Pleural malignant mesothelioma with osteoclast-like giant cells

Our plain-English summary of Pleural malignant mesothelioma with osteoclast-like giant cells, by H. Itami, C. Ohbayashi, Y. Sakai, et al (Pathology International, 2010).

The study

• Authors: H. Itami, C. Ohbayashi, Y. Sakai, K. Kajimoto, T. Sakuma
• Journal: Pathology International
• Published: 2010;60(3):217-21
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Reported herein is the first case of malignant mesothelioma with osteoclast-like giant cells (OGC) in a 55-year-old man, a building contractor. Open thoracoscopic biopsy from the left parietal pleura showed a pleomorphic tumor composed of round to spindle cells mixed with numerous OGC; focal hemorrhage and necrosis were observed, but neither bone nor osteoid tissue was seen. The tumor cells had eosinophilic cytoplasm and round to oval nuclei with varying degrees of atypia. OGC had multiple small uniform nuclei without atypia and large eosinophilic cytoplasm, similar to giant cells of the so-called giant-cell tumors. On immunohistochemistry the tumor cells stained positive for AE1/AE3 and mesothelial markers, including calretinin, thrombomodulin, D2-40, and negative for carcinoma markers, including CEA, MOC31, and thyroid transcription factor-1. Consequently the tumor was diagnosed as malignant mesothelioma with OGC. Because malignant mesothelioma with OGC has not been reported to date, described herein are the histopathology and immunohistochemistry findings of this tumor, and a review of the literature.

In plain English

The authors reported what they described as the first case of pleural malignant mesothelioma with osteoclast-like giant cells (large cells with many nuclei, resembling those in giant-cell tumors of bone). The patient was a 55-year-old man who worked as a building contractor handling insulation material. The article stated that he had no evidence of asbestos exposure at work or at home, and no asbestos bodies were found in the biopsy. The authors nevertheless wrote that he may have been exposed through his work with insulation material. Scans showed fluid and many tumors on the left pleura, with no lung lesion. The tumor cells stained for mesothelial markers (calretinin, thrombomodulin, D2-40) and not for carcinoma markers. The giant cells stained only for CD68, which the authors took to suggest they were non-cancerous, reactive cells. The tumor kept growing during chemotherapy, and the patient died 79 days after first consultation. The authors proposed classifying the tumor as high-grade (pleomorphic) epithelial mesothelioma. They noted that sarcomatoid carcinoma could not be completely ruled out, and they said further studies were needed on its prognostic significance.

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 (single patient), with a discussion of the literature
• Who was studied: One 55-year-old man with lower back pain and cough, seen by the pathology department of the Hyogo Cancer Center, Japan; article received 2009
• Exposure: Work as a building contractor handling insulation material. The article states there was no evidence of asbestos exposure at work or at home and that no asbestos bodies were found in the specimen. The authors suggest possible exposure through the insulation work.
• Main results:
  • At open thoracoscopic biopsy, multiple nodular tumors were found only on the parietal side of the left pleura
  • The tumor was made of pleomorphic cells mixed with numerous benign-looking giant cells; mitotic figures were 10/10 high-power fields; no bone or osteoid tissue was seen
  • Tumor cells stained diffusely positive for AE1/AE3 and CD68, and focally positive for calretinin, thrombomodulin, D2-40 and HLA-DR. CEA, MOC31, TTF-1, WT-1, CK5/6, CAM5.2, desmin, S-100 and CD163 were negative in both tumor cells and giant cells.
  • The osteoclast-like giant cells stained positive only for CD68
  • No asbestos bodies were found in the biopsy specimen
  • The tumor grew during chemotherapy (cyclophosphamide, adriamycin, vincristine), and the patient died from disseminated intravascular coagulation 79 days after first consultation
• The authors' conclusion: The authors diagnosed the tumor as malignant mesothelioma with osteoclast-like giant cells and proposed classifying it as high-grade (pleomorphic) epithelial mesothelioma. They suggested the giant cells were non-neoplastic, reactive and mesenchymal, and said further studies are needed to define the prognostic significance.
• Limitations the authors state:
  • Based on the staining profile, sarcomatoid carcinoma (including pleomorphic carcinoma) could not be completely ruled out
  • No useful marker exists to tell mesothelioma apart from large cell carcinoma or pleomorphic carcinoma
  • The prognostic significance of this tumor type remains undefined

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Thoracoscopic Biopsy, Parietal Pleura, Pleomorphic, Spindle Cell, Necrosis, Eosinophilic, Immunohistochemistry.

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