Metastatic pleural mesothelioma presenting with solitary involvement of the tongue: report of a new case and review of the literature

Our plain-English summary of Metastatic pleural mesothelioma presenting with solitary involvement of the tongue: report of a new case and review of the literature, by F. Zanconati, A. DelConte, D. Bonifacio-Gori, et al (International Journal of Surgical Pathology, 2003).

The study

• Authors: F. Zanconati, A. DelConte, D. Bonifacio-Gori, G. Falconieri
• Journal: International Journal of Surgical Pathology
• Published: 2003;11(1):51-5
• Type of article: Case report
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a new case of mesothelioma that presented with an isolated lingual metastasis 14 months after initial diagnosis. The patient was a 71-year-old man with a history of pleural decortication and chemotherapy for epithelioid mesothelioma who recently complained of chronic bleeding from a nodular consolidation of tongue. There was no clinical or instrumental evidence of extrathoracic tumor spread. Microscopic examination of a lingual biopsy specimen revealed nests of atypical polygonal cells with moderate cytoplasm, immunopositive for keratins, epithelial membrane antigen, vimentin, thrombomodulin, and calretinin. This case provides additional evidence that mesothelioma could rarely, but not exceptionally, metastatize, to unusual sites such as the tongue. In that location it can mimic primary poorly differentiated squamous carcinoma or adenocarcinoma as well as a number of other metastatic malignancies. In addition to obvious medicolegal implication, metastatic mesothelioma should be correctly recognized so as to avoid useless radical treatment.

In plain English

This was a case report from pathologists in Trieste and Udine, Italy, with a discussion of earlier published cases. A 71-year-old man had been treated with left pleural decortication and chemotherapy for epithelioid malignant pleural mesothelioma. About 11 months later he was admitted with an ulcerated, easily bleeding tongue nodule, which the authors described as an isolated tongue metastasis 14 months after diagnosis. A scan showed locally advanced tumor in the chest but no evidence of other spread beyond the chest. In the tongue biopsy, tumor cells stained positive for keratins, vimentin, calretinin, thrombomodulin and epithelial membrane antigen, and negative for markers including CEA, Ber-Ep4 and p63. The authors interpreted these findings as mesothelioma. He died about three months later. Autopsy found tumor in the tongue and small deposits in organs including the liver, adrenal glands and peritoneum. The authors concluded that mesothelioma in the tongue can mimic other cancers. They also concluded that new lesions in patients with known mesothelioma should be handled as possible metastases unless staining disproves it. The article did not describe asbestos exposure.

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 report of one patient, with a discussion of a few previously published cases of mesothelioma spread to the tongue
• Who was studied: One 71-year-old man previously treated for epithelioid malignant pleural mesothelioma. The authors were from pathology departments in Trieste and Udine, Italy.
• Exposure: Not reported. The article does not describe any asbestos exposure, fiber type or occupational history for the patient.
• Main results:
  • The patient had left pleural decortication and chemotherapy for epithelioid malignant mesothelioma about 11 months before he was admitted with the tongue nodule.
  • Apart from the tongue lesion, imaging at admission showed locally advanced tumor in the left chest but no evidence of spread beyond the chest. The authors described this as no clinical evidence of metastatic tumor elsewhere.
  • Tongue biopsy tumor cells were positive for broad-spectrum keratins, keratins 5/6 (variably), keratin 7 (focally), vimentin, calretinin, thrombomodulin (focally) and EMA. They were negative for Ber-Ep4, TTF-1, mesothelin, Bg8 blood group antigen, p63, CEA, keratin 20 and S-100 protein.
  • The patient was judged not suitable for further treatment. He was readmitted 3 months later and died a few days after that.
  • At autopsy there was extensive tumor around the left lung and metastatic deposits in the tongue. There were also minute nodules in the pericardium, myocardium, peritoneum, adrenal glands and liver, and in gastric and splenic lymph nodes.
• The authors' conclusion: The authors concluded that pleural mesothelioma spread to the tongue can closely imitate other cancers, and that immunohistochemistry may help narrow the diagnosis. They concluded that in a patient with known mesothelioma, new tumors found during follow-up should be handled as possible metastases unless staining disproves it.

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, Mesothelioma, Metastasis, Chemotherapy, Epithelioid, Consolidation, Biopsy, Epithelial Membrane Antigen (EMA).

Related studies

• Solitary fibrous tumour of the tongue: a case report with immunohistochemical studies — Y. Yamashita, T. Satoh, et al. (2002)
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• Floor of mouth and tongue metastasis from malignant pleural mesothelioma — D. Kirke, K. Horwood, et al. (2010)
• Tongue metastasis from a malignant diffuse mesothelioma of the pleura: report of a case — A. Piattelli, M. Fioroni, et al. (1999)
• Plasma cell myeloma presenting with diffuse pleural involvement: a hitherto unreported pattern of a new mesothelioma mimicker — A. Colonna, G. Gualco, et al. (2010)
• Hyperplastic mesothelial cells in lymph nodes: report of six cases of a benign process that can stimulate metastatic involvement by mesothelioma or carcinoma — P. Argani, J. Rosai (1998)

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