FISH analysis of intrapulmonary malignant mesothelioma without a clinically detectable primary pleural lesion: an autopsy case

Our plain-English summary of FISH analysis of intrapulmonary malignant mesothelioma without a clinically detectable primary pleural lesion: an autopsy case, by M. Hasegawa, F. Sakai, A. Sato, et al (Japanese Journal of Clinical Oncology, 2014).

The study

• Authors: M. Hasegawa, F. Sakai, A. Sato, S. Tsubomizu, K. Arimura, H. Katsura, E. Koh, Y. Sekine, D. Wu, K. Hiroshima
• Journal: Japanese Journal of Clinical Oncology
• Published: 2014;44(12):1239-42
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Patients with malignant mesothelioma typically present with a pleural effusion or pleural thickening and masses. A rare autopsy case of mesothelioma presenting with multiple bilateral lung nodules without clinically detectable pleural lesions is presented. A definitive diagnosis of the video-assisted thoracic surgery specimen could not be made, though a pattern of fibrosis mimicking organizing pneumonia was identified. Despite corticosteroid therapy, follow-up chest computed tomography showed enlargement of multiple nodules accompanied by the appearance of pleural thickening and effusions. The patient died of respiratory failure 11 months after initial presentation. Autopsy and retrospective analysis of the video-assisted thoracic surgery specimen using a p16 fluorescence in situ hybridization assay showed p16 homozygous deletion. The final diagnosis was sarcomatoid mesothelioma, and the lung nodules were intrapulmonary metastases from a clinically undetectable pleural sarcomatoid mesothelioma. It is important both to consider the possibility of mesothelioma with unusual clinical, radiological and pathological presentations and to remember that p16 fluorescence in situ hybridization analysis can play an important role in the diagnosis of mesothelioma.

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In plain English

This article was a case report about one patient, a 75-year-old man in Japan, whose malignant mesothelioma was diagnosed only after death. The patient, an ex-smoker and taxi driver, had no apparent asbestos exposure, and no asbestos bodies were found in the lung tissue at autopsy. Chest CT showed multiple nodules in both lungs with no visible pleural lesion. A surgical lung biopsy did not allow a definitive diagnosis. Despite prednisolone, the nodules grew and pleural thickening and effusions appeared. The patient died of respiratory failure 11 months after first presentation. At autopsy, a genetic test called the p16 FISH assay showed p16 homozygous deletion, and the final diagnosis was sarcomatoid mesothelioma. The same test, run afterwards on the earlier biopsy, also showed the deletion. The authors thought the cancer began in the right pleura and spread to the lungs. They concluded that mesothelioma should be considered when presentations are unusual and that p16 FISH analysis can play an important role in diagnosis.

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 75-year-old man, an ex-smoker who worked as a taxi driver, referred to a hospital in Japan (Tokyo Women's Medical University Yachiyo Medical Center) for multiple nodules in both lungs
• Exposure: No apparent asbestos exposure; no asbestos bodies were found in the lung parenchyma at autopsy
• Main results:
  • On admission, CT showed multiple nodules in both lungs with no dominant lung mass or pleural lesions
  • The video-assisted thoracic surgery (VATS) biopsy did not allow a definitive diagnosis
  • The patient died of respiratory failure 11 months after initial presentation
  • The p16 FISH assay of the autopsy specimen showed p16 homozygous deletion, and the final diagnosis was sarcomatoid mesothelioma
  • Retrospective p16 FISH testing of the earlier VATS biopsy also showed p16 homozygous deletion
  • The authors thought the primary site was the right pleura
• The authors' conclusion: The authors concluded that mesothelioma should be considered in patients with unusual clinical, radiological and pathological presentations, and that p16 FISH analysis can play an important role in diagnosing mesothelioma

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: Fluorescence In Situ Hybridization (FISH), Malignant Mesothelioma, Autopsy, Pleural Effusion, Pleural Thickening, Mesothelioma, Bilateral, Thoracic Surgery.

Related studies

• Cytologic Differential Diagnosis of Malignant Mesothelioma and Reactive Mesothelial Cells With FISH Analysis of p16 — K. Hiroshima, D. Wu, et al. (2016)
• Peritoneal malignant mesothelioma (PMM), and primary peritoneal serous carcinoma (PPSC) and reactive mesothelial hyperplasia (RMH) of the peritoneum. Immunohistochemical and fluorescence in situ hybridisation (FISH) analyses — T. Kawai, S. Tominaga, et al. (2016)
• Primary pleural angiosarcoma associated with pneumoconiosis: An autopsy case — K. Matsuda, T. Yamaryo, et al. (2015)
• A case of primary lung squamous cell carcinoma mimicking malignant mesothelioma producing granulocyte colony stimulating factor with chemotherapy (cisplatin and gemcitabine)-associated thrombotic thrombocytopenic purpura (TTP); An autopsy case report — Y. Suzuki, K. Kanazawa, et al. (2019)
• Coated and uncoated lung mineral fibres in subjects with and without pleural plaques at autopsy — A. Andrion, D. Bellis, et al. (1984)
• Diagnostic usefulness of p16/CDKN2A FISH in distinguishing between sarcomatoid mesothelioma and fibrous pleuritis — D. Wu, K. Hiroshima, et al. (2013)

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