Utility of Site-Specific Biopsy for Diagnosis of Desmoplastic Malignant Mesothelioma

Our plain-English summary of Utility of Site-Specific Biopsy for Diagnosis of Desmoplastic Malignant Mesothelioma, by T. Sakai, K. Tane, Y. Usui, et al (The Annals of Thoracic Surgery, 2018).

The study

• Authors: T. Sakai, K. Tane, Y. Usui, T. Miyoshi, S. Matsumoto, K. Aokage, K. Goto, M. Suzuki, G. Ishii, M. Tsuboi
• Journal: The Annals of Thoracic Surgery
• Published: 2018;106(3):e125-e128
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Desmoplastic malignant mesothelioma (DMM) is a relatively rare histologic subtype of malignant pleural mesothelioma (MPM). Among MPMs, the diagnosis of DMM is particularly difficult because the tumor is largely composed of dense hyalinized fibrous stroma and few malignant cells. We present two cases of DMM, one in a 47-year-old man and the other in a 64-year-old man. From detailed pathologic findings in these two cases, we conclude that cases of DMM that cannot otherwise be diagnosed with the use of conventional pleural biopsy, may be diagnosed successfully with the use of wedge lung resection.

Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This case report described two men treated at a hospital in Japan with desmoplastic malignant mesothelioma (DMM), a rare subtype of malignant pleural mesothelioma that is mostly scar-like fibrous tissue with few cancer cells. Both men, aged 47 and 64, had a history of asbestos exposure. The article did not state fiber types. In both, needle and thoracoscopic biopsies of the pleura showed fibrous tissue, sometimes with inflammatory cells, and did not establish the diagnosis. The first man could not be given a definitive diagnosis, received palliative care, and died 14 months after his arm pain began. DMM was diagnosed at autopsy. The second man had a wedge resection of the lung where the tumor was thought to invade. He was diagnosed with DMM, began chemotherapy with cisplatin and pemetrexed, and was alive 9 months after diagnosis. In both tumors, malignant cells were found mainly on the pleural side, where the tumor invaded the lung. The authors concluded that, although more evidence is required, wedge lung resection should be performed when DMM is suspected but biopsies show only fibrous tissue.

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 men, aged 47 and 64, treated at the National Cancer Center Hospital East, Japan; dates not given
• Exposure: Both patients had a history of asbestos exposure; fiber type, job and dose not stated
• Main results:
  • Case 1 (47-year-old): CT-guided pleural biopsy and bone biopsy showed only dense fibrous tissue
  • Case 1: the thoracoscopic (VATS) pleural biopsy showed collagen fibrous hyperplasia with infiltrating inflammatory cells, and a definitive diagnosis of malignant pleural mesothelioma could not be made
  • Case 1: the patient received palliative care and died 14 months after the onset of left arm pain. Autopsy showed diffuse pleural thickening and spread to bone, adrenal gland and peritoneum, and DMM was diagnosed at autopsy
  • In both cases the tumor was hyalinized fibrous stroma making up 50% of the tumor mass and could be separated into three microscopic areas
  • The area closest to the chest wall had no malignant cells. The middle area had fibrous stroma, inflammatory cells and a few atypical spindle cells. The pleural-side area had diffuse atypical spindle cells infiltrating the lung with bland necrosis, which allowed the diagnosis
  • Case 2 (64-year-old): CT-guided pleural biopsy and transbronchial lung biopsy showed only dense fibrous tissue and inflammatory cells
  • Case 2: the intraoperative pleural biopsy showed only fibrous tissue, so a wedge resection of the lung was performed
  • Case 2 was diagnosed with DMM from the wedge resection, began chemotherapy with cisplatin and pemetrexed, and was alive at 9 months after diagnosis
• The authors' conclusion: The authors concluded that when DMM is suspected clinically, such as with distant metastasis, wedge lung resection should be performed for a definitive diagnosis even if biopsy shows only fibrous stroma
• Limitations the authors state:
  • The authors stated that more evidence is required

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: Biopsy, Desmoplastic Mesothelioma, Malignant Mesothelioma, Histological Subtype, Pleural Mesothelioma, Pleural Biopsy.

Related studies

• An electrocautery pleural biopsy for the diagnosis of desmoplastic malignant mesothelioma during semirigid thoracoscopy — S. Sasada, K. Kawahara, et al. (2008)
• Mesothelioma--VATS biopsy and lung mobilization improves diagnosis and palliation — M.W. Grossebner, A.A. Arifi, et al. (1999)
• Pleuroscopic punch biopsy using insulated-tip diathermic knife-2 for the diagnosis of desmoplastic malignant mesothelioma — K. Masai, S. Sasada, et al. (2013)
• Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions — Y. Yin, R. Eberhardt, et al. (2016)
• Hazards of lung biopsy in asbestos workers — Y. Lerman, J. Ribak, et al. (1986)
• BAP1 Immunohistochemistry and p16 FISH in the Diagnosis of Sarcomatous and Desmoplastic Mesotheliomas — H.C. Hwang, S. Pyott, et al. (2016)

Browse more research in The Annals of Thoracic Surgery, or return to medical research.