Primary pleural angiosarcoma associated with pneumoconiosis: An autopsy case

Our plain-English summary of Primary pleural angiosarcoma associated with pneumoconiosis: An autopsy case, by K. Matsuda, T. Yamaryo, Y. Akazawa, et al (Pathology International, 2015).

The study

• Authors: K. Matsuda, T. Yamaryo, Y. Akazawa, K. Kawakami, M. Nakashima
• Journal: Pathology International
• Published: 2015;65(11):603-7
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a case of pleural angiosarcoma in an adult male patient confirmed by autopsy and possibly associated with pneumoconiosis. The lesion was characterized by thickened pleura of both lungs with nodular tumors. Histologically, the tumor was composed of spindle-to-polygonal epithelioid cells that were positive for CD31, CD34, vimentin, and cytokeratin on immunohistochemical staining but were negative for calretinin. Further examination revealed mix-dust pathological findings consistent with the existence of pneumoconiosis; dystrophic ossification, anthracosis, and fractal small dust particles were observed in the lung parenchyma and a hilar lymph node. The current case suggests that pneumoconiosis-associated pathologies may be risk factors for the development of angiosarcoma in the pleura.

© 2015 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.

In plain English

This case report described one 87-year-old Japanese man who had worked in a quarry for 15 years and smoked for 40 years. He was admitted with anemia and blood collecting in both chest cavities (hemothorax), received supportive care only, and died 50 days after admission. An autopsy limited to the chest found two nodules on the lining of the right lung, measuring 25 × 12 and 20 × 13 mm. Staining tests led to a diagnosis of pleural angiosarcoma, a rare cancer of blood-vessel cells. The lungs showed scarring, bone-like deposits and carbon dust, which the authors judged consistent with pneumoconiosis (dust-related lung disease). No asbestos bodies were seen under the microscope and no pleural plaques were found. A laboratory count found 177.62 asbestos bodies per gram of dry lung tissue. The authors described this as much lower than the Japanese compensation criterion, which requires more than 5000 asbestos particles per gram plus occupational asbestos exposure. The authors concluded the tumor was potentially related to mixed-dust pneumoconiosis, but said smoking and unknown factors could also have contributed.

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 autopsy case)
• Who was studied: One 87-year-old Japanese man treated at a hospital in Nagasaki, Japan, examined by chest-only autopsy after death
• Exposure: Quarry work for 15 years, between ages 41 and 56. No asbestos fiber type or history of asbestos exposure is given in the article.
• Main results:
  • The patient had smoked for 40 years, between ages 20 and 60 (smoking index 800)
  • The patient died 50 days after admission, after receiving best supportive care
  • At autopsy there was bleeding into both chest cavities: 1400 mL of fluid on the right and 1800 mL on the left
  • Two nodules arising from the visceral pleura of the right lung measured 25 × 12 mm and 20 × 13 mm
  • The tumor was strongly positive for vimentin and CD31 and focally positive for cytokeratin (AE1/AE3) and CD34. It was negative for calretinin, D2-40, desmin, EMA, CK5/6 and WT-1.
  • Pleural angiosarcoma was diagnosed
  • The background lung showed interstitial fibrosis, fibrotic nodules and dystrophic ossification. Enlarged hilar lymph nodes contained carbon dust. The authors described these findings as consistent with pneumoconiosis.
  • No asbestos bodies were found on routine pathological examination
  • Quantitative asbestos analysis of the lung tissue found 177.62 asbestos bodies per gram of dry lung tissue
  • No pleural plaques were observed
  • The authors stated the asbestos level was much lower than the Japanese government criterion for compensation and relief: more than 5000 asbestos particles per gram of dry lung tissue plus occupational asbestos exposure.
• The authors' conclusion: The authors concluded that this case of primary pleural angiosarcoma was potentially related to mixed-dust pneumoconiosis. They believed it to be the first such case reported, and said it highlights the possibility that pneumoconiosis may also lead to angiosarcoma.
• Limitations the authors state:
  • The autopsy was performed only in the chest, which limited the search for other possible origins of the tumor
  • Smoking and other unknown factors could also have contributed to the development of the angiosarcoma
  • Although the patient worked in a quarry, the pathological findings were not conclusive for simple silicosis

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: Pneumoconiosis, Autopsy, Pleura, Epithelioid, CD34, Immunohistochemistry, Calretinin, Anthracosis.

Related studies

• Primary pleural epithelioid angiosarcoma. A case report and review of the literature — E. Dainese, B. Pozzi, et al. (2010)
• Pseudomesotheliomatous angiosarcoma: a pleuropulmonary lesion simulating malignant pleural mesothelioma — G. Falconieri, R. Bussani, et al. (1997)
• Quantitative x ray microanalysis of pulmonary mineral particles in a patient with pneumoconiosis and two primary lung tumours — S. Anttila, S. Sutinen, et al. (1984)
• Frequent expression of conventional endothelial markers in pleural mesothelioma: usefulness of claudin-5 as well as combined traditional markers to distinguish mesothelioma from angiosarcoma — Y. Nakashima, K. Inamura, et al. (2020)
• Epithelioid angiosarcoma of the pleura: a case report — M.S. Roh, J.Y. Seo, et al. (2001)
• Angiosarcoma of the chest wall — T. Suzuki, S. Suzuki, et al. (1996)

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