Difference between revisions of "Malignant mesothelioma"

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#redirect [[Lung_tumours#Malignant_mesothelioma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Malignant epithelioid mesothelioma - high mag.jpg
| Width      =
| Caption    = Malignant mesothelioma. [[H&E stain]].
| Micro      = infiltrative atypical cells (epithelioid, spindled or both)
| Subtypes  = biphasic mesothelioma, epithelioid mesothelioma, desmoplastic mesothelioma, sarcomatoid mesothelioma.
| LMDDx      = mesothelial hyperplasia, fibrosing pleuritis, [[adenocarcinoma]] - esp. [[lung adenocarcinoma|lung]]
| Stains    =
| IHC        = calretinin +ve, D2-40 +ve, CK5/6 +ve, WT-1 +ve, CK7 +ve, CEA -ve, TTF-1 -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[lung]], peritoneum
| Assdx      =
| Syndromes  =
| Clinicalhx = asbestos exposure, smoking
| Signs      =
| Symptoms  =
| Prevalence = rare
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = very poor
| Other      =
| ClinDDx    =
}}
'''Malignant mesothelioma''', also '''mesothelioma''', is a form of [[cancer]] that arise from the mesothelial lining.
 
It should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.
 
==General==
*Poor prognosis - median survival <12 months.<ref name=pmid23413596>{{Cite journal  | last1 = Mineo | first1 = TC. | last2 = Ambrogi | first2 = V. | title = Malignant pleural mesothelioma: factors influencing the prognosis. | journal = Oncology (Williston Park) | volume = 26 | issue = 12 | pages = 1164-75 | month = Dec | year = 2012 | doi =  | PMID = 23413596 }}</ref>
 
Locations:
*Lung.
*Primary peritoneal.
 
Epidemiology:
*Strong association with asbestos exposure.
 
Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
*Pleural plaques.
*[[Asbestosis]].
*[[Lung carcinoma]].
*Malignant mesothelioma.
 
Possible association with asbestos exposure:
*[[Gestational trophoblastic disease]].<ref name=pmid19900938>{{Cite journal  | last1 = Reid | first1 = A. | last2 = Heyworth | first2 = J. | last3 = de Klerk | first3 = N. | last4 = Musk | first4 = AW. | title = Asbestos exposure and gestational trophoblastic disease: a hypothesis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 18 | issue = 11 | pages = 2895-8 | month = Nov | year = 2009 | doi = 10.1158/1055-9965.EPI-09-0731 | PMID = 19900938 }}</ref>
 
==Microscopic==
Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Infiltrative atypical cells - '''key feature'''.
**+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing.
***Variable architecture: sheets, microglandular, tubulopapillary.
***+/-[[Psammoma bodies]].
**+/-Spindle cells.
*+/-''Ferruginous body'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref>
** Looks like a (twirling) baton - segemented appearance, brown colour.
** Thin (asbestos) fiber in the core.
 
Note:
*''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''.
 
DDx:<ref name=pmid15559051>{{Cite journal  | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }}
</ref>
*[[Fibrosing pleuritis]].
*Mesothelial hyperplasia.
 
===Image===
<gallery>
Image:Ferruginous_body.jpg | Ferruginous body. (WC)
</gallery>
===Subtypes===
List of subtypes - mnemonic ''BEDS'':<ref name=pmid15559051/><ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Biphasic mesothelioma.
**10%+ of epithelioid & 10%+ sarcomatoid.
*Epithelioid mesothelioma.
*Desmoplastic mesothelioma.
**Should be 50%+ dense tissue with storiform pattern & atypical cells.
*Sarcomatoid mesothelioma.
 
==Stains==
*PASD -ve.
*Mucicarmine -ve.
**Typically +ve in adenocarcinoma.
 
==IHC==
===Mesothelioma versus mesothelial hyperplasia===
Features:<ref name=pmid20209622>{{Cite journal  | last1 = Hasteh | first1 = F. | last2 = Lin | first2 = GY. | last3 = Weidner | first3 = N. | last4 = Michael | first4 = CW. | title = The use of immunohistochemistry to distinguish reactive mesothelial cells from malignant mesothelioma in cytologic effusions. | journal = Cancer Cytopathol | volume = 118 | issue = 2 | pages = 90-6 | month = Apr | year = 2010 | doi = 10.1002/cncy.20071 | PMID = 20209622 }}</ref>
*EMA +ve ~100% (vs. ~10%).
*Desmin -ve ~5% (vs. ~85%).
*GLUT1 +ve ~50% (vs. ~10%)
*p53 +ve ~50% (vs. ~2%).
 
===Mesothelioma versus adenocarcinoma===
*Several panel exists - ''no agreed upon best panel''.<ref name=pmid18318582>{{cite journal |author=Marchevsky AM |title=Application of immunohistochemistry to the diagnosis of malignant mesothelioma |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=3 |pages=397-401 |year=2008 |month=March |pmid=18318582 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=397}}</ref>
**Usually two carcinoma markers + two mesothelial markers.
 
