Skin metastasis of pleural epithelioid malignant mesothelioma

Our plain-English summary of Skin metastasis of pleural epithelioid malignant mesothelioma, by T. Terada (Applied Immunohistochemistry & Molecular Morphology, 2011).

The study

• Author: T. Terada
• Journal: Applied Immunohistochemistry & Molecular Morphology
• Published: 2011;19(1):92-3
• Type of article: Case report, Letter
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter to the editor described a rare case of skin metastasis from pleural epithelioid malignant mesothelioma in a 75-year-old Japanese man with a history of asbestos exposure, seen at a hospital in Shizuoka, Japan. He presented with shortness of breath and chest pain. Imaging showed right pleural effusion and mild right pleural thickening. Cytology and a needle biopsy of the pleura were interpreted as adenocarcinoma, and he was treated with anticancer drugs for lung adenocarcinoma. Eight months later, a raised, mobile skin tumor appeared on the chest wall away from the biopsy site. Skin biopsy showed malignant epithelioid cells in the dermis, arranged in solid nests with focal tubular structures, with many tumor cells inside blood vessels. On immunohistochemistry the tumor was positive for markers including calretinin, WT-1, cytokeratin 5/6, thrombomodulin and HBME-1, and negative for CEA and B72.3. A diagnosis of skin metastasis of malignant mesothelioma was made. Re-examination of the pleural biopsy showed similar findings, and the diagnosis was corrected to malignant pleural mesothelioma. He was treated with chemoradiation but died of mesothelioma 19 months after first symptoms. The author considered the spread to be blood-borne because the skin lesion was not continuous with the pleural lesion. He concluded that mesothelioma should be considered in pleural biopsies resembling adenocarcinoma, that immunohistochemistry should be done, and that mesothelioma should be suspected in almost any pleural lesion.

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 letter was a case report about one patient. A 75-year-old Japanese man with a history of asbestos exposure had shortness of breath and chest pain. Cell testing and a needle biopsy of the pleura (the lining around the lungs) were first read as adenocarcinoma, and he was treated with anticancer drugs for lung adenocarcinoma. Eight months later, a skin tumor appeared on the chest wall away from the biopsy site. Its biopsy showed malignant epithelioid cells in the skin, many inside blood vessels. Stains were positive for mesothelioma markers including calretinin, WT-1 and cytokeratin 5/6, and negative for CEA and B72.3. The skin tumor was diagnosed as a metastasis of malignant mesothelioma. Re-examining the pleural biopsy showed matching findings, and the diagnosis was corrected to malignant pleural mesothelioma. He received chemoradiation and died of mesothelioma 19 months after his first symptoms. The author thought the spread to the skin was likely through the blood. The author concluded that mesothelioma should be suspected in just about any pleural lesion.

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 (letter to the editor) of a single patient
• Who was studied: One 75-year-old Japanese man seen at the author's hospital (Shizuoka City Shimizu Hospital, Japan) with shortness of breath and chest pain
• Exposure: A history of asbestos exposure. No fiber type, job, product or amount of exposure was given.
• Main results:
  • The patient was first diagnosed with lung adenocarcinoma from pleural cytology and needle biopsy, and was treated with anticancer drugs.
  • Eight months later, a raised, movable skin tumor appeared on the chest wall, away from the earlier needle biopsy site.
  • The skin biopsy showed malignant epithelioid cells in the dermis, with many tumor cells inside blood vessels.
  • The tumor cells in this patient stained positive for markers including calretinin, WT-1 and cytokeratin 5/6.
  • The tumor in this patient stained negative for CEA, MOC-1, B72.3, smooth muscle antigen and CA125.
  • On re-examination, the original pleural biopsy matched the skin tumor, and the diagnosis was corrected to malignant pleural mesothelioma.
  • The patient was treated with chemoradiation and died of mesothelioma 19 months after his first symptoms.
  • The author judged that the skin spread seemed to have occurred through the blood, based on the many tumor cells inside blood vessels.
• The authors' conclusion: The author concluded that mesothelioma should be suspected in just about any pleural lesion, even when it resembles adenocarcinoma, and that immunohistochemical study should be done.

Topics

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

Medical terms in this study, explained in our Lexicon: Metastasis, Epithelioid, Mesothelioma, Asbestos Exposure, Pleural Effusion, Pleural Thickening, Cytology, Needle Biopsy.

Related studies

• Distant cutaneous metastasis of malignant epithelioid mesothelioma — K. Collins, P. Nagarajan, et al. (2021)
• Skin metastasis of malignant mesothelioma — T. Mori, T. Yamamoto (2021)
• Primary pleural epithelioid haemangioendothelioma with metastases to the skin. A case report and literature review — M. Al-Shraim, B. Mahboub, et al. (2005)
• Epithelioid malignant mesothelioma metastatic to the skin: A case report and review of the literature — R.E. Ward, S.A. Ali, et al. (2017)
• NLRP3 promotes inflammation-induced skin cancer but is dispensable for asbestos-induced mesothelioma — M.T. Chow, J. Tschopp, et al. (2012)
• Initiation-promotion versus complete skin carcinogenesis in mice: importance of dark basal keratinocytes (stem cells) — T.J. Slaga, A.J. Klein-Szanto (1983)

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