clinical and imaging correlation, can help. The article did not describe the patient's 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 of one patient combined with a review of previously published case reports
• Who was studied: One 75-year-old man, a retired automobile mechanic who specialized in brake repair, plus nineteen previously reported cases of malignant mesothelioma metastatic to the skin found in the literature
• Exposure: The article gives the patient's occupation (retired automobile mechanic specializing in brake repair) but does not describe or measure any asbestos exposure for this patient. The discussion notes, citing other work, that automobile brakes formerly contained asbestos.
• Main results:
  • The patient was diagnosed with stage II malignant mesothelioma of the pleura from biopsies taken during video-assisted thoracoscopic surgery
  • Four months after diagnosis, the patient developed a single firm, pink skin nodule measuring 6 x 8 mm on the upper back
  • The nodule's growth pattern and the absence of surgical scars nearby favored metastasis over direct extension
  • The skin lesion stained positive for CK5/6, CK7, calretinin and D2-40 and negative for TTF-1, CK20, GLUT-1 and PSA, supporting epithelioid malignant mesothelioma metastatic to the skin
  • The patient died within a week after the skin biopsy
  • Literature review: nineteen previously reported cases of mesothelioma metastatic to the skin, three of them from before immunohistochemical stains were available
  • Reported cases: the average age at presentation of skin metastasis was 56.5 years (range 25 to 77)
  • Reported cases: excluding one outlier, the average time from mesothelioma diagnosis to skin metastasis was six months; seven people were diagnosed with mesothelioma at or shortly after their skin biopsy
  • Reported cases: pleural mesothelioma accounted for 85% and peritoneal mesothelioma for 15% of cases with skin metastases
  • Reported cases: the face was the most common site of skin metastasis, followed by the scalp and chest
  • Reported cases: all peritoneal cases were epithelioid. Among pleural cases, about 60% were epithelioid, 23% sarcomatoid and 17% biphasic.
• The authors' conclusion: The authors concluded that diagnosis can be challenging, but that a thorough workup including histologic, immunohistochemical and molecular investigations, combined with clinical and radiologic correlation, can aid diagnosis

Topics

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

Medical terms in this study, explained in our Lexicon: Epithelioid, Malignant Mesothelioma, Neoplasm, Pleura, Peritoneum, Pericardium, Mesothelioma, Metastasis.

Related studies

• Primary pleural epithelioid haemangioendothelioma with metastases to the skin. A case report and literature review — M. Al-Shraim, B. Mahboub, et al. (2005)
• beta-Carotene fails to act as a tumor promoter, induces RAR expression, and prevents carcinoma formation in a two-stage model of skin carcinogenesis in male Sencar mice — R.M. Ponnamperuma, Y. Shimizu, et al. (2000)
• Skin metastasis of pleural epithelioid malignant mesothelioma — T. Terada (2011)
• Phosphatide composition of normal, hyperplastic and malignant squamous epithelium — C. Carruthers (1966)
• Initiation-promotion versus complete skin carcinogenesis in mice: importance of dark basal keratinocytes (stem cells) — T.J. Slaga, A.J. Klein-Szanto (1983)
• Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura — P.M. Cury, D.N. Butcher, et al. (2000)

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