Pseudomesotheliomatous carcinoma of the pleura: an autopsy case of metastasis from a G-CSF-producing anaplastic carcinoma of the pancreas

Our plain-English summary of Pseudomesotheliomatous carcinoma of the pleura: an autopsy case of metastasis from a G-CSF-producing anaplastic carcinoma of the pancreas, by Y. Hattori, K. Sentani, T. Hattori, et al (APMIS, 2018).

The study

• Authors: Y. Hattori, K. Sentani, T. Hattori, N. Oue, W. Yasui
• Journal: APMIS
• Published: 2018;126(2):166-170
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Pseudomesotheliomatous carcinoma is a malignant tumor that extends along the pleura mimicking malignant mesothelioma. An 81-year-old male patient presented to our hospital with epigastralgia, and abdominal computed tomography (CT) showed a 36-mm tumor in the pancreatic tail. The laboratory data revealed a high leukocyte count (>44 000/μL). Chest CT showed left pleural thickening with pleural effusion. The cancer showed a poor response to chemotherapy, and the patient died of respiratory failure at 5 months after the onset of disease. Autopsy showed solid tumor with hemorrhage, measuring 6 cm in diameter, in the pancreatic tail, with wide invasion to the stomach, left adrenal gland, spleen, and diaphragm. The left pleura, which was circumferentially thickened by the involved tumor, macroscopically resembled pleural mesothelioma. Histologically, the primary pancreatic tumor was diagnosed as anaplastic carcinoma, due to the absence of glandular structures or other features that would indicate a definite direction of differentiation. The primary lesion and carcinoma involving the left pleura were all positive for G-CSF. We recently experienced an autopsy case of G-CSF-producing anaplastic carcinoma with pseudomesotheliomatous spread.

© 2017 APMIS. Published by John Wiley & Sons Ltd.

In plain English

This was an autopsy case report from Hiroshima University in Japan about one 81-year-old man with stomach-area pain. A scan showed a 36-mm tumor in the tail of the pancreas, with no spread to the pleura (the lining around the lungs) seen at that time. His white blood cell count rose to 44,750 per microliter. The cancer responded poorly to chemotherapy, and he died of respiratory failure 5 months after his first visit. At autopsy, the pancreatic tumor measured 6 cm and had invaded nearby organs, including the diaphragm. The left pleura was thickened all the way around and looked like pleural mesothelioma. Under the microscope, the tumor was anaplastic carcinoma of the pancreas that produced G-CSF, a protein that stimulates white blood cells. Staining tests weighed against primary lung cancer or pleural mesothelioma. The pleural disease was diagnosed as spread of the pancreatic cancer. The patient had worked in the metallurgical industry. The authors suggested this might have affected the growth pattern, but asbestos bodies were not clearly seen in the lungs. The authors concluded this was the first reported case of its kind.

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: autopsy case report (one patient)
• Who was studied: One 81-year-old man with a history of diabetes mellitus, who came to the authors' hospital (Hiroshima University, Japan) with epigastralgia (pain in the upper abdomen)
• Exposure: No measured asbestos exposure was reported. The patient had worked in the metallurgical industry, and asbestos bodies were not clearly observed in the lungs.
• Main results:
  • At presentation, a scan showed a 36-mm tumor in the pancreatic tail, and imaging found no metastatic lesions, including pleural lesions.
  • The patient's white blood cell (leukocyte) count rose gradually to 44,750 per microliter, with 94% neutrophils, during 6 weeks in hospital.
  • The cancer responded poorly to nab-paclitaxel plus gemcitabine chemotherapy, and the patient died of respiratory failure 5 months after his first visit.
  • At autopsy, the pancreatic tail tumor measured 6 cm across and invaded the stomach, left adrenal gland, spleen and diaphragm.
  • The left lung had no sizable mass inside it, but the parietal and visceral pleura were thickened all the way around.
  • The primary pancreatic tumor was diagnosed as anaplastic carcinoma, and its cells stained diffusely positive for G-CSF.
  • Staining done to rule out primary lung cancer or pleural mesothelioma showed the pleural tumor cells were positive for CEA and CK5/6 and negative for calretinin, D2-40, WT-1 and TTF-1. The pleural and left 4th rib involvement was diagnosed as pseudomesotheliomatous growth of the pancreatic carcinoma.
  • The authors presumed the tumor spread directly to the left pleura through the diaphragm, because the involved organs were all on the left side and continuous with the primary tumor.
  • Asbestos bodies were not clearly observed in the lungs. The authors suggested the patient's metallurgical work might have had some effect on the rare growth pattern.
• The authors' conclusion: The authors concluded that this was the first reported case of pseudomesotheliomatous carcinoma caused by pleural metastasis from a G-CSF-producing anaplastic carcinoma of the pancreas.

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: Pseudomesotheliomatous Adenocarcinoma, Pleura, Autopsy, Metastasis, Carcinoma, Mesothelioma, Pleural Thickening, Pleural Effusion.

Related studies

• G-CSF-producing malignant pleural mesothelioma: an autopsy case report with literature review — K. Oka, G. Sarashina, et al. (2012)
• A case of primary lung squamous cell carcinoma mimicking malignant mesothelioma producing granulocyte colony stimulating factor with chemotherapy (cisplatin and gemcitabine)-associated thrombotic thrombocytopenic purpura (TTP); An autopsy case report — Y. Suzuki, K. Kanazawa, et al. (2019)
• 'Pseudomesotheliomatous' carcinomas of the pleura: a 10-year analysis of cases from the Environmental Lung Disease Research Group, Cardiff — R.L. Attanoos, A.R. Gibbs (2003)
• Pseudomesotheliomatous carcinoma involving pleura and peritoneum: A clinicopathologic and immunohistochemical study of three cases — I.A. Shah, J.R. Salvatore, et al. (1999)
• Pseudomesotheliomatous carcinoma due to pleural metastasis from renal pelvic cancer — Y. Katsuya, M. Fukusumi, et al. (2014)
• Pseudomesotheliomatous carcinoma of the lung. A variant of peripheral lung cancer — T.R. Harwood, D.R. Gracey, et al. (1976)

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