Pathological anatomy and molecular pathology

Our plain-English summary of Pathological anatomy and molecular pathology, by M. Krismann, K.M. Müller, M. Jaworska, et al (Lung Cancer, 2004).

The study

• Authors: M. Krismann, K.M. Müller, M. Jaworska, G. Johnen
• Journal: Lung Cancer
• Published: 2004;45 Suppl 1:S29-33
• Type of article: Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The incidence of malignant mesotheliomas in Germany has increased since about the mid 1980s, and a further increase is expected until about 2020 due to the peak in asbestos processing in Germany between 1965 and 1980. About 90% of the mesotheliomas recorded in the files of the German Mesothelioma Registry in Bochum are asbestos-related and therefore possibly due to an occupational exposure. In 2003, 717 mesotheliomas were newly diagnosed at the German Mesothelioma Registry. Mesotheliomas are very heterogeneous in terms of histological appearances and of prognosis. At present, the diagnostic gold standard is conventional histology in combination with additional immunohistochemical analysis. We were not able to confirm a promising report that described telomerase reverse transcriptase catalytic subunit (TERT) for the differentiation between reactive and neoplastic mesothelial lesions, which can be extremely difficult. DNA cytometric analysis may also help differentiate between reactive and neoplastic mesothelial lesions. There are some characteristic patterns of chromosomal imbalances as detectable by comparative genomic hybridization (CGH), but at present, specific chromosomal or genetic defects that give rise to a mesothelioma are not known. A reliable pathological diagnosis is the basis for therapeutic, prognostic, and medicolegal consequences. In general, it can be achieved by thoracoscopic inspection with specifically directed biopsy. Furthermore, a description of the peculiarities of each mesothelioma by the pathologist might be the key to a more individual therapy in the future.

In plain English

This article was a short review by pathologists at the German Mesothelioma Registry in Bochum on the pathology and genetics of malignant mesothelioma. It did not report a new study with methods. The authors stated that more than 90% of mesotheliomas recorded in the registry were asbestos associated, and the article's opening summary reported 717 mesotheliomas newly diagnosed there in 2003. They had not seen a mesothelioma patient exposed only to man-made mineral fibres. They found no real small cell mesothelioma among more than 6000 mesotheliomas in the registry archives. In their group's earlier genetic analysis of 90 mesotheliomas, the chromosome changes also occurred in many other solid tumours, though their combination was somewhat characteristic. The opening summary said the authors could not confirm a report on a telomerase marker (TERT) for telling reactive from cancerous lesions. The main text instead called that report promising but in need of validation. The authors concluded that a reliable diagnosis, generally achievable by thoracoscopy with targeted biopsy, is the basis for treatment, prognosis and medicolegal decisions.

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: Narrative review and overview article on the pathology and molecular pathology of malignant mesothelioma, drawing on published literature and on the experience and earlier work of the German Mesothelioma Registry. No methods section and no new study design are described.
• Who was studied: No defined study population. The authors refer to the archives of the German Mesothelioma Registry in Bochum (more than 6000 mesotheliomas) and to their earlier analysis of 90 mesotheliomas.
• Exposure: Asbestos in general, described as the most important cause; the article states (citing other literature) that all commercially used asbestos types can induce mesotheliomas. Erionite and man-made mineral fibres (rockwool, slag wool) are also discussed. No fiber-specific doses or jobs are analysed.
• Main results:
  • More than 90% of mesotheliomas recorded in the German Mesothelioma Registry at Bochum were described as asbestos associated (the article's opening summary says 'About 90%').
  • The article's opening summary reported that 717 mesotheliomas were newly diagnosed at the German Mesothelioma Registry in 2003.
  • The authors had not seen a mesothelioma patient with exclusive exposure to man-made mineral fibres.
  • Among more than 6000 mesotheliomas in the registry archives, there was no single case of a real small cell mesothelioma, so the authors doubted that this variant exists.
  • In the group's earlier comparative genomic hybridization (CGH) analysis of 90 mesotheliomas, detected losses included 9p21 (34%) and 22q (32%). These changes can also be found in many other solid tumours. The combination of alterations was somewhat characteristic, with statistically significant differences between epithelioid and sarcomatoid mesotheliomas.
  • The group's earlier CGH data showed more chromosomal imbalances in a rare pleural subtype with unusual mesodermal components (which they call mesodermoma) than in the three classical mesothelioma types.
  • In the last few months before writing, the authors saw a few mesotheliomas after chemotherapy that, in most cases, showed no therapy-associated tumour regression. This is a preliminary observation; they wrote that details would be published later.
  • On the telomerase (TERT) marker for telling reactive from cancerous mesothelial lesions, the opening summary says the authors could not confirm the earlier report. The main text says the report is promising but has to be validated.
• The authors' conclusion: The authors concluded that a reliable pathological diagnosis is the basis for therapeutic, prognostic and medicolegal consequences. They wrote that such a diagnosis can generally be achieved by thoracoscopic inspection with specifically directed biopsy, and that any mesothelioma diagnosis should be confirmed by a panel of histochemical and immunohistochemical stainings.
• Limitations the authors state:
  • Because Germany has no central cancer registry, the German Mesothelioma Registry depends on voluntary submission of cases by clinicians and pathologists.
  • How precisely a mesothelioma's subtype can be described depends on how much tumour tissue is sampled.
  • Even after extensive immunohistochemical analysis, some tumours remain unclear.

Topics

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

Medical terms in this study, explained in our Lexicon: Pathology, Malignant Mesothelioma, Mesothelioma, Occupational Exposure, Prognosis, Histology, Biopsy.

Related studies

• Radiological and pathological correlations in asbestosis in the Republic of South Africa and the United Kingdom. II. A preliminary study of observer variation in the classification of radiographs of asbestos-exposed workers and the relation of pathology and x-ray appearances — A. Caplan, J.C. Gilson, et al. (1965)
• The pathological and molecular diagnosis of malignant pleural mesothelioma: a literature review — G. Alì, R. Bruno, et al. (2018)
• Pathological and molecular biological approaches to early mesothelioma — T. Tsujimura, I. Torii, et al. (2012)
• Pleural neoplastic pathology — G. Karpathiou, D. Stefanou, et al. (2015)
• Telomere length and TERT polymorphisms as biomarkers in asbestos-related diseases — A. Mervic, K. Goricar, et al. (2024)
• Diagnostic use of muscle markers in the cytologic evaluation of serous fluids — A.M. Afify, B.M. Al-Khafaji, et al. (2002)

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