The use of immunohistochemistry in the diagnosis of composite and collision tumors: exemplified by pleural mesothelioma and carcinoid tumor of the lung

Our plain-English summary of The use of immunohistochemistry in the diagnosis of composite and collision tumors: exemplified by pleural mesothelioma and carcinoid tumor of the lung, by N.G. Ordóñez (Applied Immunohistochemistry & Molecular Morphology, 2012).

The study

• Author: N.G. Ordóñez
• Journal: Applied Immunohistochemistry & Molecular Morphology
• Published: 2012;20(4):421-6
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A case of a collision lymph node metastasis of a mesothelioma and a carcinoid tumor in a 73-year-old man with a history of asbestos exposure is reported. An interesting finding in this case was that both the mesothelioma and its lymph node metastases exhibited a wide variety of histologic patterns, including one characterized by a solid growth of large cells with abundant, clear, and foamy cytoplasm and another exhibiting deciduoid features. Pathologists should be aware that mesotheliomas can present very unusual morphologic features, such as those seen in the present case, and therefore, should be included in the differential diagnosis of those tumors that can display similar morphology and can metastasize to the serosal membranes. Reexamination of the pneumonectomy specimen in the current case identified a primary peripheral carcinoid tumor. The recognition of a nonasbestos-related tumor in a patient with mesothelioma is important since its presence may have an impact on the patient's life expectancy and, therefore, may affect any compensation settlement.

In plain English

This was a case report from MD Anderson Cancer Center in Houston, Texas. It described a 73-year-old man with a history of asbestos exposure who was diagnosed with malignant pleural mesothelioma. He received chemotherapy, then an extrapleural pneumonectomy, and died 6 months later of disseminated disease. The tumor was a biphasic mesothelioma. Its epithelioid part, about 85% to 90% of the tumor, showed many microscopic patterns, including deciduoid and clear, foamy cell patterns. Five of 8 peribronchial lymph nodes and 5 of 7 separately submitted lymph nodes contained metastasis. One lymph node held both mesothelioma and a carcinoid tumor. Twenty additional sections of the lung specimen were then taken, and one showed a primary carcinoid tumor against the mesothelioma. Its exact size could not be determined, but slide measurements indicated over 3 cm. The carcinoid had been missed at first because the mesothelioma was so extensive. Calretinin and neuroendocrine marker staining told the two tumors apart. The author concluded that recognizing a nonasbestos-related tumor in a mesothelioma patient matters because it may affect life expectancy and any compensation settlement.

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 73-year-old man with malignant pleural mesothelioma, referred to and treated at MD Anderson Cancer Center, Houston, Texas; dates of treatment not given
• Exposure: A history of asbestos exposure; no fiber type, job, product or dose is given
• Main results:
  • The patient received chemotherapy followed by an extrapleural pneumonectomy and died 6 months later of disseminated disease; no autopsy was performed
  • The pleural tumor was a biphasic mesothelioma, with an epithelioid component of approximately 85% to 90% and a sarcomatoid (spindle cell) component of 10% to 15%
  • Lymph node spread: 5 of 8 peribronchial lymph nodes attached to the specimen and 5 of 7 lymph nodes submitted separately contained metastasis
  • The epithelioid component showed papillary, tubular and solid patterns, a deciduoid pattern (large cells with dense eosinophilic cytoplasm), and cells with abundant foamy cytoplasm; these patterns also appeared in the involved lymph nodes
  • One involved lymph node also contained a carcinoid tumor, confirmed by synaptophysin and chromogranin staining; 20 additional sections of the pneumonectomy specimen were then taken, and one of them identified a carcinoid tumor abutting the mesothelioma
  • The exact size of the carcinoid tumor could not be determined; measurements taken of the histologic slide indicated it measured over 3 cm in diameter
  • Calretinin expression in the mesothelioma and neuroendocrine markers in the carcinoid tumor allowed the two diagnoses to be made
  • The clear cells were periodic acid Schiff negative, indicating the clearing was not from accumulated glycogen
• The authors' conclusion: The author concluded that pathologists should be aware mesotheliomas can show very unusual features, and that recognizing a nonasbestos-related tumor in a patient with mesothelioma is important because it may affect the patient's anticipated life expectancy and therefore any compensation settlement
• Limitations the authors state:
  • The carcinoid tumor was not detected on initial examination of the specimen because of extensive involvement by the mesothelioma
  • The exact cause of the cytoplasmic clearing could not be determined because no lymph node samples were sent for ultrastructural studies
  • The exact size of the carcinoid tumor could not be determined

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: Immunohistochemistry, Pleural Mesothelioma, Metastasis, Mesothelioma, Asbestos Exposure, Differential Diagnosis, Pneumonectomy, Life Expectancy.

Related studies

• Pulmonary carcinoid tumors and asbestos exposure — B. Clin, P. Andujar, et al. (2012)
• Atypical carcinoid presenting as mesothelioma — P. van Hengel, F. van Geffen, et al. (2001)
• Distinct keratin patterns demonstrated by immunoperoxidase staining of adenocarcinomas, carcinoids, and mesotheliomas using polyclonal and monoclonal anti-keratin antibodies — H.J. Kahn, P.S. Thorner, et al. (1986)
• Application of immunohistochemistry in the diagnosis of epithelioid mesothelioma: a review and update — N.G. Ordóñez (2013)
• p40 is the best marker for diagnosing pulmonary squamous cell carcinoma: comparison with p63, cytokeratin 5/6, desmocollin-3, and sox2 — T. Tatsumori, K. Tsuta, et al. (2014)
• Comparative genetic analysis of a rare synchronous collision tumor composed of malignant pleural mesothelioma and primary pulmonary adenocarcinoma — T. Naka, Y. Hatanaka, et al. (2016)

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