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Article/Cases Studies on Desmoplastic Malignant Mesothelioma or Malignant Mesothelioma
Desmoplastic malignant mesothelioma is the growth of fibrous or connective tissues around the tumor of the lining of the lung or chest cavity. The term "desmoplastic" refers to the growth of fibrous or connective tissue. "Desmo-" comes from the Greek "desmos" meaning "a fetter or band" and "-plastic" is also borrowed from the Greek, from "plassein" meaning "to form" = to form a band or fetter
Kannerstein M, Churg J: Desmoplastic diffuse mesothelioma. In: Progress in Surgical Pathology, Vol. II (Fenoglio CM, Wolff M, eds.), New York: Masson Pub., 1980, pp. 19-29.
Machin T, Mashiyama ET, Henderson JAM, McCaughey WTE: Bony metastases in desmoplastic pleural mesothelioma. Thorax 43:155-156, 1988.
Hillerdal G: Malignant mesothelioma 1982: Review of 4710 published cases. Br J Dis Chest 77:321-343, 1983.
McCaughey Wte: Criteria for diagnosis of diffuse mesothelial tumors. Ann NY Acad Sci 132:603-613, 1965.
Adams VI, Unni KK, Muhm JR, Jett JR, Ilstrup DM, Bernatz PE: Diffuse malignant mesothelioma of pleura: Diagnosis and survival in 92 cases. Cancer 58:1540-1551, 1986.
Obers VJ, Leiman G, Girdwood RW, Spiro FI: Primary malignant pleural tumors (mesothelioma) presenting as localized masses: Fine needle aspiration cytologic findings, clinical and radiologic features and review of the literature. Acta Cytolog 32:567-575, 1988.
Solomons K, Polakow R, Marchand P: Diffuse malignant mesothelioma presenting as bilateral malignant lymphangitis. Thorax 40:682-683, 1985.
Alexander E, Clark RA, Colley DP, Mitchell SE: CT of malignant pleural mesothlioma. AJR 137:287-291, 1981.
Mirvis S, Dutcher JP, Haney PJ, Whitley NO, Aisner J: CT of malignant pleural mesothelioma. AJR 140:665-670, 1983.
Lorigan JG, Libshitz HI: MR imaging of malignant pleural mesothelioma. J Comput Asst Tomogr 13:617-620, 1989.
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Whitaker D, Shilkin KB: Diagnosis of pleural malignant mesothelioma in life: A practical approach. J Pathol 143:147-175, 1984.
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The onset of pleural diffuse malignant mesothelioma is usually insidious. Chest pain and dyspnea are the most frequent initial complaints; cough, weight loss, and asthenia tend to develop somewhat later. Infrequently, diffuse malignant mesothelioma may present as recurrent pneumothorax. (Situnayake RD, Middleton WG.
Recurrent pneumothorax and malignant pleural mesothelioma. RespirMed 1991;85:255-6.) , miliary dissemination in the absence of clinically identifiable pleural- based tumor. (Musk AW, Dewar J, Shilkin KB, Whitaker D. Miliary spread of malignant pleural mesothelioma without a clinically identifiable pleural tumor. Aust NZ J Med 1991;21:460-2.) , or enlargement of ipsilateral supraclavicular lymph nodes (Sussman J, Rosai J. Lymph node metastasis as the initial manifestation of malignant mesothelioma: report of six cases. Am J Surg Pathol 1990;14:819-28.)
The most distressing symptom as the disease progresses is pain due to infiltration of the chest wall. The pain is often of an aching, nonpleuritic type and may be referred to the abdomen or shoulder. Evidence of pleural effusion is the most frequent finding on initial physical and radiographic examination.
(Legha SS, Muggia FM.
Pleural mesotheliomas. Clinical features and therapeutic implications. Ann Intern Med 1977;87:613-21.) , and a small proportion of diffuse malignant mesotheliomas are preceded for periods ranging from 1 to 7 years by recurrent pleural effusions. Close to 10 percent of patients have radiologic evidence of tumor without effusion.
Asbestos workers may have recurrent pleural effusions with associated fibrous pleurisy (asbestos pleurisy) in the absence of any tumor. (Gaensler EA, Kaplan AI. Asbestos pleural effusion. Ann Int Med 1971;74:178-91.) Chest roentgenogram and computerized tomographic (CT) scan may show a diffusely nodular or irregularly thickened pleura , hilar or mediastinal masses, or masses of apparent pulmonary origin. (Heller RM, Janower ML, Weber AL. The radiological manifestations of malignant pleural mesothelioma. Am J Roentgenol 1970;108:53-9.) .