Panel:<ref name=pmid18318582/>
*Mesothelial markers:
**Calretinin.
**WT-1.
**D2-40.
**CK5/6.
*Carcinoma markers:
**CEA (monoclonal and polyclonal).
**TTF-1.
**Ber-EP4.
**MOC-31.
**CD15.
 
==See also==
*[[Lung tumours]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 22:51, 11 July 2013

Malignant mesothelioma
Diagnosis in short

Malignant mesothelioma. H&E stain.
LM infiltrative atypical cells (epithelioid, spindled or both)
Subtypes biphasic mesothelioma, epithelioid mesothelioma, desmoplastic mesothelioma, sarcomatoid mesothelioma.
LM DDx mesothelial hyperplasia, fibrosing pleuritis, adenocarcinoma - esp. lung
IHC calretinin +ve, D2-40 +ve, CK5/6 +ve, WT-1 +ve, CK7 +ve, CEA -ve, TTF-1 -ve
Site lung, peritoneum
Clinical history asbestos exposure, smoking
Prevalence rare
Prognosis very poor

Malignant mesothelioma, also mesothelioma, is a form of cancer that arise from the mesothelial lining.

It should not be confused with benign multicystic mesothelioma and benign papillary mesothelioma.

General

  • Poor prognosis - median survival <12 months.[1]

Locations:

  • Lung.
  • Primary peritoneal.

Epidemiology:

  • Strong association with asbestos exposure.

Conditions associated with asbestos exposure (mnemonic PALM):[2]

Possible association with asbestos exposure:

Microscopic

Features:[4]

  • Infiltrative atypical cells - key feature.
    • +/-Epithelioid cells - may be cytologically bland, i.e. benign appearing.
      • Variable architecture: sheets, microglandular, tubulopapillary.
      • +/-Psammoma bodies.
    • +/-Spindle cells.
  • +/-Ferruginous body - strongly supportive.[5]
    • Looks like a (twirling) baton - segemented appearance, brown colour.
    • Thin (asbestos) fiber in the core.

Note:

  • Asbestos body is not strictly speaking a synonym for ferruginous body.

DDx:[6]

Image

  • Ferruginous body. (WC)

Subtypes

List of subtypes - mnemonic BEDS:[6][4]

  • Biphasic mesothelioma.
    • 10%+ of epithelioid & 10%+ sarcomatoid.
  • Epithelioid mesothelioma.
  • Desmoplastic mesothelioma.
    • Should be 50%+ dense tissue with storiform pattern & atypical cells.
  • Sarcomatoid mesothelioma.

Stains

  • PASD -ve.
  • Mucicarmine -ve.
    • Typically +ve in adenocarcinoma.

IHC

Mesothelioma versus mesothelial hyperplasia

Features:[7]

  • EMA +ve ~100% (vs. ~10%).
  • Desmin -ve ~5% (vs. ~85%).
  • GLUT1 +ve ~50% (vs. ~10%)
  • p53 +ve ~50% (vs. ~2%).

Mesothelioma versus adenocarcinoma

  • Several panel exists - no agreed upon best panel.[8]
    • Usually two carcinoma markers + two mesothelial markers.

Panel:[8]

  • Mesothelial markers:
    • Calretinin.
    • WT-1.
    • D2-40.
    • CK5/6.
  • Carcinoma markers:
    • CEA (monoclonal and polyclonal).
    • TTF-1.
    • Ber-EP4.
    • MOC-31.
    • CD15.

See also

References

  1. ↑ Mineo, TC.; Ambrogi, V. (Dec 2012). "Malignant pleural mesothelioma: factors influencing the prognosis.". Oncology (Williston Park) 26 (12): 1164-75. PMID 23413596.
  2. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 375. ISBN 978-1416054542.
  3. ↑ Reid, A.; Heyworth, J.; de Klerk, N.; Musk, AW. (Nov 2009). "Asbestos exposure and gestational trophoblastic disease: a hypothesis.". Cancer Epidemiol Biomarkers Prev 18 (11): 2895-8. doi:10.1158/1055-9965.EPI-09-0731. PMID 19900938.
  4. ↑ 4.0 4.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 156. ISBN 978-0781765275.
  5. ↑ URL: http://medical-dictionary.thefreedictionary.com/asbestos+body. Accessed on: 4 November 2011.
  6. ↑ 6.0 6.1 Corson, JM. (Nov 2004). "Pathology of mesothelioma.". Thorac Surg Clin 14 (4): 447-60. doi:10.1016/j.thorsurg.2004.06.007. PMID 15559051.
  7. ↑ Hasteh, F.; Lin, GY.; Weidner, N.; Michael, CW. (Apr 2010). "The use of immunohistochemistry to distinguish reactive mesothelial cells from malignant mesothelioma in cytologic effusions.". Cancer Cytopathol 118 (2): 90-6. doi:10.1002/cncy.20071. PMID 20209622.
  8. ↑ 8.0 8.1 Marchevsky AM (March 2008). "Application of immunohistochemistry to the diagnosis of malignant mesothelioma". Arch. Pathol. Lab. Med. 132 (3): 397-401. PMID 18318582. http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=397.
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