Mesotheliomas with deciduoid morphology: a morphologic spectrum and a variant not confined to young females

Our plain-English summary of Mesotheliomas with deciduoid morphology: a morphologic spectrum and a variant not confined to young females, by J.H. Shanks, M. Harris, S.S. Banerjee, et al (The American Journal of Surgical Pathology, 2000).

The study

• Authors: J.H. Shanks, M. Harris, S.S. Banerjee, B.P. Eyden, V.M. Joglekar, A. Nicol, P.S. Hasleton, A.G. Nicholson
• Journal: The American Journal of Surgical Pathology
• Published: 2000;24(2):285-94
• Type of article: Case report
• Cited by: 54 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Deciduoid mesotheliomas are rare with only four previously reported cases, all affecting the peritoneum of young females. We describe another six cases (three men and three women; age range 52-65 yrs, median 55 yrs; five peritoneal and one pleural). Three patients had an occupational history of asbestos exposure. The deciduoid appearance predominated in four cases, whereas in two it represented a minor component within conventional tubulopapillary epithelioid mesothelioma. All tumors were strongly cytokeratin-positive (including CK5/6) and all showed at least focal staining for thrombomodulin, HBME-1, and calretinin. All were negative for epithelial mucin (D/PAS), CEA, BerEP4, LeuM1 (CD15), CD21, CD35, and S100 protein. Five of six cases (83%) were vimentin-positive and two (33%) were focally positive for alpha-smooth muscle actin. A differential diagnosis of gastrointestinal autonomic nerve tumor (GANT) had been initially considered from the morphology of one case, and we found positivity for some of the "neuronal" markers described in GANTs. This prompted us to apply such a panel to the other five tumors, accepting that the cytokeratin positivity encountered in all of our cases would exclude GANT. All cases of deciduoid mesothelioma (100%) were positive for PGP 9.5 and NSE and four of six (66%) were positive for NKI/C3. Weak focal staining (<5% cells) for synaptophysin was seen in two of six tumors. All cases were chromogranin-negative. All cases examined by electron microscopy showed desmosomes and smooth microvilli without rootlets but no neuroendocrine granules. In conclusion, a deciduoid morphology appears to be part of the histopathologic spectrum encountered in epithelioid mesothelioma. This variant is not confined to female patients and occurs over a wider age range than previously recognized. The overlapping immunophenotype with GANTs illustrates that caution should be exercised when interpreting positivity for "neuronal" markers in this context. An immunohistochemical panel that includes cytokeratins should always be used.

In plain English

This case series described six patients with malignant mesothelioma of 'deciduoid' appearance, meaning large tumor cells with abundant glassy cytoplasm resembling decidua. The authors noted that all four earlier cases were peritoneal, in young females. The article said its patients were three men and three women aged 52 to 65 years (median 55), but its case histories described four men and two women. Five tumors were peritoneal and one was pleural. Three had an occupational history of asbestos exposure (shipyard painting, blue asbestos work, factory asbestos cutting). A fourth had a short history of possible exposure. The deciduoid appearance made up most of the tumor in four cases and focal areas in two. All tumors stained for cytokeratin 5/6, calretinin, and the 'neuronal' markers PGP 9.5 and NSE. Four patients died within 4 to 9 months of presentation; one was alive at 5 years. The authors concluded that this morphology is not restricted to the young or to females. They suggested that at least some peritoneal deciduoid mesotheliomas may be asbestos-related.

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 (clinicopathologic report of six cases with immunohistochemistry and electron microscopy)
• Who was studied: Six adult patients with deciduoid malignant mesothelioma, aged 52 to 65 years (median 55); five peritoneal, one pleural. They were treated at or referred to hospitals in England (Christie Hospital, Manchester, and Royal Brompton Hospital, London). The abstract and introduction give three men and three women, but the individual case histories describe four men (cases 1, 3, 4 and 6) and two women (cases 2 and 5).
• Exposure: Occupational asbestos exposure history taken from case notes. The authors counted three patients with an occupational history of exposure, one with a short history of possible exposure, and two with no specific or known history.
• Main results:
  • The individual case histories describe men in cases 1, 3, 4 and 6 and women in cases 2 and 5, for example case 1, a 59-year-old man.
  • Case 3 worked in a shipyard for 25 years as a painter and decorator, often painting near pipe-lagging work.
  • Case 4 had a history of heavy asbestos exposure, including industrial work with blue asbestos in the 1950s and further exposure in the 1960s.
  • Case 6 had occupational exposure 36 years earlier, cutting asbestos in a factory for 3 months.
  • Case 2 had a short history of possible asbestos exposure.
  • The deciduoid component was focal in cases 5 and 6 and made up most of the tumor biopsied in cases 1 through 4.
  • Cytokeratin 5/6 was strongly and diffusely positive in tumor cells in all cases.
  • All cases were positive for calretinin.
  • All cases were negative for S100 protein, and all biopsies were negative for CD21 and CD35.
  • The tumors were positive for the 'neuronal' markers PGP 9.5 and NSE (all cases, per Table 3), which the authors found unexpected.
  • Synaptophysin staining in two cases (cases 2 and 6) was weak and seen in fewer than 5% of tumor cells.
  • All cases were chromogranin-negative.
  • Electron microscopy found no neuroendocrine granules in any case examined.
  • Electron microscopy found smooth microvilli without rootlets at the cell surfaces in all cases examined.
  • At autopsy, two asbestos bodies were found in four lung sections in case 3.
  • At autopsy in case 1 (no specific exposure history), no ferruginous (asbestos) bodies were identified in lung sections, though pleural plaques were present.
  • At autopsy in case 5 (no known exposure history), pleural plaques were present on the diaphragm.
  • Cases 1, 3 and 5 died 4 months after presentation, and case 2 died 9 months after presentation.
  • Case 4 remained alive 5 years after initial presentation.
  • Case 6 (pleural) remained alive with disease 8 months after initial presentation.
  • The authors suggested that at least some peritoneal deciduoid mesotheliomas may be asbestos-related.
• The authors' conclusion: The authors concluded that deciduoid morphology is not restricted to the young or to females, and that, like other mesotheliomas, it is often, though not always, associated with a history of prior asbestos exposure.
• Limitations the authors state:
  • Tissue for electron microscopy was not available for cases 4 and 5 or for the needle biopsy in case 1.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Peritoneum, Occupational History, Asbestos Exposure, Tubulopapillary, Epithelioid, HBME-1, Calretinin.

Related studies

• Deciduoid or pseudodecidual mesothelioma — A. Talerman (2000)
• Primary Malignant Deciduoid Mesothelioma: A Challenging Diagnosis — M. Regragui, N.B. Guebessi (2019)
• Deciduoid pleural mesothelioma affecting a young female without prior asbestos exposure — K. Gloeckner-Hofmann, X.Z. Zhu, et al. (2000)
• Malignant peritoneal mesothelioma, clear cell variant, in a female and its differentiation from clear cell carcinoma — H. Hayashi, T. Kawata, et al. (2017)
• Diffuse epithelial mesothelioma: a review of the ultrastructural spectrum — I. Dardick, M. Jabi, et al. (1987)
• Mesothelial proliferations. An increasing morphologic spectrum — M.R. Wick, S.E. Mills (2000)

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