Tumors that mimic asbestos-related mesothelioma: time to consider a genetics-based tumor registry?

Our plain-English summary of Tumors that mimic asbestos-related mesothelioma: time to consider a genetics-based tumor registry?, by B.D. Kerger, R.C. James, D.A. Galbraith (Frontiers in Genetics, 2014).

The study

• Authors: B.D. Kerger, R.C. James, D.A. Galbraith
• Journal: Frontiers in Genetics
• Published: 2014;5:151
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The diagnosis of mesothelioma is not always straightforward, despite known immunohistochemical markers and other diagnostic techniques. One reason for the difficulty is that extrapleural tumors resembling mesothelioma may have several possible etiologies, especially in cases with no meaningful history of amphibole asbestos exposure. When the diagnosis of mesothelioma is based on histologic features alone, primary mesotheliomas may resemble various primary or metastatic cancers that have directly invaded the serosal membranes. Some of these metastatic malignancies, particularly carcinomas and sarcomas of the pleura, pericardium and peritoneum, may undergo desmoplastic reaction in the pleura, thereby mimicking mesothelioma, rather than the primary tumor. Encasement of the lung by direct spread or metastasis, termed pseudomesotheliomatous spread, occurs with several other primary cancer types, including certain late-stage tumors from genetic cancer syndromes exhibiting chromosomal instability. Although immunohistochemical staining patterns differentiate most carcinomas, lymphomas, and mestastatic sarcomas from mesotheliomas, specific genetic markers in tumor or somatic tissues have been recently identified that may also distinguish these tumor types from asbestos-related mesothelioma. A registry for genetic screening of mesothelioma cases would help lead to improvements in diagnostic criteria, prognostic accuracy and treatment efficacy, as well as improved estimates of primary mesothelioma incidence and of background rates of cancers unrelated to asbestos that might be otherwise mistaken for mesothelioma. This information would also help better define the dose-response relationships for mesothelioma and asbestos exposure, as well as other risk factors for mesothelioma and other mesenchymal or advanced metastatic tumors that may be indistinguishable by histology and staining characteristics.

In plain English

This was a "hypothesis and theory" article: a narrative review with a proposal, not a study of patients. The authors reviewed published literature on tumors that can look like mesothelioma under the microscope and in standard staining tests, and argued for a genetics-based tumor registry. Drawing on other researchers' work, they described several such tumors. Germ cell tumors can carry a chromosome 12 change (iso-12p). Papillary serous carcinoma can mimic epithelioid mesothelioma. Synovial sarcoma of the pleura is hard to tell apart from sarcomatoid mesothelioma. Late-stage tumors can arise in an inherited syndrome called MEN-1. Pericardial mesothelioma was estimated at 0.7 to 1% of all mesotheliomas. The authors outlined a preliminary genetic screening table. They said screening would matter most in three groups: people with no identified occupational asbestos exposure, people under 50, and people with no pleural plaques, asbestosis or raised lung asbestos fiber counts. They argued that the share of mesothelioma cases unrelated to asbestos will likely increase. They concluded that a registry would help improve diagnostic criteria, prognostic accuracy and treatment. They stated that their categories drew on notes from mesothelioma claims whose details privacy laws kept them from reporting.

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: Hypothesis and theory article (narrative review of published literature with a proposal for a registry-based research program); no new data collected
• Who was studied: No patients were studied. The article reviews published literature on mesothelioma and tumors that resemble it. The authors state their proposed research categories draw on notes from actual mesothelioma claims, which are not reported.
• Exposure: No exposure was measured. Asbestos is discussed as background. The authors suggest genetic screening particularly in three groups: cases with no identified occupational asbestos exposure, cases in people under 50, and cases without pleural plaques, asbestosis or elevated lung asbestos fiber counts.
• Main results:
  • From the reviewed literature: germ cell tumors can show a characteristic chromosome 12 change (iso-12p) that may help identify tumors of germ cell origin.
  • From the reviewed literature: papillary serous carcinoma (PSC) can mimic epithelioid mesothelioma.
  • From the reviewed literature: synovial sarcoma of the pleura is difficult to distinguish from sarcomatoid mesothelioma.
  • From the reviewed literature: pericardial mesothelioma is estimated to make up 0.7 to 1% of all mesotheliomas.
  • From the reviewed literature: late-stage tumors in patients with the inherited syndrome MEN-1 have been associated with chromosomal instability.
  • The authors outlined a preliminary genetic screening matrix for suspected malignant mesothelioma cases (Table 1).
  • The authors argued that the proportion of mesothelioma cases unrelated to asbestos will likely increase in coming decades.
• The authors' conclusion: The authors concluded that a registry for genetic screening of mesothelioma cases would help improve diagnostic criteria, prognostic accuracy and treatment.
• Limitations the authors state:
  • The authors state that details of the mesothelioma claims behind their proposed categories could not be reported because of US privacy laws.
  • The authors describe the screening matrix as preliminary, with many candidate features that could still be added.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Cancer Registry, Amphibole Asbestos, Carcinoma, Sarcoma, Pleura, Pericardium, Peritoneum.

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• Yellow Nail Syndrome with Bilateral Pleural Plaques and Diffuse Pleural Thickening: A Mimic of Asbestos Related Disease — A. Dallmann, R.L. Attanoos (2018)
• Genetic alterations of malignant pleural mesothelioma: association with tumor heterogeneity and overall survival — L. Quetel, C. Meiller, et al. (2020)
• Bap1 Is a Bona Fide Tumor Suppressor: Genetic Evidence from Mouse Models Carrying Heterozygous Germline Bap1 Mutations — Y. Kadariya, M. Cheung, et al. (2016)
• Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors. Mesothelioma — A.A. Sandberg, J.A. Bridge (2001)

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