Localised spontaneous regression in mesothelioma -- possible immunological mechanism

Our plain-English summary of Localised spontaneous regression in mesothelioma -- possible immunological mechanism, by B.W. Robinson, C. Robinson, R.A. Lake (Lung Cancer, 2001).

The study

• Authors: B.W. Robinson, C. Robinson, R.A. Lake
• Journal: Lung Cancer
• Published: 2001;32(2):197-201
• Type of article: Case report
• Cited by: 56 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma (MM) is an aggressive tumor usually associated with asbestos exposure. Although it can remain stable for prolonged periods, it has not been described to spontaneously regress. MM tumors are thought to be immunogenic based both on animal studies and on the good responses in some humans treated with immunotherapy. Here we present a case of pleural MM in which a transient spontaneous regression was associated with tumor tissue infiltration with mononuclear cells and serological evidence of anti-MM reactivity. The patient's tumor eventually progressed and with this progression there was evidence of loss of serological reactivity to some, but not all, of her MM antigens. The patient survived for 20 months and, in contrast to her initial biopsy, no significant lymphoid infiltrate was detected in her MM tissue at post mortem examination.

In plain English

This case report described one patient with pleural mesothelioma, a 54-year-old woman whose tumor was found on a routine chest X-ray. Between ages 19 and 23 she was incidentally exposed to crocidolite in the asbestos mining town of Wittenoom, while working as a shop assistant and while handling her husband's asbestos-contaminated work clothes. A biopsy of the larger front (anterior) lesion showed mesothelioma mixed with many lymphocytes and scattered plasma cells, which are immune cells. She received no anti-tumor treatment. Three months later the anterior lesion had markedly shrunk. A smaller back (posterior) lesion, which was never biopsied, did not shrink. It later grew and encased the lung. She survived 20 months. At post mortem no significant lymphoid infiltrate was found in her tumor, and 308 asbestos bodies per gram lung weight were counted in the apex of the left lower lobe. Blood samples from her last 11 months showed antibodies against mesothelioma. Two of these reactions faded and one stayed stable. The authors judged this strong circumstantial evidence linking the immune cells to the regression. They concluded that the case reinforces the notion that mesothelioma is potentially immunogenic.

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 patient)
• Who was studied: one 54-year-old woman with pleural malignant mesothelioma, found on a routine chest X-ray and confirmed by CT scan; dates and treating location not stated
• Exposure: incidental crocidolite exposure in the asbestos mining town of Wittenoom between ages 19 and 23, while working as a shop assistant and while handling her husband's asbestos-contaminated work clothes; she was a non-smoker
• Main results:
  • The biopsy of the large anterior lesion showed tumor cells mixed with large numbers of small lymphocytes and scattered plasma cells
  • The patient received no anti-tumor treatment
  • A CT scan 3 months after presentation showed regression of the anterior mass only; the smaller posterior lesion was unchanged
  • The posterior lesion later grew, eventually encasing the posterior and anterior surfaces of the lung; the anterior lesion never appeared to regrow
  • The patient survived for 20 months
  • At post mortem, unlike the initial biopsy, no significant lymphoid infiltrate was found in her mesothelioma tissue
  • The post mortem asbestos body count was 308 asbestos bodies per gram lung weight in the apex of the left lower lobe
  • Blood (serum) samples were collected over the last 11 months of her disease
  • Antibody reactions against mesothelioma antigens were present; over time two of them waned while one remained stable
  • The authors' interpretation was that the presence of the immune-cell infiltrate in the regressing lesion and its absence from the progressive lesion at post mortem was strong circumstantial evidence of an association with the regression
• The authors' conclusion: The authors concluded that this single case, in which spontaneous regression was associated with a lymphoid infiltrate and a serological response to the tumor, reinforces the notion that mesothelioma is a potentially immunogenic tumor
• Limitations the authors state:
  • No blood samples were available from the initial stage of her disease
  • The posterior lesion, which did not regress, was not biopsied
  • The reason the posterior nodule was not destroyed by the immune response is unclear
  • The authors note that spontaneous regression is rare and transient

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Malignant Mesothelioma, Asbestos Exposure, Immunotherapy, Biopsy.

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• 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)
• Serologic responses in patients with malignant mesothelioma: evidence for both public and private specificities — C. Robinson, M. Callow, et al. (2000)
• Immunohistochemical panels for differentiating epithelial malignant mesothelioma from lung adenocarcinoma: a study with logistic regression analysis — R. Carella, G. Deleonardi, et al. (2001)
• p53 autoantibodies in patients with malignant mesothelioma: stability through disease progression — J. Creaney, B.M. McLaren, et al. (2001)

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