Foamy cell mesothelioma

Our plain-English summary of Foamy cell mesothelioma, by A. Cavazza, G. Pasquinelli, L. Agostini, et al (Histopathology, 2002).

The study

• Authors: A. Cavazza, G. Pasquinelli, L. Agostini, K.O. Leslie, T.V. Colby
• Journal: Histopathology
• Published: 2002;41(4):369-71
• Type of article: Case report, Letter
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter reported a malignant epithelial mesothelioma of the pleura in which part of the tumour cells had abundant foamy cytoplasm. The authors described this pattern as deceptively bland and largely unrecognized among pathologists. The patient was a 56-year-old woman, a smoker with no history of asbestos exposure, who presented with thoracic pain and dyspnoea. Imaging showed a left pleural effusion with no lesions elsewhere. Thoracoscopy revealed nodules involving the parietal pleura, diaphragm and pericardium, and multiple biopsies were taken. She received palliative therapy and died of disease 6 months after diagnosis; no autopsy was done. The biopsies showed a solid and tubulo-papillary tumour of large cells. In about 40% of the tumour cells the cytoplasm was clear and foamy, and these cells merged with eosinophilic cells. Both components were strongly positive for cytokeratin AE1/AE3, calretinin and CD10, and negative for CEA, BER-EP4, B72.3, CD68, CD15 and TTF-1. Electron microscopy showed long, slender microvilli of the mesothelial type. The authors reviewed earlier reports of foamy or clear cells in mesothelioma. They stressed recognizing the malignant nature of foamy cell mesothelioma and distinguishing it from other clear cell tumours, particularly metastatic renal carcinoma. They noted that CD10 positivity could mislead, because CD10 reacts with about 90% of renal cell carcinomas but is also positive in 18% of mesotheliomas. They concluded that clinico-radiological findings, areas of more traditional mesothelioma and a limited immunohistochemical panel enable the correct diagnosis.

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 was a case report of one patient with a malignant epithelial mesothelioma of the pleura in which part of the tumour cells had abundant foamy cytoplasm. The patient was a 56-year-old woman who smoked and had no history of asbestos exposure. Scans showed fluid around the left lung with no lesions elsewhere. Thoracoscopy found nodules on the chest wall lining, the diaphragm and the pericardium. Under the microscope, about 40% of the tumour cells had clear, foamy cytoplasm. Both foamy and more typical cells stained for calretinin, CD10 and a cytokeratin marker, and were negative for CEA, BER-EP4, B72.3, CD68, CD15 and TTF-1. Electron microscopy showed long, slender microvilli of the mesothelial type. She died of the disease 6 months after diagnosis. The authors concluded that the key points are to recognize foamy cell mesothelioma as malignant and to distinguish it from other clear cell tumours, particularly metastatic kidney cancer. They noted that the CD10 staining could have been misleading, and that electron microscopy could not determine what the foamy material was.

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 to the editor)
• Who was studied: one patient: a 56-year-old woman, a smoker, with chest pain and shortness of breath (Italy; authors at hospitals in Reggio Emilia and Bologna, Italy, and Mayo Clinic Scottsdale, USA)
• Exposure: The article reports no history of asbestos exposure for this patient; no fiber type is discussed.
• Main results:
  • Imaging showed a left pleural effusion with no lesions in other locations.
  • In this patient's tumour, about 40% of the neoplastic cells had clear, foamy cytoplasm; the rest had mostly eosinophilic cytoplasm.
  • Both the foamy and the eosinophilic tumour cells were strongly reactive for a cytokeratin marker, calretinin and CD10, and negative for CEA, BER-EP4, B72.3, CD68, CD15 and TTF-1.
  • Electron microscopy showed tumour cells with long, slender microvilli of the mesothelial type.
  • The patient received palliative therapy and died of the disease 6 months after diagnosis; no autopsy was performed.
• The authors' conclusion: The authors concluded that the main points are to recognize the malignant nature of foamy cell mesothelioma and to distinguish it from other clear cell tumours, particularly metastatic renal carcinoma. They noted that the strong CD10 staining in this case could have been misleading.
• Limitations the authors state:
  • Because of how the tissue was recovered, electron microscopy could not determine the nature of the material inside the foamy cells.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleura, Asbestos Exposure, Pleural Effusion, Thoracoscopy, Parietal Pleura, Diaphragm, Pericardium.

Related studies

• Case report: Papillary mesothelioma of the peritoneum with foamy cell lining — S. Stolnicu, E. Quiñonez, et al. (2013)
• The value of 'mesothelium-associated' antibodies in distinguishing between metastatic renal cell carcinomas and mesotheliomas — M. Osborn, N. Pelling, et al. (2002)
• Mesothelioma with signet-ring cell features: report of 23 cases — N.G. Ordóñez (2013)
• A comparative immunohistochemical study of malignant mesothelioma and renal cell carcinoma: the diagnostic utility of Leu-M1, Ber EP4, Tamm-Horsfall protein and thrombomodulin — R.L. Attanoos, H. Goddard, et al. (1995)
• Value of PAX8, PAX2, napsin A, carbonic anhydrase IX, and claudin-4 immunostaining in distinguishing pleural epithelioid mesothelioma from metastatic renal cell carcinoma — N.G. Ordóñez (2013)
• Metastatic renal cell carcinoma mimicking pleural mesothelioma — D.R. Taylor, W. Page, et al. (1987)

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