Pseudomesotheliomatous adenocarcinoma of the lung with rhabdoid features

Our plain-English summary of Pseudomesotheliomatous adenocarcinoma of the lung with rhabdoid features, by J.H. Attems, F. Lintner (Pathology, Research and Practice, 2001).

The study

• Authors: J.H. Attems, F. Lintner
• Journal: Pathology, Research and Practice
• Published: 2001;197(12):841-6
• Type of article: Case report
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pseudomesotheliomatous adenocarcinoma of the lung is a rare entity, clinically and pathologically mimicking diffuse malignant pleural mesothelioma. We report a case of pseudomesotheliomatous adenocarcinoma consisting of two distinct histopathologic components with marked differences in morphological appearance and immunohistochemical staining pattern: a small subpleural nodule consisting of adenocarcinoma and undifferentiated carcinoma with rhabdoid features, the latter extending to the visceral pleura in a diffuse mesothelioma-like growth pattern. The adenocarcinomatous component showed strong reactivity with various epithelial markers, but no reactivity with vimentin. The undifferentiated component showed strong reactivity for vimentin, but no reactivity for epithelial markers. Both components showed no reactivity with CEA, Ber Ep4, MOC-31, B72.3, cytokeratin 5/6, calretinin and thrombomodulin. Metastatic lesions in the duodenum and the periumbilical skin consisted entirely of undifferentiated carcinoma with rhabdoid features. Fluorescence in situ hybridisation (FISH) was performed for chromosomes 4, 7, 20, and 22. FISH results showed polysomy 7 in both components. The diagnosis of pseudomesotheliomatous adenocarcinoma in this case was based on the finding of the subpleural nodule. We conclude that in cases of undifferentiated malignant pleural tumors with cells of rhabdoid phenotype, the possibility of peripheral pulmonary adenocarcinoma dedifferentiating into a more aggressive phenotype should be considered.

In plain English

This teaching case report from Vienna, Austria, described a 69-year-old woman with right-sided chest pain. She smoked 15 to 20 cigarettes per day and had no personal history of asbestos exposure. A pleural biopsy suggested malignant mesothelioma. After surgery, the authors found a 1 cm nodule beneath the pleura containing adenocarcinoma together with an undifferentiated component. They changed the diagnosis to pseudomesotheliomatous adenocarcinoma, a lung cancer that mimics pleural mesothelioma. The pleural part, 99% of the lung tumor mass, was a 2 cm-thick sheet replacing the entire visceral pleura of the right upper and adjacent middle lobes. It contained only undifferentiated cells with a "rhabdoid" appearance. These cells stained for vimentin but not for epithelial markers, while the adenocarcinoma part showed the reverse. Both parts had extra copies of chromosome 7. The cancer had spread to the duodenum and to a lump under the skin near the navel, and both adrenal glands were affected at autopsy. She died 3 months later. The authors concluded that the case was a high-grade lung adenocarcinoma that had dedifferentiated into a more aggressive form.

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 (teaching case) of a single patient, with histology, immunohistochemistry and fluorescence in situ hybridization (FISH)
• Who was studied: one 69-year-old Caucasian woman who presented with right-sided chest pain; Department of Pathology, SMZ – Otto Wagner Hospital, Vienna, Austria
• Exposure: no personal history of asbestos exposure; she smoked 15–20 cigarettes per day
• Main results:
  • The diagnosis was first malignant mesothelioma. The authors changed it to pseudomesotheliomatous adenocarcinoma (PMAC) after finding an adenocarcinoma nodule beneath the pleura in the resected right upper lobe.
  • The subpleural nodule measured 1 cm in diameter. It consisted of a moderately differentiated solid adenocarcinoma with an undifferentiated component.
  • 99% of the lung tumor mass was a 2 cm-thick sheet replacing the entire visceral pleura of the right upper lobe and the adjacent middle lobe.
  • The undifferentiated component, made of cells with a rhabdoid phenotype, was the only finding in the pleural rind, the two duodenal metastases and the subcutaneous metastasis.
  • Epithelial markers were positive in the adenocarcinoma component, and vimentin stained only the rhabdoid component. Neither component reacted with CEA, Ber Ep4, MOC-31, B72.3, cytokeratin 5/6, calretinin or thrombomodulin.
  • FISH showed polysomy (extra copies) of chromosome 7 and disomy (two copies) of chromosomes 4, 20 and 22 in both components of the primary tumor and in the metastases.
  • The patient died 3 months later. Autopsy showed acute myocardial infarction and metastases in both adrenal glands.
• The authors' conclusion: The authors concluded that the case was a high-grade peripheral adenocarcinoma of the lung that had dedifferentiated into a more aggressive phenotype.

Topics

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

Medical terms in this study, explained in our Lexicon: Pseudomesotheliomatous Adenocarcinoma, Rhabdoid, Pleural Mesothelioma, Immunohistochemistry, Adenocarcinoma, Carcinoma, Visceral Pleura, Mesothelioma.

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