Revisiting localized malignant mesothelioma

Our plain-English summary of Revisiting localized malignant mesothelioma, by S. Mann, S. Khawar, C. Moran, et al (Annals of Diagnostic Pathology, 2019).

The study

• Authors: S. Mann, S. Khawar, C. Moran, N. Kalhor
• Journal: Annals of Diagnostic Pathology
• Published: 2019;39:74-77
• Type of article: Case report, Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant Mesothelioma is an uncommon tumor that usually presents with diffuse pleural involvement and carries a dismal prognosis. Rarely, however, it can present as a localized, circumscribed mass or focal pleural lesion without evidence of diffuse spread. We found four such cases in our database. Three patients had localized epithelioid malignant mesothelioma and one had localized sarcomatoid mesothelioma. These localized tumors are a potential diagnostic pitfall for the pathologists as well as radiologists, especially those practicing in a community setting. Herein we discuss the clinicopathologic features of our cases along with a review of literature.

Copyright © 2019 Elsevier Inc. All rights reserved.

In plain English

This article, labeled a review, described four patients with localized malignant mesothelioma from the authors' database and discussed earlier reports. Localized tumors do not spread diffusely along the pleura, which is the usual pattern. In three of these patients, imaging showed a single well-circumscribed pleural-based mass. In the fourth, a flat lesion was found only under the microscope, in tissue removed for another tumor. Three tumors were epithelioid and one was sarcomatoid. The patients were two men and two women, with a mean age of 64 years (range 42 to 78). The authors reported that all four were non-smokers with no history of asbestos exposure. All tumors were removed with tumor-free surgical margins. One patient relapsed 35 months after first presentation. Another relapsed at 21 months and died of the disease at 39 months. A third had no mesothelioma recurrence at 84 months. The fourth was disease free when lost to follow-up after 2 months. The authors concluded that this is a distinct entity. They wrote that the literature suggests longer survival than with the diffuse type, but that progression is hard to predict, and that awareness of it helps avoid diagnostic errors, especially with small biopsies.

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 of four patients with a review of the published literature (the journal labels it a review article)
• Who was studied: Four patients with localized malignant mesothelioma: two men and two women, mean age 64 years (range 42 to 78). The article does not state where or when the cases were collected beyond 'our database'.
• Exposure: No asbestos exposure was reported. The article states that none of the four patients had a history of asbestos exposure, and all were non-smokers.
• Main results:
  • Three of the four tumors were epithelioid malignant mesothelioma and one was sarcomatoid mesothelioma.
  • In three cases, imaging showed a well-circumscribed pleural-based mass.
  • In the fourth case (a woman), the mesothelioma was a flat epithelioid lesion found incidentally next to a carcinoid tumor in a resection specimen. It was not recognized on imaging before surgery.
  • Case 1 (man) relapsed in the left pleura 35 months after initial presentation.
  • Two patients relapsed, one at 21 months and one at 35 months.
  • Case 2 (man) relapsed at 21 months despite further chemotherapy, extrapleural pneumonectomy and radiation, and died of disease 39 months after initial presentation.
  • Case 4 (woman) had no recurrence of mesothelioma 84 months after initial presentation, although her neuroendocrine tumor recurred.
  • Case 3 (woman, sarcomatoid tumor) was disease free when lost to follow-up after 2 months.
  • The calretinin stain marked the tumor cells in all four cases.
• The authors' conclusion: The authors concluded that localized pleural malignant mesothelioma is a distinct clinicopathologic entity. In their reading, the literature suggests longer overall survival than with the diffuse type, but disease progression is difficult to predict. They stated that awareness of this entity when assessing solitary lung lesions is essential to avoid diagnostic errors, especially with small biopsy specimens.

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: Localized Malignant Mesothelioma, Malignant Mesothelioma, Prognosis, Epithelioid, Sarcomatoid, Mesothelioma.

Related studies

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• Future developments in the management of malignant pleural mesothelioma — P.A. Zucali, F. De Vincenzo, et al. (2009)
• Improved Outcomes with Modern Lung-Sparing Trimodality Therapy in Patients with Malignant Pleural Mesothelioma — F. Shaikh, M.G. Zauderer, et al. (2017)
• Multimodal management of malignant pleural mesothelioma: where are we today? — P.E. Van Schil, I. Opitz, et al. (2014)
• How does the timing of chemotherapy affect outcome following radical surgery for malignant pleural mesothelioma? — A.J. Sharkey, K.J. O'Byrne, et al. (2016)

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