Peritoneal mesothelioma

Our plain-English summary of Peritoneal mesothelioma, by M. Kannerstein, J. Churg (Human Pathology, 1977).

The study

• Authors: M. Kannerstein, J. Churg
• Journal: Human Pathology
• Published: 1977;8(1):83-94
• Cited by: 245 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. 002237).

Abstract

The cytohistology in 82 cases diagnosed as malignant peritoneal mesothelioma was correlated with available clinical and gross pathologic information. The cases were then evaluated as to ceratainty of diagnosis. The material had come from a large number of sources, most of it having been traced by a history of occupational exposure to asbestos. A relatively short interval of significant symptoms, with already existent diffuse peritoneal involvement and ascites, and an average survival time of less than a year characterized the group. The microscopic morphology formed a spectrum from highly characteristic, pure epithelial and mixed epithelial and sarcomatoid types, through nonspecific although relatively differentiated appearances, to pleomorphic analplatic proliferations. Local invasion and metastasis were common but much more limited than with tumors of other histogenesis showing comparable serous membrane involvement. Autopsy was of considerable exclusionary value although not in itself always determinative, and mucopolysaccharide histochemistry was occasionally decisive in diagnosis. Because of the microscopic versatlity of mesothelioma and the clinical and gross morphologic overlap with other neoplasms, all available data must be taken into consideration in arriving at a diagnosis. We believe that the dgree of certainty of diagnosis should be indicated by a succinct but reasonably explicit terminology.

In plain English

This 1977 report described 82 cases diagnosed as malignant peritoneal mesothelioma (the methods section says 83; the results total 82), gathered from many US sources, most traced through occupational asbestos exposure. The authors examined tissue slides from every case, compared them with available clinical, surgical and autopsy information, and graded each diagnosis by certainty. Only six patients were female, and 68 (83 per cent) were known to have had occupational asbestos exposure. Of 61 patients whose survival from symptom onset could be calculated, 15 were known to have lived more than a year, and 44 per cent were dead within six months. Most tumors (62) were epithelial, 18 were mixed epithelial and sarcomatoid, and two were sarcomatoid. Asbestos bodies were found in lung sections from 31 of the 32 cases examined. The authors rated 22 cases (27 per cent) definite, 51 (62 per cent) probable and nine possible. They noted that the high rate of asbestos exposure reflected how the cases were selected. The authors concluded that all available data must be considered in diagnosis, and that grading diagnostic certainty is realistic.

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: a pathology review of cases diagnosed as malignant peritoneal mesothelioma, with microscopic findings compared against clinical and gross pathology information and each diagnosis graded by certainty
• Who was studied: A series of 187 cases of diffuse malignant mesothelioma, of which 83 (44 per cent) were primary in the peritoneum. Results and tables account for 82 cases. Cases came from many sources throughout the United States, from files dating back to 1949. In 69 (84 per cent) of the peritoneal cases the patient came to biopsy or autopsy in 1964 to 1974. Only six patients were female. Ages ranged from 38 to 82 years.
• Exposure: Occupational exposure to asbestos: 68 patients (83 per cent) were known to have had it. No fiber types, products, specific jobs or doses are given.
• Main results:
  • Survival from the onset of symptoms could be calculated for 61 patients and ranged from one month to almost six years. Only 15 patients were known to have survived more than one year, and 44 per cent were dead in six months.
  • 62 cases (75 per cent) were classed as epithelial, 18 (22 per cent) as mixed (epithelial and sarcomatoid), and two as entirely sarcomatoid.
  • Local invasion occurred in 28 cases. Metastasis was known to have occurred in 18 of the autopsy cases (50 per cent).
  • Asbestos bodies were found in lung sections in 31 of the 32 cases where lung tissue was available. Of these, 8 showed no lung fibrosis, 15 minimal to mild, 7 moderate and 1 severe fibrosis.
  • Hyaline pleural plaques were mentioned in 16 cases. Lung sections were available for 13 of these, and all 13 contained asbestos bodies.
  • Of the 28 cases tested with the colloidal iron reaction, 11 gave positive staining that was negated or diminished by hyaluronidase.
  • 22 cases (27 per cent) met all criteria for a definite diagnosis, 51 (62 per cent) were rated probable, and 9 were rated possible.
  • 20 of the probable cases had characteristic histology but were downgraded, mostly for lack of an autopsy. Counting them on histology alone, 42 cases (51 per cent) could be regarded as established.
  • The authors found no consistent correlation between cell type, histologic pattern or degree of differentiation and length of survival.
• The authors' conclusion: The authors concluded that, because mesothelioma varies so much under the microscope and overlaps with other tumors, all available data must be taken into account in diagnosis. They believed that a grading system for diagnostic certainty, like the one used in this report, is realistic.
• Limitations the authors state:
  • Case information varied in quality and quantity and was quite deficient in many cases.
  • Autopsy findings were available for only 36 cases, and in some cases more tumor sampling would have been desirable.
  • The small number of women and the high rate of asbestos exposure reflect occupational selection of cases. Too few patients were known to be unexposed to allow exposed and unexposed patients to be compared.
  • Fluid cytology preparations were available in too few cases to analyze.
  • Classification by cell type is subject to observer variability.

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: Peritoneal Mesothelioma, Occupational Exposure, Ascites, Sarcomatoid, Pleomorphic, Metastasis, Autopsy, Mesothelioma.

Related studies

• Metastatic peritoneal mesothelioma in the setting of recurrent ascites: a case report — V. Samedi, S. White, et al. (2010)
• Peritoneal mesothelioma — J. Churg (1974)
• Well-differentiated papillary mesothelioma: peritoneal implants are not always metastases in the presence of cancer — G.W. Irwin, A. Ervine, et al. (2014)
• From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation — A.D. Levy, J. Arnáiz, et al. (2008)
• CT imaging of peritoneal carcinomatosis and its mimics — A.D. Diop, M. Fontarensky, et al. (2014)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)

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