Skin metastasis of malignant mesothelioma

Our plain-English summary of Skin metastasis of malignant mesothelioma, by T. Mori, T. Yamamoto (Anais Brasileiros de Dermatologia, 2021).

The study

• Authors: T. Mori, T. Yamamoto
• Journal: Anais Brasileiros de Dermatologia
• Published: 2021;96(5):642-643
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Summary of the article

The authors reported a case of malignant pleural mesothelioma with distant metastasis to the skin, which they described as rare. The patient was a 78-year-old man in Japan who had worked as a welder, had worked in construction areas for a long time, and had been exposed to asbestos. He had six months of shortness of breath. An aspiration biopsy of the right chest wall showed atypical tumor cells. These were strongly positive for epithelial membrane antigen and vimentin, focally positive for AE1/3, calretinin, D2-40 and Wilms tumor-1, and negative for carcinoembryonic antigen, thyroid transcription factor-1 and cytokeratin 5/6. Malignant pleural mesothelioma (T3N0M0, stage 3) was diagnosed and treated with pemetrexed and carboplatin. Five months after chemotherapy ended, a solitary nodule appeared in the left axilla, away from the biopsy site. It was removed and showed similar epithelioid tumor cells, with vimentin, AE1/AE3 and D2-40 staining, but calretinin was not detected. Three months later, more skin nodules appeared on the lower abdomen (12 mm and 17 mm), the left chest (20 mm) and the right chest (50 × 35 mm). Chemotherapy was stopped and best supportive care was chosen. The authors noted that diagnosis can be difficult when calretinin staining is negative. In this case, the patient's history of asbestos exposure and differentiation from pulmonary adenocarcinoma led to the diagnosis of mesothelioma.

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 case letter from Fukushima Medical University in Japan described one patient whose malignant pleural mesothelioma spread to the skin. The patient, a 78-year-old man, had worked as a welder and was exposed to asbestos. The authors also wrote that he had worked in construction areas for a long time. No asbestos fiber type was named. A chest wall biopsy led to a diagnosis of stage 3 malignant pleural mesothelioma, which was treated with pemetrexed and carboplatin. Five months after chemotherapy ended, a single firm skin nodule appeared in the left armpit, away from the biopsy site. Its tumor cells resembled the pleural tumor and stained strongly for vimentin, but calretinin, a mesothelioma marker, was not detected. Three months later, more nodules appeared on the lower abdomen and on both sides of the chest. Chemotherapy was stopped and best supportive care was chosen. The authors wrote that diagnosis is often challenging when calretinin staining is negative. They wrote that the patient's history of asbestos exposure at work, and distinguishing the tumor from lung adenocarcinoma, led to the diagnosis.

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 (case letter to the editor)
• Who was studied: One 78-year-old man seen at Fukushima Medical University, Fukushima, Japan; the dates of the case are not given (the letter was received in May 2020)
• Exposure: Occupational asbestos exposure. The article describes the man as a welder and also says he had worked in construction areas for a long time. No fiber type or dose is given.
• Main results:
  • A biopsy of the right chest wall led to a diagnosis of malignant pleural mesothelioma (T3N0M0, stage 3), treated with pemetrexed and carboplatin chemotherapy
  • Five months after finishing chemotherapy, the patient developed a single firm nodule in the skin of the left axilla (armpit), at a site unrelated to the biopsy
  • The removed skin nodule stained intensely for vimentin and focally for AE1/AE3 and D2-40, but calretinin was not detected
  • Three months later, further skin nodules appeared: two on the lower abdomen (12 mm and 17 mm), one on the left chest (20 mm) and one on the right chest (50 by 35 mm)
  • Chemotherapy was stopped and best supportive care was chosen
• The authors' conclusion: The authors wrote that cutaneous metastasis of malignant pleural mesothelioma is rare. They also wrote that diagnosis is often challenging when calretinin staining is negative, and that in this case the patient's history of asbestos exposure at work and differentiation from pulmonary adenocarcinoma led to the diagnosis of malignant mesothelioma.

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: Metastasis, Mesothelioma, Pleural Mesothelioma, Biopsy, Epithelial Membrane Antigen (EMA), Calretinin, Podoplanin (D2-40), Carcinoembryonic Antigen (CEA).

Related studies

• Skin metastasis of pleural epithelioid malignant mesothelioma — T. Terada (2011)
• NLRP3 promotes inflammation-induced skin cancer but is dispensable for asbestos-induced mesothelioma — M.T. Chow, J. Tschopp, et al. (2012)
• Primary pleural epithelioid haemangioendothelioma with metastases to the skin. A case report and literature review — M. Al-Shraim, B. Mahboub, et al. (2005)
• Initiation-promotion versus complete skin carcinogenesis in mice: importance of dark basal keratinocytes (stem cells) — T.J. Slaga, A.J. Klein-Szanto (1983)
• beta-Carotene fails to act as a tumor promoter, induces RAR expression, and prevents carcinoma formation in a two-stage model of skin carcinogenesis in male Sencar mice — R.M. Ponnamperuma, Y. Shimizu, et al. (2000)
• Epithelioid malignant mesothelioma metastatic to the skin: A case report and review of the literature — R.E. Ward, S.A. Ali, et al. (2017)

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