Sarcomatous tumor of the chest wall with osteochondroid differentiation. Evidence of mesothelial origin

Our plain-English summary of Sarcomatous tumor of the chest wall with osteochondroid differentiation. Evidence of mesothelial origin, by A. Andrion, G. Mazzucco, P. Bernardi, et al (The American Journal of Surgical Pathology, 1989).

The study

• Authors: A. Andrion, G. Mazzucco, P. Bernardi, F. Mollo
• Journal: The American Journal of Surgical Pathology
• Published: 1989;13(8):707-12
• Type of article: Case report
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000050).

Abstract

We describe a case of sarcomatous tumor of the chest wall with differentiation toward bone and cartilage that was observed in an asbestos-exposed worker. Although the mesothelial nature of the tumor was at first considered, it was not proven. Later, the tumor was shown to be a mesothelioma using a panel of pertinent antibodies that included a recently described anti-mesothelial cell marker. In addition, asbestos bodies were found in association with the sarcoma cells. Our findings indicate that whenever physicians encounter any type of primary sarcomatoid tumor involving serous membranes, the possibility of malignant mesothelioma should be regarded a priori.

In plain English

This case report described one patient: a 51-year-old female nonsmoker who had worked in an asbestos factory from November 1968 to February 1970. She was hospitalized in May 1984 with fatigue, cough, shortness of breath and chest pain. The article does not name the asbestos fiber type. Imaging showed fluid around the right lung and thickened pleura with a mass. No lung fibrosis or pleural plaques were seen. The patient died within 4 months, and no autopsy was done. Under the microscope the tumor was sarcomatous, with areas turning into bone-like and cartilage-like tissue. The authors first classified it as consistent with malignant fibrous histiocytoma or extraosseous osteosarcoma. On re-examination with more antibody stains, including a newly described marker for mesothelial cells, they identified it as a mesothelioma. They cautioned that the specificity of such new antibodies should be interpreted cautiously. Several asbestos bodies were found within the tumor tissue, often near giant cells. The authors concluded that, when facing a primary sarcomatoid tumor involving serous membranes, physicians should not disregard malignant mesothelioma a priori.

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 (single patient)
• Who was studied: One 51-year-old female nonsmoker, hospitalized in May 1984 with a 2-month history of fatigue, nonproductive cough, dyspnea and chest pain; authors at the University of Turin, Italy
• Exposure: Employment in an asbestos factory from November 1968 to February 1970; fiber type and dose not stated
• Main results:
  • No parenchymal lung fibrosis or pleural plaques were seen on chest radiograph or CT scan in this patient
  • The patient died within 4 months; no autopsy was performed
  • The tumor showed transition to bone-like (osteoid) and cartilage-like (chondroid) tissue in many fields
  • Electron microscopy was not conclusive. Light microscopy, staining and ultrastructure initially led the authors to classify the tumor as consistent with malignant fibrous histiocytoma (giant-cell type) or extraosseous osteosarcoma
  • On re-examination, the entire tumor cell population stained intensely for vimentin and also stained with the antimesothelial cell antiserum
  • Keratin 55 to 57 kDa staining was positive in many spindle-shaped and histiocytic-like cells but not in giant cells
  • Several typical asbestos bodies were found in clumps or scattered within the tumor tissue, often near the giant cells. The authors stated that, as far as they knew, this was the first such demonstration in human sarcomatoid mesothelioma
• The authors' conclusion: The authors concluded that the new immunohistochemical techniques identified this tumor as mesothelioma. They concluded that physicians encountering a primary sarcomatoid tumor involving serous membranes should not disregard the possibility of malignant mesothelioma a priori.
• Limitations the authors state:
  • The authors stated that the specificity of the new antimesothelial antibodies should be interpreted cautiously
  • The authors noted that at the time of the first investigation the use of intermediate filament markers such as vimentin was limited

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Mesothelial Cells, Asbestos Bodies, Sarcoma, Sarcomatoid, Malignant Mesothelioma.

Related studies

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• BAP1 Immunohistochemistry and p16 FISH in the Diagnosis of Sarcomatous and Desmoplastic Mesotheliomas — H.C. Hwang, S. Pyott, et al. (2016)
• Sarcomatous pleural mesothelioma metastatic to left ventricular endocardium — N. Senkottaiyan, L.M. Seacord, et al. (2006)
• Expression of E-cadherin in bone and soft tissue sarcomas: a possible role in epithelial differentiation — H. Sato, T. Hasegawa, et al. (1999)
• Solitary (localized) fibrous mesothelioma: evidence against mesothelial cell origin — P.A. Dervan, B. Tobin, et al. (1986)
• So-called sclerosing hemangioma of the lung. Evidence for mesothelial origin — A.L. Katzenstein, D.L. Weise, et al. (1983)

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