Pleural mesothelioma: an approach to diagnostic problems

Our plain-English summary of Pleural mesothelioma: an approach to diagnostic problems, by N.S. Wang (Respirology, 1996).

The study

• Author: N.S. Wang
• Journal: Respirology
• Published: 1996;1(4):259-71
• Type of article: Review
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In the 1960s, a close relationship between heavy exposures to crocidolite asbestos and mesothelioma was established. The debate on the diagnosis of mesothelioma became complicated because of the possibility of litigation. Well differentiated mesothelioma cells are mucicarmine negative but alcian blue and periodic acid-Schiff (PAS) positive, which are removed by hyaluronidase and diastase digestion. By electron microscopy (EM), they show bush-like elongated, slender, and branching microvilli. By immunohistochemistry they express both keratin and vimentin but not carcinoembryonic antigenicity (CEA), B72.3, Ber-EP4, and Leu-M1. In poorly differentiated mesotheliomas, chromosomal and molecular biological alterations are common and complex but these alterations also overlap with that of poorly differentiated tumours of the lung and other organs. A poorly differentiated pleural tumour is most likely metastatic and needs good team work to locate the primary site. The diagnosis of a mesothelioma and asbestosis should be established separately. Future studies will be focused less on the phenotypic differences but more on the broad molecular and multi-phasic mechanisms of carcinogenesis, irrespective of the aetiological agents, in poorly differentiated tumours.

In plain English

This article was a review, not a new study. The author reviewed the history of asbestos and of mesothelioma, and the methods pathologists used to diagnose pleural mesothelioma. The review described how well differentiated mesothelioma cells typically stain (PAS positive, mucicarmine negative), how they look under electron microscopy (bush-like elongated, slender, branching microvilli), and how they react in immunohistochemistry (no CEA, which most adenocarcinoma cells show). It reported that no antibody test was 100% consistent, that experts on mesothelioma panels often disagreed, and that chromosomal and molecular findings in mesothelioma were complex and had not helped tell it apart from other tumours. The author stated that crocidolite was the main fibre associated with mesothelioma and that there was no clear evidence linking uncontaminated chrysotile or anthophyllite to it. The author also argued that low-level environmental asbestos exposure must have a negligible effect. The author's proposed approach assumed most pleural tumours are metastatic, relied on team work, and called for diagnosing mesothelioma and asbestosis separately.

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 article on the history and diagnostic problems of pleural mesothelioma, including the author's own earlier work
• Who was studied: No study population; a review of published literature on pleural mesothelioma and its diagnosis
• Exposure: Asbestos in general, with discussion of crocidolite, amosite, chrysotile, anthophyllite and tremolite; crocidolite described as most closely related to mesothelioma
• Main results:
  • The review states that mesothelioma cells frequently store glycogen, which stains PAS positive and mucicarmine negative
  • The author reported, from the author's earlier electron microscopy work, that bush-like elongated, slender, branching microvilli were most characteristic of mesothelioma cells
  • The author reported, from earlier work, that mesothelioma cells do not express CEA, while most adenocarcinoma cells do
  • The review states that all antibodies proposed to tell mesothelioma apart from other cancers are not 100% consistent
  • Experts on mesothelioma panels in the United States, Canada and other countries often disagreed among themselves
  • Chromosomal and molecular findings in pleural mesothelioma were described as very complex and not helpful in distinguishing it from other tumours; some chromosomal changes overlap with lung cancer
  • The author stated that crocidolite is the main fibre associated with mesothelioma and that there is no clear evidence of an association with uncontaminated chrysotile or anthophyllite
  • The author argued that, because asbestos fibres are widespread and mesothelioma is rare, the effect of low-level environmental asbestos exposure on the lung and pleura must be negligible
• The authors' conclusion: The author concluded that most pleural tumours are metastatic and difficult cases need team work, that the diagnosis of mesothelioma or lung cancer and the diagnosis of asbestosis should be established independently, and that future research will likely focus on broad molecular mechanisms of carcinogenesis rather than on differences in tumour appearance

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Crocidolite, Mesothelioma, Immunohistochemistry, B72.3 (TAG-72), Ber-EP4, Carcinogenesis.

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• Diagnostics of BAP1-Tumor Predisposition Syndrome by a Multitesting Approach: A Ten-Year-Long Experience — M. Sculco, M. La Vecchia, et al. (2022)
• The difficult diagnostic approach of the intraperitoneal mesothelioma — S.M. Yoo, A.J. ten Tije, et al. (2000)
• A clinical diagnostic model for the assessment of asbestosis: a new algorithmic approach — A. Schwartz, S.D. Rockoff, et al. (1988)
• Methods to improve the diagnostic accuracy of malignant mesothelioma — A. Dejmek (1996)

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