Pleural malignant mesothelioma in Tuscany, Italy (1970-1988): I. Anatomo-pathologic aspects

Our plain-English summary of Pleural malignant mesothelioma in Tuscany, Italy (1970-1988): I. Anatomo-pathologic aspects, by S. Dini, M. Santucci, M. Biancalani, et al (American Journal of Industrial Medicine, 1992).

The study

• Authors: S. Dini, M. Santucci, M. Biancalani, R. Pingitore, P. Lopane, P. Tosi, T. Megha, V. Sforza
• Journal: American Journal of Industrial Medicine
• Published: 1992;21(4):569-76
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Our investigation did not confirm the general experience that significant numbers of cases initially considered malignant mesothelioma or metastatic carcinoma are actually found to be metastatic carcinoma or malignant mesothelioma, respectively, upon deeper investigation using ancillary techniques (e.g., histochemistry, immunohistochemistry, electron microscopy). Well-trained pathologists, expert in thoraco-pulmonary pathology, have a high inter- and intra-rater agreement and significantly better results than standard hospital pathologists in correctly differentiating malignant mesothelioma from metastatic carcinoma. Therefore, epidemiologic investigations which exclude an accurate and rigorous reevaluation of the histologic slides have to be considered unreliable, unless the data come from a specialized medical center experienced in this type of pathology.

In plain English

University pathologists in Florence, Pisa and Siena re-examined slides of all pleural tumors diagnosed as malignant mesothelioma or metastatic carcinoma in their 1970 to 1988 files: 539, 103 and 69 cases respectively. They reached consensus diagnoses, using special stains, immunohistochemistry or electron microscopy in selected cases. Eighteen cases with inadequate material were excluded. Of the rest, 569 (82.1%) were classed as metastatic cancer and 124 (17.9%) as pleural mesothelioma. On review, 8 of 104 original mesothelioma diagnoses proved to be metastatic adenocarcinoma, and 33 of 607 original carcinoma diagnoses proved to be mesothelioma. The mesothelioma patients were 95 males and 29 females, aged 29 to 84 at diagnosis; 85 tumors were epithelial, 34 biphasic and 5 sarcomatoid. No mesothelioma tested stained for CEA, while 95% of metastatic cancer specimens tested did; these tests covered a limited number of cases. Occupational exposures are reported in a companion article. The authors concluded that expert pathologists distinguish mesothelioma from metastatic carcinoma better than standard hospital pathologists. They added that epidemiologic studies lacking rigorous slide review have to be considered unreliable unless from a specialized center.

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: Pathology review (re-examination of archived histologic slides with consensus diagnosis)
• Who was studied: Pleural tumors diagnosed as malignant mesothelioma or metastatic carcinoma from 1970 to 1988 in the files of the university pathology institutes of Florence (539 cases), Pisa (103) and Siena (69), Tuscany, Italy; 18 were excluded for inadequate material
• Exposure: Not studied in this article; occupational exposures of these patients are reported in a companion article by Chellini et al.
• Main results:
  • 18 cases were excluded because the material was inadequate for a reliable diagnosis
  • After review, 569 cases (82.1%) were diagnosed as metastatic cancer; the remaining 124 cases (17.9%) were diagnosed as malignant mesothelioma
  • 8 of 104 (7.7%) cases originally diagnosed as mesothelioma were found to be metastatic adenocarcinoma; 33 of 607 (5.4%) cases originally diagnosed as non-mesotheliomatous tumors were found to be mesothelioma
  • Of the 124 mesothelioma patients, 95 were males and 29 females
  • Mesothelioma patients' age at diagnosis ranged from 29 to 84 years (mean 59, median 60), with no significant differences between sexes
  • Mesothelioma subtypes: epithelial 85 cases (68.5%), biphasic 34 (27.4%), sarcomatoid 5 (4.1%)
  • Among specimens tested (a limited number of cases), no mesothelioma showed CEA positivity in tumor cells, whereas 95% of tested metastatic cancer specimens showed clearly positive cells; the article does not give how many metastatic cancers were tested
• The authors' conclusion: The authors concluded that pathologists expert in thoraco-pulmonary pathology have high inter- and intra-rater agreement and significantly better results than standard hospital pathologists in telling malignant mesothelioma from metastatic carcinoma. They concluded that epidemiologic studies lacking rigorous slide re-evaluation should be considered unreliable unless the data come from a specialized center.
• Limitations the authors state:
  • Histochemical and immunohistochemical tests were done in only a limited number of cases
  • Poorly preserved mesothelioma cells may fail to stain for lower-molecular-weight cytokeratins, so negative staining must be interpreted cautiously

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Carcinoma, Immunohistochemistry, Pathology.

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