Two malignant pleural mesotheliomas with unusual histological features

Our plain-English summary of Two malignant pleural mesotheliomas with unusual histological features, by B. Goldstein (Thorax, 1979).

The study

• Author: B. Goldstein
• Journal: Thorax
• Published: 1979;34(3):375-9
• Type of article: Case report
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Morphologically, mesotheliomas may be composed of epithelial and/or sarcomatous elements with various patterns, such as tubular, papillary, tubulopapillary, and diffuse epithelial or mixtures of these. Two cases are descirbed in which, in addition to typical mesothelioma, there was cartilage with foci of calcification and ossificated with the mesothelioma, which suggested that they formed an integral part of the tumour. One of the cases also showed a cuff of cartilage and bone round blood vessels and bronchioles in the lung parenchyma. The patholgenesis could be explained if the mesothelial cell is considered to be totipotent and able to give rise to epithelial and connective tissue elements. Other theories that must be considered are: that there are two separate neoplasms; that there is a circulating substance, perhaps induced by the mesothelioma, which stimulated the cartilage and bone formation; and that the cartilage and bone were due to a previous or associated infection such as tuberculosis. Calcification is also common in asbestotic pleural plaques.

In plain English

This article reported two cases of malignant pleural mesothelioma studied at the National Research Institute for Occupational Diseases in Johannesburg, South Africa. The first patient was a 35-year-old black woman from the Kuruman area of the NW Cape Province. She had no known asbestos exposure, but electron microscope analysis of her lung tissue found several crocidolite asbestos fibres. The second was a 38-year-old black man who had worked on an amosite mine. His lungs showed numerous asbestos bodies and fibres with moderate interstitial fibrosis. In both, besides typical mesothelioma, the tumour contained cartilage with bone formation and areas of fibrochondrosarcoma. The woman also had cuffs of bone or cartilage around lung blood vessels and bronchi. The man had a focus of chondrosarcoma in the lung. The author weighed several explanations: two separate tumours, a substance released by the tumour, or earlier tuberculosis. The author wrote that the features appeared to favour the cartilage and bone being part of the tumour itself. As a report of two cases, it describes these patients, not how often this occurs.

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 (two cases)
• Who was studied: Two patients in South Africa examined at necropsy. Case 1 was a 35-year-old black woman who had lived in the Kuruman area of the NW Cape Province. Case 2 was a 38-year-old black man who had worked in mining.
• Exposure: Case 1: no history of asbestos exposure could be elicited, but crocidolite asbestos fibres were found in lung tissue by electron microscope microprobe analysis. Case 2: worked on an amosite mine as an underground lasher for 1140 shifts and as a surface lorry loader for 540 shifts, plus one year's service each in gold and coal mines.
• Main results:
  • Case 1: electron microscope microprobe analysis of digested lung tissue showed several crocidolite asbestos fibres. The lung tissue showed no evidence of asbestosis.
  • Case 1: the pleural tumour had features typical of a mesothelioma, with more cellular sarcomatous areas.
  • Case 1: islands of cartilage within the tumour, with atypical cells and mitotic figures consistent with fibrochondrosarcomatous change, and occasional foci of ossification.
  • Case 1: cuffs of bone or cartilage formed around blood vessels and bronchi in the lung parenchyma.
  • Case 1: a 3 mm focus of encapsulated necrosis in the right lung showed active fibrocaseous tuberculosis.
  • Case 2: numerous asbestos bodies and asbestos fibres were seen in the air-spaces and interstitial tissues of both lungs, with a moderate degree of interstitial fibrosis.
  • Case 2: the right pleural tumour invaded the superior vena cava and extended into the right atrium.
  • Case 2: besides typical mesothelioma, there were foci of cartilage with bone formation, and areas of chondrosarcoma merging with fibrosarcoma, giving the appearance of a fibrochondrosarcoma.
  • Case 2: a tumour nodule in the right lower lobe showed a focus of chondrosarcoma in the lung parenchyma, with tumour emboli in nearby blood vessels and lymphatics.
  • There was no evidence of tuberculous involvement of the pleura at necropsy.
• The authors' conclusion: The author concluded that the two cases illustrate a mesothelioma with typical features together with areas of fibrochondrosarcoma and the formation of bone and cartilage. Of several possible explanations, the author wrote that features appeared to favour the cartilage and bone being part of the neoplastic process. This could be explained if the mesothelial cell can differentiate into epithelial as well as connective tissue elements. The author did not consider the bone and cartilage related to the calcification seen in asbestotic pleural plaques.
• Limitations the authors state:
  • Biochemical studies were not carried out to test whether the tumour produced a substance promoting cartilage and bone formation.
  • The possibility of two separate neoplasms could not be excluded entirely.
  • In case 2, the metastatic nodule on the liver surface was not examined.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Tubulopapillary, Parenchyma, Mesothelial Cells, Neoplasm, Pleural Plaques.

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