Pleural neoplastic pathology

Our plain-English summary of Pleural neoplastic pathology, by G. Karpathiou, D. Stefanou, M.E. Froudarakis (Respiratory Medicine, 2015).

The study

• Authors: G. Karpathiou, D. Stefanou, M.E. Froudarakis
• Journal: Respiratory Medicine
• Published: 2015;109(8):931-43
• Type of article: Review
• Cited by: 49 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background/purpose: Malignant pleural effusion is a frequent situation in pulmonary medicine. However, it is sometimes difficult to recognize the underlying etiology. The aim of this review is to provide the key characteristics of primary and metastatic pleural neoplasms.

Methods: A review of the recent literature regarding pleural neoplasia is provided.

Results: Malignant pleural mesothelioma (MPM) is the commonest primary pleural epithelial tumor showing remarkable histological heterogeneity often with prognostic significance. Various genetic alterations like changes in INK4 locus, NF2, BAP1 but also epigenetic changes are present in MPM. It should be distinguished from atypical mesothelial hyperplasia, mainly through morphological and clinical criteria, and from other rare primary and metastatic tumors, for which immunohistochemistry is rather important. Solitary fibrous tumor, the commonest primary pleural mesenchymal tumor is characterized by STAT6 overexpression. Other primary tumors, like adenomatoid tumor, well-differentiated papillary mesothelioma, synovial sarcoma, vascular tumors, various other sarcomas, thymic tumors and tumors of uncertain histogenesis are rarely encountered in the pleura. In contrast, metastatic disease is the commonest neoplasia of the pleura, and especially lung, breast and lymphoid malignancies.

Conclusion: The basic pathological, immunohistochemical and molecular characteristics of these entities are provided in the current review, along with their differential diagnosis.

Copyright © 2015 Elsevier Ltd. All rights reserved.

In plain English

This article was a narrative review, not a new study. The authors summarized recent published research on tumors of the pleura, the lining around the lungs. Most of it covered how pathologists tell malignant pleural mesothelioma apart from benign changes and from cancers that have spread to the pleura from elsewhere, using tissue appearance, staining markers and genetic changes. Citing other studies, the review stated that 87.3% of male and 64.8% of female mesothelioma cases are attributable to asbestos. It stated that pleural plaques develop in 20.4% of asbestos-exposed subjects. It also reported that a 7-year follow-up of 5287 asbestos-exposed subjects found 17 pleural mesotheliomas, which the authors took to imply individual susceptibility. It cited survival of 16.2 months for epithelioid, 3.8 months for sarcomatoid and 7 months for biphasic mesothelioma. Expert panels disagreed on whether difficult cases were benign or malignant in 22% of 217 cases and in 47% of 97 cases. Lung cancer, followed by breast cancer, was named as the most frequent source of tumors spreading to the pleura. The authors concluded that knowledge of tissue features and markers can lead to accurate diagnosis.

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 of recent literature on primary and metastatic pleural tumors; no new data were collected
• Who was studied: No study population; the review covered published literature on primary and metastatic tumors of the pleura
• Exposure: Asbestos was discussed as the main cause of malignant pleural mesothelioma and as associated with pleural plaques; no specific fiber types were named and no exposure was measured
• Main results:
  • Citing another study, the review stated that 87.3% of male and 64.8% of female malignant pleural mesothelioma cases are attributable to asbestos
  • Citing another study, pleural plaques develop in 20.4% of asbestos-exposed subjects
  • Citing another study, 17 pleural malignant mesotheliomas were diagnosed during a 7-year follow-up of 5287 asbestos-exposed subjects; the authors took this to imply individual susceptibility to asbestos
  • Citing another study, survival was 16.2 months for epithelioid, 3.8 months for sarcomatoid and 7 months for biphasic malignant pleural mesothelioma
  • Expert panels disagreed on whether difficult mesothelial cases were benign or malignant: the US-Canadian Mesothelioma Reference Panel in 22% of 217 cases, and the French Group Mesopath in 47% of 97 cases
  • Metastatic tumor was described as the most common neoplasm involving the pleura, with lung carcinoma the most frequent primary, followed by breast carcinoma
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma is not always easy to tell apart from metastatic disease or atypical mesothelial hyperplasia. They concluded that knowledge of tissue features and available markers can lead to accurate diagnosis, and that unresolved cases must be submitted to a panel of experts.

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: Pathology, Pleural Effusion, Etiology, Neoplasm, Pleural Mesothelioma, BAP1, Atypical Mesothelial Proliferation, Immunohistochemistry.

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• Challenges and controversies in the diagnosis of mesothelioma: Part 1. Cytology-only diagnosis, biopsies, immunohistochemistry, discrimination between mesothelioma and reactive mesothelial hyperplasia, and biomarkers — D.W. Henderson, G. Reid, et al. (2013)
• How useful is GLUT-1 in differentiating mesothelial hyperplasia and fibrosing pleuritis from epithelioid and sarcomatoid mesotheliomas? An international collaborative study — A.N. Husain, M.K. Mirza, et al. (2014)
• Pleural mesothelioma classification-update and challenges — S. Dacic (2022)
• Challenges and controversies in the diagnosis of malignant mesothelioma: Part 2. Malignant mesothelioma subtypes, pleural synovial sarcoma, molecular and prognostic aspects of mesothelioma, BAP1, aquaporin-1 and microRNA — D.W. Henderson, G. Reid, et al. (2013)

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