Well-differentiated papillary mesothelioma with invasion to the chest wall

Our plain-English summary of Well-differentiated papillary mesothelioma with invasion to the chest wall, by I. Torii, M. Hashimoto, T. Terada, et al (Lung Cancer, 2010).

The study

• Authors: I. Torii, M. Hashimoto, T. Terada, N. Kondo, H. Fushimi, K. Shimazu, S. Takeda, T. Takuwa, Y. Okumura, A. Sato, T. Yamamoto, K. Fukuoka, F. Tanaka, T. Nishigami, T. Nakano, S. Hasegawa, T. Tsujimura
• Journal: Lung Cancer
• Published: 2010;67(2):244-7
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Well-differentiated papillary mesothelioma (WDPM) is an uncommon tumor with a papillary architecture, bland cytologic features, a tendency toward superficial spread without invasion, and good prognosis with prolonged survival. WDPM occurs primarily in the peritoneum of women, but also rarely in the pleura. We here report a case of 48-year-old woman who developed WDPM in the pleura with no history of asbestos exposure. Tumors were multifocal and widespread with a velvety appearance on the surface of parietal and visceral pleurae resected by extrapleural pneumonectomy (EPP). Tumors showed papillary structures with fibrovascular cores and lined by epithelioid cells. Immunohistochemically, these epithelioid tumor cells were positive for epithelial membrane antigen (EMA), a marker of malignant mesothelioma, with more than 50% positive for p53. Tumor cells microinvaded into subpleural parenchyma of the lung and minimally spread to adipose tissues of the mediastinal lesion. In addition, tumor cells invaded into the chest wall with a trabecular or glandular architecture. Based on these findings, this case is pathologically considered as WDPM of the pleura with malignant potential.

Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

In plain English

This article was a case report about one patient. She was a 48-year-old woman, a housewife with no history of occupational or environmental asbestos exposure. A chest X-ray found fluid around her left lung (a pleural effusion) by chance. A biopsy suggested well-differentiated papillary mesothelioma (WDPM) of the pleura. She received three courses of the drugs cisplatin and pemetrexed, then had surgery called extrapleural pneumonectomy, which removed the lung and the pleura. The removed tissue showed multiple tumors on the pleural surfaces. Tumor cells stained strongly for the marker EMA, and more than 50% stained for p53. Tumor cells had invaded slightly into the lung just under the pleura, spread minimally into fatty tissue in the middle of the chest, and invaded the chest wall at the spot used to drain the fluid. Pleural plaques were absent. The authors concluded that this was pleural WDPM with malignant potential. They wrote that pleural WDPM may develop without relation to asbestos, but that more cases are needed to clarify this. Eight months after surgery she was stable, with no signs of recurrence.

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 (one patient)
• Who was studied: One 48-year-old woman whose left pleural effusion was found incidentally on chest X-ray
• Exposure: No asbestos exposure: the patient was a housewife with no history of occupational or environmental asbestos exposure. Pleural plaques were absent.
• Main results:
  • Treatment: the patient received three courses of cisplatin and pemetrexed before extrapleural pneumonectomy
  • The tissue removed by extrapleural pneumonectomy showed multiple tumors on the pleural surfaces
  • Tumor cells covering the papillae were positive for EMA
  • More than 50% of tumor cells were positive for p53
  • Tumor cells microinvaded the lung tissue beneath the pleura and spread minimally to fatty tissue of the mediastinal lesion
  • Tumor cells invaded the chest wall at the drainage site for the effusion
  • Pleural plaque, which the authors called a marker of asbestos exposure, was absent
  • The authors wrote that the findings indicate pleural WDPM may develop without being related to asbestos exposure
  • During 8 months of follow-up after surgery, the patient was stable with no signs of recurrence
• The authors' conclusion: The authors concluded that the case was pathologically WDPM of the pleura with malignant potential
• Limitations the authors state:
  • More cases of pleural WDPM need to be examined to clarify its relationship with asbestos
  • Follow-up was short, and further follow-up is needed to see how the disease progresses

Topics

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

Medical terms in this study, explained in our Lexicon: Well-Differentiated Papillary Mesothelioma, Prognosis, Peritoneum, Pleura, Asbestos Exposure, Extrapleural Pneumonectomy (EPP), Epithelioid, Epithelial Membrane Antigen (EMA).

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