Lymphohistiocytoid mesothelioma of the pleura: a case report with cytological findings

Our plain-English summary of Lymphohistiocytoid mesothelioma of the pleura: a case report with cytological findings, by F. Tresserra, M. Castella, G. Fabra, et al (Diagnostic Cytopathology, 2013).

The study

• Authors: F. Tresserra, M. Castella, G. Fabra, M. Angeles Martinez, M. Dominguez, C. Fernandez-Cid, M.D. Amalrich, C. Ramos
• Journal: Diagnostic Cytopathology
• Published: 2013;41(6):546-9
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Lymphohistiocytoid malignant mesothelioma is an infrequent variant of sarcomatoid mesothelioma representing approximately 0.5-3.3% of malignant mesotheliomas. It has been related to asbestos exposure. The tumor is characterized by a diffuse large histiocyte-like cells proliferation mixed with an inflammatory infiltrate of lymphocytes and plasma cells. Its cytological diagnosis is difficult. We present a case of a 67-year-old female with lymphohistiocytoid mesothelioma involving the left pleura. The cytological, histological, and immunohistochemical features are discussed.

Copyright © 2011 Wiley Periodicals, Inc.

In plain English

This article was a case report of one patient, described by authors at an institute in Barcelona, Spain. She was a 67-year-old woman who had never smoked and who had lymphohistiocytoid mesothelioma of the left pleura. The authors described this as an infrequent variant of sarcomatoid mesothelioma. From age 13 to 20 she had worked in a spinning mill with asbestos fibers for insulating covers. The article did not name the fiber type. The authors reported a latency period of 40 years between exposure and diagnosis. She had three months of worsening breathlessness and left chest pain. A CT scan showed a large left pleural effusion with small nodules on the pleura. Cells from the drained fluid, which contained abundant lymphocytes and plasma cells, were first diagnosed as reactive mesothelium, with a note that malignancy should be ruled out. The authors said the mesothelioma was misdiagnosed because of this inflammatory infiltrate. Biopsies and immunohistochemical staining led to the final diagnosis of lymphohistiocytoid mesothelioma. She was treated with chemotherapy and was alive with persistent disease after 4 months. The authors concluded that this tumor type can be a challenging diagnosis on cytology.

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 (one patient) with cytological, histological and immunohistochemical findings
• Who was studied: one 67-year-old nonsmoking woman with lymphohistiocytoid mesothelioma of the left pleura, reported by authors at USP-Institut Universitari Dexeus, Barcelona, Spain; dates of care not given
• Exposure: occupational: worked in a spinning mill with asbestos fibers for insulating covers from age 13 to 20; fiber type not specified
• Main results:
  • Thoracic CT showed a large left pleural effusion with small nodules of about 15 mm on the left parietal pleura (and an 11 mm nodule on the diaphragmatic pleura)
  • Cytology of the pleural fluid, with abundant lymphocytes and plasma cells, gave a diagnosis of reactive mesothelium, with the note that malignancy should be ruled out because of histiocyte-like cells
  • The authors stated the mesothelioma was misdiagnosed on cytology because of the lymphoplasmocytic infiltrate
  • Tumor cells in the biopsy were positive for cytokeratin 5, 6 and 7, vimentin, calretinin, EMA, CD30 (focal), p53 (more than 10% of cells) and Ki67 (higher than 10%)
  • Final diagnosis was lymphohistiocytoid malignant mesothelioma
  • In this patient the authors reported a latency of 40 years between asbestos exposure and diagnosis
  • The patient was treated with chemotherapy and was alive with persistent disease after 4 months
• The authors' conclusion: The authors concluded that lymphohistiocytoid mesothelioma is an infrequent type of malignant mesothelioma that can be a challenging cytologic diagnosis

Topics

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

Medical terms in this study, explained in our Lexicon: Lymphohistiocytoid, Mesothelioma, Pleura, Sarcomatoid, Asbestos Exposure.

Related studies

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• Findings from high resolution computed tomography of the lung and pleura of symptom free workers exposed to amosite who had normal chest radiographs and pulmonary function tests — S. Neri, A. Antonelli, et al. (1994)
• Lymphohistiocytoid mesothelioma of the pleura — T. Kawai, S. Hiroi, et al. (2010)
• Pleural fluid cytological yield and visceral pleural invasion in patients with epithelioid malignant pleural mesothelioma — V. Pinelli, S. Laroumagne, et al. (2012)
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