The recurrence of malignant pleural mesothelioma 14 years after extrapleural pneumonectomy: possible histological transformation

Our plain-English summary of The recurrence of malignant pleural mesothelioma 14 years after extrapleural pneumonectomy: possible histological transformation, by T. Kinoshita, G. Ishii, Y. Matsumura, et al (Pathology International, 2012).

The study

• Authors: T. Kinoshita, G. Ishii, Y. Matsumura, T. Shiozawa, K. Aokage, T. Hishida, J. Yoshida, K. Nagai
• Journal: Pathology International
• Published: 2012;62(11):754-7
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 56-year-old man underwent extrapleural pneumonectomy for malignant pleural mesothelioma (MPM). The histological diagnosis was epithelioid mesothelioma with T2N0M0, and no sarcomatoid component was observed. Subsequently, 14 years after complete resection, screening computed tomography detected a rapidly growing right thoracic mass, which was diagnosed as a recurrence of MPM on resection. However, it was composed of both epithelioid (50%) and sarcomatoid (50%) components, suggesting possible histological transformation. Although there have been some previous reports on the recurrence of MPM, to the best of our knowledge, this is the first clinical case which indicated that histological transformation of MPM might occur.

© 2012 The Authors. Pathology International © 2012 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.

In plain English

This case report described one 56-year-old Japanese man whose malignant pleural mesothelioma was removed by extrapleural pneumonectomy in 1997. The tumor was classified as epithelioid type, stage T2N0M0. The authors found no sarcomatoid component in any of the 36 tissue blocks they examined. He had worked as an electronic repairman, was a heavy smoker, and had no apparent history of occupational or incidental exposure to asbestos. Six years later he was treated for esophageal cancer. Five years after that, follow-up CT found a 3.5 cm chest mass that at first did not grow. Fourteen years after the first operation, the mass grew over one year to 8 cm. It was diagnosed as a local recurrence and removed with two ribs. The recurrent tumor was biphasic: 50% epithelioid and 50% sarcomatoid cells, with an area where the two types mixed. He died of systemic metastases 4 months later. The authors concluded that the epithelioid cells had possibly transformed into sarcomatoid cells. They could not compare a growth marker between the two tumors or examine genetic abnormalities.

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 56-year-old Japanese man first seen in 1997, later treated at National Cancer Center Hospital East, Kashiwa, Chiba, Japan
• Exposure: No apparent history of occupational or incidental asbestos exposure. He worked as an electronic repairman for most of his life and was a heavy smoker.
• Main results:
  • The original tumor removed in 1997 was epithelioid-type mesothelioma, T2N0M0. No sarcomatoid component was seen in any of the 36 tissue blocks.
  • A 3.5 cm chest mass found on follow-up CT grew slowly at first, then grew rapidly over 1 year to 8 cm, 14 years after the first operation.
  • The recurrent tumor was biphasic mesothelioma, made up of 50% epithelioid cells and 50% sarcomatoid cells, with a transitional area where the two types were mixed.
  • In the recurrent tumor, the MIB-1 index (a marker of cell growth) was 30% in sarcomatoid cells and less than 5% in epithelioid cells.
  • The patient died of systemic metastases of mesothelioma 4 months after the second operation. The authors gave his survival time as 181 months.
• The authors' conclusion: The authors concluded that the epithelioid cells had transformed into sarcomatoid cells, which grew quickly within 1 year. They described this as, to their knowledge, the first clinical case suggesting that histological transformation of mesothelioma might occur.
• Limitations the authors state:
  • The authors could not compare the MIB-1 index between the primary and recurrent tumors.
  • The authors could not examine genetic abnormalities to confirm that the second tumor was a recurrence of the first.

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: Pleural Mesothelioma, Extrapleural Pneumonectomy (EPP), Epithelioid, Mesothelioma, Sarcomatoid.

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• Fifteen years in the evaluation of extrapleural pneumonectomy: Lessons to be learned — T. Treasure, F. Macbeth (2015)
• Post-recurrence chemotherapy for mesothelioma patients undergoing extrapleural pneumonectomy — T. Takuwa, M. Hashimoto, et al. (2017)
• Epithelioid and sarcomatoid malignant pleural mesothelioma in endoscopic gastric biopsies: a diagnostic pitfall — A. Agaimy, P.H. Wünsch (2006)
• Constrictive pericarditis after left extrapleural pneumonectomy and radiotherapy for malignant mesothelioma — E.J. Hickey, A.A. Khan, et al. (2007)

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