The Diagnosis of Pleural Tumors Other Than Mesothelioma

Our plain-English summary of The Diagnosis of Pleural Tumors Other Than Mesothelioma, by R.L. Attanoos, M.R. Pugh (Archives of Pathology & Laboratory Medicine, 2018).

The study

• Authors: R.L. Attanoos, M.R. Pugh
• Journal: Archives of Pathology & Laboratory Medicine
• Published: 2018;142(8):902-913
• Type of article: Review
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Context: - Pleural pathology has been dominated by discussions relating to the diagnosis, prognosis, etiology, and management of malignant mesothelioma. However, there exists a diverse group of other neoplasms that involve the pleura; the most common by far is metastatic carcinoma, usually of pulmonary origin. Other metastatic tumors of varied histogenesis do occur but are less common. Primary pleural neoplasms other than diffuse malignant mesothelioma are either uncommon or rare and have received less attention.

Objective: - To provide a review of those diverse tumors that can involve the pleura other than mesothelioma in order to facilitate their accurate diagnosis.

Data Sources: - Review of relevant literature published via PubMed and other search engines.

Conclusions: - A wide variety of tumors can involve the pleura. In most cases, the approach of considering the morphologic features with appropriate immunohistochemistry, in the correct clinical context, allows for a confident diagnosis. For a number of those soft tissue tumors that are well recognized in the pleura, such as solitary fibrous tumor, desmoid-type fibromatosis, synovial sarcoma, and epithelioid hemangioendothelioma, novel markers now exist based on an understanding of the individual tumors' molecular characteristics. Primary pleural lymphomas are rare with poor prognosis. They represent localized specific diffuse large B-cell lymphomas, with either post-germinal center B-cell or plasma cell lineage, arising in the context of either immunodeficiency or immune sequestration and with viral infection.

In plain English

This article was a review of tumors other than mesothelioma that can involve the pleura, the lining around the lungs. The authors, from a cellular pathology department in Cardiff, Wales, based it on published literature found through PubMed and other search engines and on a 2017 conference presentation. It did not study new patients. The review noted that cancer spreading to the pleura from elsewhere, usually lung carcinoma, is by far the most common cancer there. It then described rarer tumors that start in the pleura, including solitary fibrous tumor, desmoid-type fibromatosis, epithelioid hemangioendothelioma, angiosarcoma, synovial sarcoma and pleural lymphomas. It also described the tissue stains and genetic tests used to tell these tumors apart from sarcomatoid mesothelioma. The review stated that solitary fibrous tumor has no link with tobacco or asbestos and that epithelioid hemangioendothelioma has no association with asbestos. It stated that angiosarcoma has no proven association with asbestos. The authors concluded that in most cases, microscopic features, appropriate staining and clinical context together allow a confident diagnosis. They added that newer molecular markers have made several of these tumors easier to diagnose accurately.

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: Narrative review of published literature (not an original study of patients)
• Who was studied: No patients were studied. The review covered published literature found via PubMed and other search engines. The article does not give dates or the number of articles reviewed. It was based on a 2017 presentation by the first author and written from the Department of Cellular Pathology, Cardiff, Wales.
• Exposure: Not an exposure study. The review mentions asbestos only when stating that certain pleural tumors (solitary fibrous tumor, epithelioid hemangioendothelioma, angiosarcoma) have no known or no proven association with asbestos. Other causes it mentions include pyothorax and radiation for angiosarcoma, and the viruses HHV-8 and Epstein-Barr virus for primary pleural lymphomas.
• Main results:
  • The review stated that secondary (metastatic) tumors, usually carcinoma from the lung, are by far the most common cancer to involve the pleura.
  • For solitary fibrous tumor of the pleura, the review stated there is no known cause and no link with tobacco or asbestos.
  • For epithelioid hemangioendothelioma, the review stated there is no association with asbestos.
  • For primary pleural angiosarcoma, the review stated that some cases have been related to pyothorax and radiation, and that there is no proven association with asbestos.
  • Citing earlier work, the review reported that nuclear STAT6 staining was positive in 100% of 49 solitary fibrous tumor cases and is a useful marker for this tumor.
  • Citing earlier work, the review reported that the marker TLE1 was found in 82% of 73 synovial sarcomas, 15% of 47 malignant peripheral nerve sheath tumors and 8% of 49 solitary fibrous tumors. One author had also observed TLE1 in sarcomatoid mesothelioma (unpublished data). The authors therefore advised caution in using this marker alone.
  • The review described two primary pleural lymphomas. Primary effusion lymphoma is linked with HHV-8, and its median survival is 6 months. Diffuse large B-cell lymphoma associated with chronic inflammation is linked with Epstein-Barr virus; for this lymphoma in the pleura, median survival is less than one year and 5-year overall survival is approximately 20%.
• The authors' conclusion: The authors concluded that many different tumors can involve the pleura. In most cases, they wrote, considering the microscopic features with appropriate staining in the correct clinical context allows a confident diagnosis. They added that molecular markers for tumors such as synovial sarcoma, solitary fibrous tumor, desmoid-type fibromatosis and epithelioid hemangioendothelioma have made accurate diagnosis easier.
• Limitations the authors state:
  • The authors stated that mesothelial tumors were outside the scope of the review.
  • The authors stated that the review did not discuss how to diagnose the various metastatic tumors that involve the pleura, beyond noting how common and varied they are.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pathology, Prognosis, Etiology, Neoplasm, Pleura, Carcinoma, Immunohistochemistry.

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