Primary malignant gonadal mesotheliomas and asbestos

Our plain-English summary of Primary malignant gonadal mesotheliomas and asbestos, by R.L. Attanoos, A.R. Gibbs (Histopathology, 2000).

The study

• Authors: R.L. Attanoos, A.R. Gibbs
• Journal: Histopathology
• Published: 2000;37(2):150-9
• Type of article: Case report
• Cited by: 53 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: The clinicopathological, immunohistochemical and aetiological aspects, with respect to asbestos, of seven primary gonadal mesotheliomas (three intratesticular, four ovarian) are described and compared. These tumours are extremely rare, poorly described and the knowledge of their natural history is very limited.

Methods And Results: The cases were collated from the UK Health and Safety Executive Mesothelioma Register over a 24-year period (1968-91). Primary mesotheliomas of the tunica vaginalis and ovary comprised 0. 09% (10 cases) and 0.03% (three cases) of mesothelioma deaths, respectively. No primary intratesticular (non-tunica vaginalis) malignant mesotheliomas have been described. In this study, we present seven (three intratesticular, four ovarian) primary malignant gonadal mesotheliomas. In both genders the tumours show a similar age distribution (with median onset in the sixth decade), a similar association with asbestos (in approximately 50% cases), a diverse histological spectrum (with predominantly tubulopapillary epithelial subtype tumours) and an immunophenotype that is comparable with malignant pleural and peritoneal mesothelioma. The clinical course appears variable (mean, 26 months; range, 9-50 months). All tumours in the study presented as localized masses and their prognosis appeared more favourable than that of diffuse pleural and peritoneal cases.

Conclusions: An awareness of the existence of these rare forms of malignant mesothelioma is important to prevent misdiagnosis. Immunohistochemistry has an important role in confirmation of the diagnosis. The accurate diagnosis of primary gonadal mesothelioma has potentially important medicolegal compensation considerations as a significant proportion of these cases are associated with asbestos.

In plain English

This was a case series describing seven primary malignant mesotheliomas of the gonads: three arising within the testis and four in the ovary. The authors reviewed death-certificate records in the UK Health and Safety Executive Mesothelioma Register for 1968 to 1991, and found one more testicular case in routine surgical practice. In the register, mesotheliomas of the tunica vaginalis and of the ovary made up 0.09% and 0.03% of 11 629 mesothelioma deaths. Of the seven patients, two had occupational asbestos exposure (a dockyard crane driver and an asbestos factory cleaner) and one had possible domestic exposure. Three had no known exposure, and one had no details. Asbestos bodies were found in the lungs of the two occupationally exposed patients. Most tumours were of epithelial type, and all stained for the marker AE1/AE3. Among patients who died, mean survival was 23 months. The authors concluded that their results strongly suggest an association between asbestos and localized ovarian and testicular mesothelioma, but that the link appears less strong than for pleural and peritoneal mesothelioma. They noted that register-based studies are prone to selection bias.

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 (clinicopathological description of seven cases drawn mainly from a national mesothelioma register)
• Who was studied: Seven patients with primary malignant gonadal mesothelioma: three men with intratesticular tumours (aged 71, 77 and 33) and four women with ovarian tumours (aged 47, 61, 66 and 66). Cases came from death certificates in the UK Health and Safety Executive Mesothelioma Register (study period 1968 to 1991), plus one testicular case from routine surgical practice.
• Exposure: Asbestos exposure taken from occupational histories. Case 1 (man) was a dockyard crane driver for over 20 years. Case 5 (woman) was a cleaner in an asbestos factory for 7 years, 1945 to 1951. Case 7 (woman) had possible domestic exposure because her husband was a builders' labourer. Cases 2, 3 and 4 had no known exposure, and there were no details for case 6. No fiber types were named.
• Main results:
  • Of 11 629 mesothelioma deaths in the UK register over the study period, primary mesotheliomas of the tunica vaginalis made up 0.09% and those of the ovary 0.03%.
  • In addition to the two occupationally exposed patients, one woman (case 7) had possible domestic asbestos exposure through her husband's work.
  • Lung tissue was examined in five of the seven cases. The asbestos factory cleaner (case 5) had grade 4 fibrosis (honeycomb lung) and numerous asbestos bodies. The dockyard worker (case 1) had grade 2 interstitial fibrosis with occasional asbestos bodies. Case 7 had no fibrosis or asbestos bodies, but pleural plaques were recorded at post mortem. Cases 2 and 4 had normal lungs with no asbestos bodies.
  • Two of three testicular and three of four ovarian tumours were of epithelial type. Two tumours were biphasic.
  • All seven tumours stained diffusely for the pan-cytokeratin marker AE1/AE3. None reacted with the carcinoma markers carcinoembryonic antigen or Leu M1.
  • Among patients who died, mean survival was 23 months (range 9 to 50 months). One man (case 2) developed a pleural mesothelioma 28 months after orchidectomy.
  • The authors judged that the link with asbestos exposure appears less strong than for pleural and peritoneal mesothelioma.
• The authors' conclusion: The authors concluded that their results strongly suggest an association between asbestos exposure and localized primary ovarian and testicular mesothelioma. They considered further multicentre studies with formal mineral analysis essential to address dose-response and latency.
• Limitations the authors state:
  • The register undercounts these tumours, because cases found at surgery are only counted if the patient died with mesothelioma recorded on the death certificate.
  • Mesothelioma studies are prone to selection bias: asbestos-exposed people are more likely to have a tumour diagnosed as mesothelioma.
  • Only 2 of 10 registered testicular and 2 of 3 registered ovarian cases had tissue available for diagnostic confirmation.
  • Lung tissue could not be assessed in the two patients who were still alive.
  • No formal mineral (fiber) analysis was performed, and the authors called for further multicentre studies with such analysis.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Malignant Mesothelioma, Tubulopapillary, Peritoneal Mesothelioma, Prognosis, Misdiagnosis, Immunohistochemistry.

Related studies

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• Malignant epithelioid mesothelioma: anti-mesothelial marker expression correlates with histological pattern — R.L. Attanoos, R. Webb, et al. (2001)
• Primary thymic epithelial tumours of the pleura mimicking malignant mesothelioma — R.L. Attanoos, F. Galateau-Salle, et al. (2002)
• Immunohistochemical analysis still has a limited role in the diagnosis of malignant mesothelioma. A study of thirteen antibodies — F. Roberts, C.M. Harper, et al. (2001)
• Calretinin, thrombomodulin, CEA, and CD15: a useful combination of immunohistochemical markers for differentiating pleural epithelial mesothelioma from peripheral pulmonary adenocarcinoma — C.E. Comin, L. Novelli, et al. (2001)
• Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura — P.M. Cury, D.N. Butcher, et al. (2000)

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