Sarcomatoid Peritoneal Mesothelioma: Clinicopathologic Correlation of 13 Cases

Our plain-English summary of Sarcomatoid Peritoneal Mesothelioma: Clinicopathologic Correlation of 13 Cases, by E.N. Pavlisko, V.L. Roggli (The American Journal of Surgical Pathology, 2015).

The study

• Authors: E.N. Pavlisko, V.L. Roggli
• Journal: The American Journal of Surgical Pathology
• Published: 2015;39(11):1568-75
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peritoneal mesothelioma is rare, and the sarcomatoid variant is more infrequent, with <30 cases reported to date in the literature. Several case series have described the morphologic features of sarcomatoid peritoneal mesothelioma (SPe); however, the clinicopathologic features are not well characterized. To our knowledge, this is the first large series reporting the clinicopathologic features of SPe. We reviewed our database of 3106 malignant mesothelioma cases. Of 248 peritoneal mesotheliomas, 15 (4%) were sarcomatoid variant (0.5% of all mesotheliomas). Only cases with 100% sarcomatoid morphology diagnosed by open surgical biopsy and/or autopsy were included. Thus, 4 cases were excluded leaving 11 cases of SPe. Two additional cases of SPe previously published by 1 of the authors (V.L.R.), not included in the database, are added yielding 13 cases total. The median age at diagnosis was 66 years (range=48 to 85 y), and there was a male predominance (M:F=3.25:1). Survival from date of diagnosis to date of death was 5 months (range=0 to 12 mo). The most common presenting symptom was abdominal pain, and 3 of 4 women were suspected to have cholecystitis/cholelithiasis. All cases stained positive for cytokeratins, and 2 contained heterologous elements. Seven cases had objective markers of asbestos exposure, and 2 additional cases had occupations strongly associated with mesothelioma. Two cases with alleged household contact exposures could not be confirmed to be asbestos related by lung fiber analysis. SPe is a rare variant of mesothelioma attributed to asbestos exposure in 69% of our cases.

In plain English

This case series drew on a pathology database of 3106 mesothelioma cases (consultation and medicolegal referrals to one author) from 1981 to 2011. The authors found 11 cases of purely sarcomatoid peritoneal mesothelioma, a rare tumor of the abdominal lining, confirmed by open surgical biopsy or autopsy, and added 2 previously published cases, for 13 in total. Nine were men and 4 women; median age at diagnosis was 66. Men typically had abdominal pain; 3 of 4 women were first thought to have gallbladder disease. Median survival was 5 months in men and 4.75 months in women. The men's jobs included shipyard work, electrical work, welding, construction and asbestos manufacturing; all 4 women had husbands with industrial exposures. Seven of 13 cases had microscopic evidence of asbestos exposure. Of 6 cases with lung fiber analysis, 2 had commercial amphibole asbestos above background levels, one a woman whose husband was a shipyard worker; 2 other women had background levels, and none had detectable chrysotile. The authors concluded the tumor is sometimes related to asbestos exposure, while noting small numbers.

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: Retrospective case series (clinicopathologic review) drawn from one pathologist's consultation and medicolegal referral database
• Who was studied: 13 cases of purely sarcomatoid peritoneal mesothelioma: 11 from a database of 3106 mesothelioma cases (1981 to 2011, Duke University pathology), after excluding 4 diagnosed only by closed biopsy, plus 2 cases previously published by one author but not in the database. There were 9 men and 4 women.
• Exposure: Asbestos exposure assessed from occupation and exposure history, pleural plaques, asbestosis and lung fiber analysis. Men worked in asbestos-related jobs (shipyard worker, electrician, welder, construction, asbestos manufacturing facility). All 4 women had household contact with a husband who had industrial exposures. Fiber types found included amosite, crocidolite and tremolite. No chrysotile was detected.
• Main results:
  • Of the 13 cases, 4 (31%) were women and 9 (69%) were men. Median age at diagnosis was 66 years (range 48 to 82).
  • 3 of the 4 women presented with symptoms suggesting gallbladder inflammation or gallstones (cholecystitis/cholelithiasis).
  • Survival data were available for 12 of 13 cases. Median survival was 5 months (range 0 to 11) in men and 4.75 months (range 1.5 to 12) in women.
  • One patient (case 12) was still living 4 years after diagnosis.
  • All 13 cases stained positive for keratin (AE1/AE3).
  • Parietal pleural plaques were present in 4 of 10 cases with data, all men.
  • Asbestosis was present in 4 cases, all men. The Results section gives this as 4 of 8 cases with data, and the Discussion as 4 of 7 (57%) cases with lung tissue examined.
  • Seven of 13 cases had microscopic evidence of asbestos exposure, and 2 more had an occupation associated with asbestos exposure.
  • Of the 6 cases with fiber analysis, 2 (cases 4 and 6) had commercial amphibole asbestos above background levels. Case 4 also had elevated tremolite.
  • Two household-contact cases (cases 7 and 9, both women) had fiber content in the background range.
  • None of the 6 analyzed cases had detectable chrysotile.
  • The authors stated that case 4, a woman exposed through her husband, a shipyard worker, was to their knowledge the first household-contact peritoneal mesothelioma shown to be asbestos related by fiber analysis.
• The authors' conclusion: The authors concluded that sarcomatoid peritoneal mesothelioma is sometimes related to asbestos exposure, and that sarcomatoid morphology does not carry the same implications in the peritoneum as in the pleura.
• Limitations the authors state:
  • The authors note that the number of cases is small.

Topics

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

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Peritoneal Mesothelioma, Malignant Mesothelioma, Mesothelioma, Biopsy, Autopsy, Heterologous Elements, Asbestos Exposure.

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