Malignant mesothelioma cells in sputum

Our plain-English summary of Malignant mesothelioma cells in sputum, by D. Whitaker, G. Sterrett, K. Shilkin, et al (Diagnostic Cytopathology, 1986).

The study

• Authors: D. Whitaker, G. Sterrett, K. Shilkin, M. Walters
• Journal: Diagnostic Cytopathology
• Published: 1986;2(1):21-4
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In five patients with malignant mesothelioma of pleura, malignant cells, presumably derived from intrapulmonary deposits, were found in sputum specimens. The cells presented mainly as papillary aggregates of epithelial-like cells, in most cases without specific identifiable mesothelial cell features. In one patient, the specimen was received early in the diagnostic work-up and led to a strong consideration of the diagnosis of adenocarcinoma. In the remainder, the finding was incidental, occurring after the diagnosis of mesothelioma had been established. The cases are reported to draw attention to this phenomenon, previously unreported in the cytologic literature, and to emphasize that the finding of malignant cells in sputum does not preclude the diagnosis of malignant mesothelioma.

In plain English

This article is a series of five case reports from Western Australia. While reviewing all pathology material, including sputum (coughed-up mucus) samples, from 120 patients with mesothelioma, the authors found five patients whose sputum contained malignant cells at some point in their illness. Four were men aged 70 to 78 and one was a woman aged 66. All had past asbestos exposure. It included six months in a blue asbestos mine, work at power stations, making gas masks with blue and white asbestos during World War II, and carpentry-building. The cancer cells mostly appeared as papillary clusters that usually could not be told apart from adenocarcinoma. In only one case did they closely resemble mesothelioma cells as seen in body fluids. In the woman, the sputum cells were first read as most likely adenocarcinoma. Autopsies in three patients found tumor in the lung or main airway. The authors concluded that mesothelioma may shed malignant cells into sputum and that this finding does not rule out mesothelioma. They noted the cells were not particularly distinctive.

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 series (five case reports) identified from a review of pathology material
• Who was studied: Five patients with malignant mesothelioma (four men aged 70, 76, 77 and 78; one woman aged 66), found among 120 patients with mesothelioma whose pathology material was reviewed at the Combined Cytology Unit, Sir Charles Gairdner Hospital, and the University of Western Australia, Nedlands, Western Australia
• Exposure: Occupational asbestos exposure: 6 months as a miner in a blue asbestos mine in Western Australia (case 1); 10 years as an insulator in an electrical power station (case 2); 6 years at a power station (case 3); blue and white asbestos while manufacturing gas masks during World War II (case 4); over 20 years as a self-employed carpenter-builder (case 5)
• Main results:
  • In most of the five cases, the malignant cells in sputum appeared as papillary aggregates that usually could not be distinguished from adenocarcinoma cell groups; in only one case did the cells closely resemble malignant mesothelial cells as seen in serous effusions
  • In case 4 (the woman), the sputum cells were initially interpreted as most likely coming from an adenocarcinoma; necropsy later showed malignant mesothelioma
  • In case 1, sputum at first presentation showed only asbestos bodies and no atypical cells; one year later, sputum showed a few large papillary clusters of malignant cells considered mesothelial in type
  • At autopsy, tumor was found in the lung or airway: in case 2, metastases to lung including mucosal infiltration of the left main bronchus; in case 3, a submucosal tumor deposit in the left main bronchus; in case 4, peribronchial and perivascular spread within the lung
  • In case 5, sputum taken one week after pleural fluid cytology showed papillary aggregates of malignant cells, including one aggregate containing a psammoma body
• The authors' conclusion: The authors concluded that malignant mesothelioma may shed malignant cells into sputum and that finding such cells does not exclude mesothelioma from the differential diagnosis
• Limitations the authors state:
  • The authors stated that the cytologic findings in their series were not particularly distinctive
  • The authors stated that in some cases the nuclear atypia was only moderate, making it problematic to distinguish malignant cells from reactive bronchial cell groups, and occasionally this distinction could not be made with certainty

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Sputum, Pleura, Mesothelial Cells, Adenocarcinoma, Mesothelioma.

Related studies

• Copy number gains on 5p15, 6p11-q11, 7p12, and 8q24 are rare in sputum cells of individuals at high risk of lung cancer — E. Kettunen, K. Salmenkivi, et al. (2006)
• Sputum asbestos bodies and radiographic changes in residents of Wittenoom, Western Australia — A.W. Musk, J.E. Baker, et al. (1983)
• A method for extracting ferruginous bodies from sputum and pulmonary tissue — M.J. Smith, B. Naylor (1972)
• A procedure for the isolation of amosite asbestos and ferruginous bodies from lung tissue and sputum — M.G. Williams, R.F. Dodson, et al. (1982)
• Assessment of hazardous dust exposure by BAL and induced sputum — E. Fireman, J. Greif, et al. (1999)
• Perls' Prussian Blue Stains of Lung Tissue, Bronchoalveolar Lavage, and Sputum — A.J. Ghio, V.L. Roggli (2021)

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