Malignant mesothelioma of the pleura with desmoplastic histology: a case series and literature review

Our plain-English summary of Malignant mesothelioma of the pleura with desmoplastic histology: a case series and literature review, by K. Hashimoto, Y. Okuma, Y. Hosomi, et al (BMC Cancer, 2016).

The study

• Authors: K. Hashimoto, Y. Okuma, Y. Hosomi, T. Hishima
• Journal: BMC Cancer
• Published: 2016;16(1):718
• Type of article: Case report, Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Desmoplastic malignant pleural mesothelioma (DMM) is rare histological subtype of diffuse malignant pleural mesothelioma (MPM), accounting for 5-10 % of cases. It has a poor prognosis, with direct invasion of the chest wall or lungs and distant metastases. Its pathological characteristics include dense collagen fibers in a storiform pattern. Its pretreatment pathological diagnosis is difficult, with fibrous pleuritis and reactive mesothelial hyperplasia as potential differential diagnoses.

Case Presentation: We retrospectively reviewed the medical charts of patients with MPM from 1996 to 2012. Among 60 patients with MPM, four patients with the desmoplastic subtype were identified and their clinical characteristics, including asbestos exposure, treatment, and prognosis, were reviewed. All of the patients with DMM were men, with a median age of 69 years (range: 63-74 years). All four patients had been exposed to asbestos. The definitive diagnosis was made histologically and the International Mesothelioma Interest Group classification was advanced (III/IV: 2/3) in all four patients. Three patients were treated with chemotherapy (two with cisplatin/pemetrexed and one with cisplatin/gemcitabine) and one patient underwent surgery. The median survival time in the patients with DMM was 3.8 months (range: 0.9-11.5 months), compared with 10.5 months in patients with other subtypes of MPM in our institution.

Conclusions: DMM continues to have a poor prognosis. It is important to recognize this variant and distinguish it from pleural plaques, non-specific reactive pleural fibrosis, pleurisy, and other lung diseases.

In plain English

This was a case series from a cancer hospital in Tokyo, Japan, with a discussion of published reports. The authors reviewed the charts of 60 patients with malignant pleural mesothelioma seen from 1996 to 2012 and found four with the rare desmoplastic subtype. All four were men aged 63 to 74. The text says all four had been exposed to asbestos, but the article's table lists one patient's exposure as unknown. Fiber types and jobs were not described. All four were diagnosed by thoracoscopic biopsy at an advanced stage (two stage III, two stage IV). In two of them the disease had to be told apart from fibrous pleurisy. The authors described the chemotherapy given as ineffective. Individual survival times in the table ranged from 0.9 to 11.6 months. The authors reported a median of 3.8 months, compared with 10.5 months for patients with other mesothelioma subtypes at the same hospital. The authors concluded that this subtype continues to have a poor prognosis and should be distinguished from pleural plaques, non-specific reactive pleural fibrosis and pleurisy.

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: Retrospective case series (chart review of four patients at one hospital), with a discussion of published literature
• Who was studied: Four patients with desmoplastic malignant pleural mesothelioma, identified among 60 patients with malignant pleural mesothelioma at Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Japan, 1996 to 2012. All were men, median age 69 years (range 63 to 74).
• Exposure: Asbestos exposure, reported as present in all four patients in the text. The table lists one patient (Case 3) as unknown. Fiber types, jobs and doses were not reported.
• Main results:
  • Median survival in the four patients with the desmoplastic subtype was reported as 3.8 months (range 0.9 to 11.5 months), compared with 10.5 months in patients with other subtypes of malignant pleural mesothelioma at the same institution.
  • All four patients had advanced disease: two at stage III and two at stage IV (iMig staging).
  • Individual outcomes. Case 1 died 11.6 months after starting treatment. Case 2 died of disease progression 8.1 months after diagnosis. Case 3 died of acute renal dysfunction 4.7 months after diagnosis. Case 4 died 0.9 months after admission, and autopsy confirmed the desmoplastic subtype.
  • The authors reported that chemotherapy was ineffective in the patients who received it.
  • In two cases (Cases 1 and 4) the disease had to be distinguished from fibrous pleurisy. All cases were ultimately diagnosed by histology.
  • Case 1 had been diagnosed with non-specific pleural thickness by thoracoscopic surgery at another institution three years before the mesothelioma diagnosis.
• The authors' conclusion: The authors concluded that the desmoplastic subtype continues to have a poor prognosis. In their view it is important to recognize it and distinguish it from pleural plaques, non-specific reactive pleural fibrosis, pleurisy and other lung diseases. They noted that in their four patients the diagnosis was made only at an advanced stage.

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: Mesothelioma, Pleura, Desmoplastic Mesothelioma, Histology, Pleural Mesothelioma, Histological Subtype, Prognosis, Collagen.

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