Malignant vascular tumours of the pleura in "asbestos" workers and endothelial differentiation in malignant mesothelioma

Our plain-English summary of Malignant vascular tumours of the pleura in "asbestos" workers and endothelial differentiation in malignant mesothelioma, by R.L. Attanoos, S.K. Suvarna, E. Rhead, et al (Thorax, 2000).

The study

• Authors: R.L. Attanoos, S.K. Suvarna, E. Rhead, M. Stephens, T.J. Locke, M.N. Sheppard, F.D. Pooley, A.R. Gibbs
• Journal: Thorax
• Published: 2000;55(10):860-3
• Type of article: Case report
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Three cases of diffuse malignant vascular tumours of the pleura are described which mimicked malignant mesothelioma clinically and pathologically (so called "pseudomesothelioma"). All had occupational histories of exposure to asbestos. The relationship of these tumours to mesothelioma and asbestos exposure is discussed.

Methods: To examine the histogenetic relationship between mesothelioma and these three tumours an immunohistochemical analysis of vascular marker (CD31, CD34, and Von Willebrand factor) expression was undertaken in 92 cases of pleural mesothelioma, in addition to these three tumours. Electron microscopic fibre analysis of lung tissue was performed on each of the three cases to assess asbestos fibre content.

Results: Diffuse pleural epithelioid haemangioendotheliomas may closely resemble malignant mesothelioma clinically and pathologically but, of the 92 pleural mesotheliomas tested, none showed expression of CD31, CD34, and Von Willebrand factor. Although all three cases had claimed exposure to asbestos, ferruginous bodies typical of asbestos were only seen by light microscopy in case 2, and only in this subject was the asbestos fibre content raised in comparison with the range seen in a non-exposed background population. The latent period in the pleural epithelioid haemangioendotheliomas ranged from 18 to 60 years.

Conclusions: Endothelial differentiation does not appear to occur in mesothelioma and therefore should be clearly separated from it. No definite association between pleural epithelioid haemangioendothelioma and exposure to asbestos can be made from this small series but further investigation is warranted.

In plain English

This article described three cases of a rare malignant blood-vessel tumour of the pleura, epithelioid haemangioendothelioma (also called epithelioid angiosarcoma), which can closely resemble malignant mesothelioma. All three patients had been referred for pathological review during compensation claims for asbestos-related disease. They had worked as a labourer, a shipyard joiner and a shipyard welder. The tumour cells tested positive for vimentin and for at least two of three endothelial (blood-vessel lining) markers. Electron microscope analysis of lung tissue showed raised asbestos fibre levels, mostly crocidolite and amosite, only in the shipyard joiner (case 2). Cases 1 and 3 did not show a clear-cut increase. The authors also tested 92 pleural mesotheliomas for the same markers (CD31, CD34 and von Willebrand factor) and found no staining in any of them. The authors concluded that endothelial differentiation does not occur, or is very infrequent, in mesothelioma. They also concluded that no definite association between this tumour and asbestos could be drawn from this small series, which they said showed referral bias, and that further investigation was warranted.

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 of three patients with primary pleural epithelioid haemangioendothelioma, with electron microscopic lung fibre analysis, plus an immunohistochemical study of vascular markers in 92 malignant mesotheliomas
• Who was studied: Three patients referred for pathological review during compensation claims for asbestos-related disease (UK). For comparison, 92 archived cases of malignant mesothelioma: 84 from Llandough Hospital, Penarth and 8 from Northern General, Sheffield.
• Exposure: Claimed occupational asbestos exposure. Case 1 was a labourer, 1956 to 1958 (2 years), exposure light, frequency unknown. Case 2 was a shipyard joiner, 1938 to 1943 (5 years), exposure heavy and intermittent. Case 3 was a shipyard welder, 1975 to 1976 (18 months), exposure heavy and intermittent. Lung fibre types measured were amosite, crocidolite, chrysotile, mullite and others, including tremolite.
• Main results:
  • In the three pleural tumours, the tumour cells were positive for vimentin and for at least two of the three endothelial markers (CD31, CD34, von Willebrand factor).
  • None of the 92 malignant mesotheliomas, of any subtype, showed immunoreactivity for CD31, CD34 or von Willebrand factor.
  • From the 92-case results, the authors concluded that vascular marker expression (and endothelial differentiation) does not occur, or is a very infrequent finding, in malignant mesothelioma.
  • Case 2 (shipyard joiner) lung fibre counts, in fibres per gram of dry lung tissue times 10 to the sixth power: total 51.7, amosite 12.3, crocidolite 29.5, chrysotile not detected, mullite 7.5, others 2.4.
  • In case 2, the authors judged that all parameters indicated an increased crocidolite fibre count consistent with occupational exposure.
  • Case 1 (labourer) lung fibre counts, in fibres per gram of dry lung tissue times 10 to the sixth power: total 27.2; amosite, crocidolite and chrysotile not detected; mullite 8.8; others 18.4, including 0.5 tremolite.
  • Case 3 (shipyard welder) lung fibre counts, in fibres per gram of dry lung tissue times 10 to the sixth power: total 6.9, amosite 0.4, crocidolite not detected, chrysotile 0.2, mullite 5.8, others 0.5.
  • Cases 1 and 3 did not show a clear-cut increase in asbestos fibre levels.
  • Ferruginous bodies were present in cases 1 and 3, but bodies typical of asbestos were seen only in case 2.
  • In case 1, 90% of the non-fibrous particulate matter in the lung was mica.
  • The text reports latent periods of 18 to 60 years for the three cases (Table 2 lists 42, 60 and 17 years).
• The authors' conclusion: The authors concluded that endothelial differentiation does not appear to occur in mesothelioma, so these tumours should be clearly separated from it. They also concluded that no definite association between pleural epithelioid haemangioendothelioma and asbestos exposure can be made from this small series, but that further investigation is warranted.
• Limitations the authors state:
  • The three cases were identified during compensation claims for asbestos-related disease and so show referral bias.
  • Occupational histories of exposure depend on recall and can under- or overestimate exposure.
  • In case 1, chrysotile may have been cleared from the lung and been undetectable at death, because chrysotile has low biopersistence.
  • In case 3, the tissue was suboptimal for ultrastructural (electron microscope) analysis.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleura, Mesothelioma, Pseudomesotheliomatous Adenocarcinoma, Asbestos Exposure, CD34, Pleural Mesothelioma, Epithelioid, Ferruginous body.

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