The radiologic appearance may change markedly within a short time . Radiologic evidence of asbestosis is uncommon, whereas pleural plaques are seen quite frequently. Effusions are often blood stained, and may be massive and require frequent tapping.
They tend to disappear in the later stages of the disease with advancing neoplastic thickening of the pleura and obliteration of the pleural cavity. Contraction of the affected hemithorax often occurs in the late stages, with pulling of the mediastinal structures to the affected side.
Subcutaneous tumor nodules may appear in the chest wall, especially in relation to aspiration needle or thoracoscopy tracts and thoracotomy scars The tumor may occasionally present as a mass in the chest wall or mimic Pancoast's tumor.
Tumors of the Serosal Membranes.
Battifora H, McCaughey WT. Tumors of the serosal membranes.
Atlas of Tumor Pathology, 3rd Series Fascicle 15.
Washington, D.C., Armed Forces Institute of Pathology, 1995.
key words: AFIP, serosa, peritoneum, peritoneal, pleura, pleural
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68658
Nodules of fibrous tumor sometimes infiltrate alveolar spaces in the adjacent lung or the soft tissues of the chest wall. In most instances, cellular areas with sarcomatous characteristics can be found in parts of the tumor, although a careful search is sometimes necessary.
In about one third of cases, epithelial- type tumor elements, usually of tubular or papillary form, are seen at least focally and may be accompanied by obvious sarcomatous areas. Zones of bland infarct-like necrosis are quite common. As such zones are rarely seen in inflammatory fibrosis, they help to distinguish desmoplastic mesothelioma from fibrous pleurisy.
It has been suggested that the most cellular tissue found in desmoplastic mesothelioma is at the mediastinal aspect of the pleura. (Henderson DW, Shilkin KB, Whitaker D, et al. Unusual histological types and anatomic sites of mesothelioma. In: Henderson DW, Shilkin KB, Langlois SL, Whitaker D, eds.
Malignant mesothelioma. New York: Hemisphere Publishing, 1992:140-63.) A feature frequently seen in desmoplastic mesothelioma and rarely, if ever, in fibrosing pleuritis is focal invasion into the underlying pulmonary parenchyma along interlobular septa and fissures and into subserosal adipose tissue in the parietal pleura . Such areas of focal invasion may be made apparent by immunostaining with antibodies to low molecular weight cytokeratins . (Battifora H. The pleura. In: Sternberg SS, ed. Diagnostic surgical pathology. New York: Raven Press, 1989:829-55.)
Nonetheless, even when abundant decortication material is available, and numerous samples are taken, confident differentiation between desmoplastic mesothelioma and fibrous pleurisy may be difficult or impossible.
It should be remembered that there are many causes of benign diffuse pleural fibrosis, one of which is asbestos. (Gaensler EA, Kaplan AI. Asbestos pleural effusion. Ann Int Med 1971;74:178-91.) Asbestos is also the main cause of the discrete fibrous plaques that are frequently seen on the parietal pleura in persons exposed to asbestos.
Tumors of the Serosal Membranes.
Battifora H, McCaughey WT. Tumors of the serosal membranes.
Atlas of Tumor Pathology, 3rd Series Fascicle 15.
Washington, D.C., Armed Forces Institute of Pathology, 1995.
key words: AFIP, serosa, peritoneum, peritoneal, pleura, pleural
Packet No.: 4
68659
In cases in which only small biopsy specimens are available, localized malignant fibrous tumors of the pleura (so-called malignant localized mesothelioma) may enter into the differential diagnosis because of the dense fibrosis that occurs in some of them.
Immunostaining for low molecular weight keratins helps in diagnosis since desmoplastic mesotheliomas nearly always express keratin, whereas benign localized fibrous tumors do not. Ultrastructurally, desmoplastic mesothelioma is similar to conventional sarcomatoid mesothelioma, but with more cells with the appearance of myofibroblasts. (d'Andiran G, Gabbiani GA. Metastasizing sarcoma of the pleura composed of myofibroblasts. In: Fenoglio CM, Woolf M, eds. Progress in surgical pathology. New York: Masson Publishing, 1980:34-40.)
However, the frequent expression of cytokeratins by the cells of desmoplastic mesothelioma sets them apart from myofibroblasts. (Battifora H. The pleura. In: Sternberg SS, ed. Diagnostic surgical pathology. New York: Raven Press, 1989:829-55.) .
Tumors of the Serosal Membranes.
Battifora H, McCaughey WT. Tumors of the serosal membranes.
Atlas of Tumor Pathology, 3rd Series Fascicle 15.
Washington, D.C., Armed Forces Institute of Pathology, 1995.
key words: AFIP, serosa, peritoneum, peritoneal, pleura, pleural.
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