Sarcomatoid mesothelioma with osteoid differentiation

Our plain-English summary of Sarcomatoid mesothelioma with osteoid differentiation, by M. Evison, P.A. Crosbie, M. Howe, et al (Journal of Thoracic Oncology, 2013).

The study

• Authors: M. Evison, P.A. Crosbie, M. Howe, R. Booton
• Journal: Journal of Thoracic Oncology
• Published: 2013;8(9):1222-3
• Type of article: Case report
• Read it: PubMed · Publisher

Summary of the article

The authors reported the case of a 75-year-old man at the University Hospital of South Manchester, United Kingdom. He presented with 3 months of progressive breathlessness and right-sided chest pain. Initial investigations showed a right pleural effusion with extensive pleural calcification and irregular pleural thickening. His serum alkaline phosphatase was markedly elevated at 11,209 (reference range 30–130). An isotope bone scan showed marked tracer uptake in the right hemithorax. Pleural biopsies taken at video-assisted thoracoscopic surgery showed a malignant neoplasm of plump to spindle cells with focal areas of osteoid formation. The malignant cells were positive for calretinin and cytokeratin 5/6. After clinical, radiological and histological review at thoracic oncology and sarcoma multidisciplinary team meetings, sarcomatoid mesothelioma with osteoid differentiation was diagnosed. The patient was given palliative chemotherapy with cisplatin and pemetrexed. After three cycles his condition deteriorated and repeat imaging confirmed significant disease progression. Chemotherapy was stopped, and he died 4 weeks later. The authors noted that this subtype is well described in the literature, with reported survival ranging from an average of 5.7 months in a series of 10 patients to case reports of 36 to 69 months. They stated that this was the first case to show significant elevation of serum alkaline phosphatase, diffuse rather than focal pleural calcification on follow-up computed tomography, and abnormal tracer uptake on bone scan. They concluded that radiological features of malignant pleural disease together with pleural calcification should raise suspicion of this rare subtype of mesothelioma. The report did not mention asbestos exposure.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was a short case report by doctors at the University Hospital of South Manchester in the United Kingdom. It described one 75-year-old man with three months of worsening breathlessness and right-sided chest pain. Tests showed fluid around the right lung, extensive calcification and irregular thickening of the pleura (the lining around the lung), and a markedly raised blood alkaline phosphatase level of 11,209, against a reference range of 30 to 130. A bone scan showed strong tracer uptake in the right side of the chest. Biopsies showed a malignant tumour of plump to spindle-shaped cells with areas of osteoid, a bone-like tissue. He was diagnosed with sarcomatoid mesothelioma with osteoid differentiation. After three cycles of palliative chemotherapy with cisplatin and pemetrexed, his disease had progressed significantly. Chemotherapy was stopped, and he died 4 weeks later. The article does not mention asbestos or any other exposure. The authors called this the first reported case with these blood and scan findings. They concluded that signs of malignant pleural disease together with pleural calcification should raise suspicion of this rare subtype.

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 of a single patient (published as an 'Image of the Month')
• Who was studied: One 75-year-old man. The authors were at the University Hospital of South Manchester, United Kingdom. No dates were given.
• Exposure: Not reported. The article does not mention asbestos or any occupational or other exposure.
• Main results:
  • At presentation, the patient's serum alkaline phosphatase was markedly elevated at 11,209 (reference range 30 to 130; units not stated).
  • Imaging showed a right pleural effusion, extensive pleural calcification and irregular pleural thickening. An isotope bone scan showed marked tracer uptake in the right hemithorax.
  • Pleural biopsies showed a malignant neoplasm of plump to spindle cells with focal areas of osteoid formation. The malignant cells were positive for calretinin and Cytokeratin 5/6.
  • After review at thoracic oncology and sarcoma multidisciplinary team meetings, the diagnosis was sarcomatoid mesothelioma with osteoid differentiation.
  • The patient received palliative cisplatin and pemetrexed. After three cycles his condition deteriorated and imaging showed significant disease progression. Chemotherapy was stopped and he died 4 weeks later.
  • The authors stated that this was the first reported case to show significant elevation of serum alkaline phosphatase, diffuse rather than focal pleural calcification on follow-up imaging, and abnormal tracer uptake on bone scan.
• The authors' conclusion: The authors concluded that any radiological features of malignant pleural disease together with pleural calcification should raise suspicion of this rare subtype of mesothelioma.

Topics

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

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Mesothelioma, Pleural Effusion, Pleural Calcification, Pleural Thickening, Hemithorax, Video-Assisted Thoracoscopic Surgery (VATS), Neoplasm.

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• Primary malignant sarcomatoid mesothelioma in the pericardium — K. Tateishi, M. Ikeda, et al. (2013)
• Primary sarcomatoid malignant pericardial mesothelioma — D. Jiang, M. Kong, et al. (2013)
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• Primary sarcomatoid malignant mesothelioma of the pericardium — T. Terada (2012)

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