Malignant pleural mesothelioma: some aspects of epidemiology, differential diagnosis and prognosis. Histological and immunohistochemical evaluation and follow-up of mesotheliomas diagnosed from 1964 to January 1985

Our plain-English summary of Malignant pleural mesothelioma: some aspects of epidemiology, differential diagnosis and prognosis. Histological and immunohistochemical evaluation and follow-up of mesotheliomas diagnosed from 1964 to January 1985, by R. Walz, H.K. Koch (Pathology, Research and Practice, 1990).

The study

• Authors: R. Walz, H.K. Koch
• Journal: Pathology, Research and Practice
• Published: 1990;186(1):124-34
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003836).

Abstract

64 diffuse pleural mesotheliomas diagnosed between 1964 and January 1985 at the Institute of Pathology of the University of Freiburg were analyzed. Since 1980 an increase from one case to 10 cases per year has been observed. The tumor was 3 to 4 times more frequent in men than in women. The age distribution showed a peak between the age of 50 and 60. In 26 cases evidence of exposure to asbestos was detected. In one patient radiotherapy of Hodgkin's disease may have been of etiological significance. The median survival time was 13 months. The five-year survival rate was only 4%. Histologic reevaluation was only possible in cases diagnosed after 1975. Of 43 cases thus evaluated 26 were pure mesothelial, 15 biphasic and 2 of the spindle-cell subtype. A median survival time of 23 months for pure mesothelial mesothelioma in comparison to 13 months for the biphasic mesothelioma indicated a better prognosis for pure mesothelial mesothelioma. Although no other primary tumors were detected, in 10 cases the differential diagnosis of adenocarcinoma had to be considered, and in 3 cases tumors of non-epithelial origin had to be excluded. 35 of 43 mesothelioma were CEA-negative, 38 out of 43 cytokeratin-positive, and 33 out of 43 were EMA-positive. Factor-VIII-related antigen was not demonstrated. 12 of 43 mesotheliomas showed PAS-positive staining, 29 of 43 were stained with Alcian blue. 7 of these 29 showed a positive digestion with hyaluronidase. Although CEA may not be negative in every mesothelioma, this marker seems to be a valid tool for the differential diagnosis of adenocarcinoma. In order to safeguard against a mistaken diagnosis of pleural mesothelioma, the exclusion of other tumors is always indispensable.

In plain English

The authors reviewed 64 patients diagnosed with malignant pleural mesothelioma at the Robert-Koch-Klinik, University of Freiburg, West Germany, between 1964 and January 1985. There were 50 men and 14 women, with an age peak between 50 and 60, and yearly cases rose, particularly from 1980. Alleged asbestos exposure was found in 26 patients, mostly through their occupation. The article does not name fiber types. Median survival was 13 months, and the five-year survival rate was 4%. Tissue from 43 cases, the only ones with material available from 1975 onward, was re-examined: 26 were the mesothelial type, 15 biphasic and 2 spindle-cell. Median survival was 23 months for the mesothelial type and 13 months for the biphasic type, a difference that was not statistically significant. Most tumors tested negative for the marker CEA (35 of 43) and positive for cytokeratin (38 of 43). The authors concluded that other tumors must always be excluded before diagnosing pleural mesothelioma, and that CEA seems useful for distinguishing it from adenocarcinoma.

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 from one hospital and pathology institute. It combined histological re-evaluation, histochemical and immunohistochemical staining, and survival follow-up using case histories and interviews.
• Who was studied: 64 patients with malignant pleural mesothelioma diagnosed at the Robert-Koch-Klinik, University of Freiburg, West Germany, between 1964 and January 1985. Of these, 43 cases from 1975 onward had tissue available for re-examination.
• Exposure: Alleged asbestos exposure in 26 of 64 patients. In 23 it was indicated by occupation, in 2 by asbestos particles seen in adherent lung tissue, and in 1 by an increased amount of asbestos fibres in a broncho-alveolar lavage. Fiber types are not named. One patient had earlier radiation and chemotherapy for Hodgkin's disease.
• Main results:
  • 50 male and 14 female patients.
  • Age peak between 50 and 60 years.
  • The number of cases registered per year grew, particularly since 1980.
  • 26 cases with alleged exposure to asbestos fibres were identified.
  • In the other 38 cases, with no obvious occupational asbestos exposure, the authors stated that the job descriptions given by more than half made higher than usual contact with asbestos fibres conceivable.
  • Presumed latency could be defined in 7 cases (11, 14, 30, 33, 35, 37 and 40 years), with an average of 33 years.
  • In one patient, pleural mesothelioma developed 6 years after radiation and chemotherapy for Hodgkin's disease. The authors considered this a causal factor, although they noted the latency seemed short.
  • 12 patients had a history of previous pleuro-pulmonary illness.
  • Among all 64 patients, survival ranged from 1 to 114 months, with a mean of 22 months and a median of 13 months.
  • Survival rates for all patients: 53% at 1 year, 29% at 2 years, 11% at 3 years, 8% at 4 years and 4% at 5 years.
  • Of the 43 re-examined cases, 30 showed a typical histological picture and 13 were classed as doubtful diagnosis.
  • Of the 43 re-examined cases, 26 (60%) were mesothelial mesothelioma, 15 (35%) biphasic and 2 spindle-cell type.
  • Median survival was 23 months for mesothelial mesothelioma and 13 months for the biphasic type.
  • The difference in survival by histological subtype was not statistically significant.
  • Both patients with the spindle-cell type survived only 6 months.
  • By EMA staining: tumors with numerous stained cells had a median survival of 24 months; few stained cells, 16 months; none, 11 months.
  • Patients under age 50 had a median survival of 21 months; those aged 50 to 60, 13 months.
  • Patients over age 60 had a median survival of 9 months.
  • 8 of 43 cases showed CEA-positive tumor cells. None of the cases with a typical histological pattern showed clearly CEA-positive cells.
  • Cytokeratin was positive in 38 of 43 mesotheliomas.
  • EMA was positive in 33 of 43 tumors.
  • Factor VIII-related antigen did not stain tumor cells in any case.
  • 12 of 43 cases were PAS-positive.
  • 29 of 43 cases stained with Alcian blue, and 7 of these showed positive hyaluronidase digestion.
• The authors' conclusion: The authors concluded that CEA, though not negative in every mesothelioma, seems to be a valid tool for distinguishing mesothelioma from adenocarcinoma. They also concluded that other tumors must always be excluded to safeguard against a mistaken diagnosis of pleural mesothelioma.
• Limitations the authors state:
  • Tissue was only available from 1975 onward, so only 43 of the 64 cases could be re-examined.
  • Only two spindle-cell cases were seen.
  • Cases clustered in and around larger towns, but the authors could not say whether this reflects a higher urban risk.
  • The authors judged that the worse survival with age most probably reflects age-related decline in heart and lung function rather than different tumor behaviour.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Epidemiology, Differential Diagnosis, Prognosis, Mesothelioma, Pathology, Median Survival, Biphasic Mesothelioma.

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