Sarcomatoid Mesothelioma: A Clinicopathological and Immunohistochemical Study of 64 Cases

Sixty-four cases of sarcomatoid pleural mesothelioma represent the basis of this study. The patients are 51 men and 13 women between the ages of 42 and 79 years, who presented with symptoms of chest pain, cough, and weight loss. Diagnostic imaging showed the presence of diffuse pleural thickening with encasement of the lung parenchyma in all the cases. All patients had surgical resection via extrapleural pneumonectomy. By immunohistochemistry, all cases were positive for cytokeratin AE1/AE3; however, reactivity with other markers including keratin 5/6, calretinin, and D2-40 was seen in different proportions, whereas a few cases showed positive staining for GATA3, WT1, and p40. All tumors were negative for carcinomatous epitopes (carcinoembryonic antigen, CD15, and TTF1). Our findings show that even though the use of immunohistochemical stains plays an important role in the final interpretation, the best results are accomplished by a global interpretation of clinical, radiographical, and immunohistochemical findings. It is also important to highlight that it does not seem to be a single immunohistochemical stain that is pathognomonic of sarcomatoid mesothelioma and that some other stains that are commonly used for other tumors may also show positive staining in a small percentage of sarcomatoid mesotheliomas.

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Clinical consequences of asbestos-related diffuse pleural thickening: A review

Journal of Occupational Medicine and Toxicology ◽

10.1186/1745-6673-3-20 ◽

2008 ◽

Vol 3 (1) ◽

pp. 20 ◽

Cited By ~ 37

Author(s):

Susan E Miles ◽

Alessandra Sandrini ◽

Anthony R Johnson ◽

Deborah H Yates

Keyword(s):

Pleural Thickening ◽

Diffuse Pleural Thickening ◽

Clinical Consequences

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Yellow Nail Syndrome with Bilateral Pleural Plaques and Diffuse Pleural Thickening: A Mimic of Asbestos Related Disease

Case Reports in Pulmonology ◽

10.1155/2018/7302898 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Adam Dallmann ◽

Richard L. Attanoos

Keyword(s):

Asbestos Exposure ◽

Electron Microscopic ◽

Yellow Nail Syndrome ◽

Pleural Thickening ◽

Pleural Plaques ◽

Pulmonary Manifestations ◽

Diffuse Pleural Thickening ◽

Mineral Fibre ◽

Asbestos Related Disease ◽

Fibre Analysis

Yellow nail syndrome is a rare acquired condition of unknown aetiology associated with distinct nail discolouration/xanthonychia, pulmonary manifestations, and lymphoedema. Pleural plaques and diffuse pleural thickening are typically, although not exclusively, recognised as markers of prior commercial asbestos exposure. The presence of such biomarkers may assist an asbestos personal injury evaluation. A postmortem examination performed on a 72-year-old man with known long-standing yellow nail syndrome identified pleural plaques and diffuse pleural thickening. An evaluation of the occupational history identified no known asbestos exposure. Electron microscopic mineral fibre analysis detected no asbestos fibres. To the best of our knowledge, this is the only case of yellow nail syndrome in which these benign pleural changes are reported ex asbestos. Alternate causes for such pleural pathology were absent. There is merit in physicians and pathologists having an awareness of these new manifestations when considering claimed asbestos related changes during life and at postmortem.

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P206 Asbestos related diffuse pleural thickening; Likelihood of progression in the secondary care setting: Abstract P206 Table 1.

Thorax ◽

10.1136/thoraxjnl-2013-204457.358 ◽

2013 ◽

Vol 68 (Suppl 3) ◽

pp. A169.1-A169

Author(s):

JL Hoyle ◽

S Gudur

Keyword(s):

Secondary Care ◽

Care Setting ◽

Pleural Thickening ◽

Diffuse Pleural Thickening ◽

Secondary Care Setting

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Development, radiological zone patterns, and importance of diffuse pleural thickening in relation to occupational exposure to asbestos.

Occupational and Environmental Medicine ◽

10.1136/oem.44.10.673 ◽

1987 ◽

Vol 44 (10) ◽

pp. 673-681

Author(s):

H Bohlig ◽

A Calavrezos

Keyword(s):

Occupational Exposure ◽

Pleural Thickening ◽

Diffuse Pleural Thickening

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Occupational lung disease

10.1093/med/9780199568741.003.0142 ◽

2018 ◽

Author(s):

Paul Cullinan ◽

Joanna Szram

Keyword(s):

Occupational Asthma ◽

Toxic Exposure ◽

Allergic Alveolitis ◽

Lung Cancers ◽

Pleural Diseases ◽

Pleural Thickening ◽

Occupational Lung Disease ◽

Pleural Plaques ◽

Diffuse Pleural Thickening ◽

The Many

Some occupational lung diseases are defined by their clinical or pathological nature (e.g. occupational asthma or mesothelioma), while others are defined by their specific etiology (e.g. silicosis, farmer’s lung). Most fall into one of three categories. The first is airways disease, including occupational asthma (induced by a workplace agent), work-exacerbated asthma (preexisting asthma provoked by one or more agents at work), and irritant-induced asthma (initiated by a single, toxic exposure to a respiratory irritant); COPD and obliterative bronchiolitis may arise from workplace exposures, and around 10% of lung cancers have an occupational etiology. The second is parenchymal diseases, incorporating the many types of pneumoconiosis, differentiated by the dust that caused them, and the many types of extrinsic allergic alveolitis (or hypersensitivity pneumonia) categorized by the occupations in which they arise. The third is pleural diseases comprising pleural plaques, diffuse pleural thickening, and mesothelioma.

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Determinants of restrictive lung function in asbestos-induced pleural fibrosis

Journal of Applied Physiology ◽

10.1152/jappl.1990.68.5.1932 ◽

1990 ◽

Vol 68 (5) ◽

pp. 1932-1937 ◽

Cited By ~ 40

Author(s):

D. A. Schwartz ◽

J. R. Galvin ◽

C. S. Dayton ◽

W. Stanford ◽

J. A. Merchant ◽

...

Keyword(s):

Lung Function ◽

Sheet Metal ◽

Forced Vital Capacity ◽

Vital Capacity ◽

Pleural Thickening ◽

Metal Workers ◽

Pleural Fibrosis ◽

Diffuse Pleural Thickening ◽

Parenchymal Injury ◽

Restrictive Lung Function

We evaluated whether restrictive lung function among asbestos-exposed individuals with pleural fibrosis was caused by radiographically inapparent parenchymal inflammation and/or parenchymal fibrosis. All 24 study participants were sheet metal workers who were nonsmokers with normal parenchyma on posteroanterior chest radiograph. These subjects had either normal pleura (n = 7), circumscribed plaques (n = 9), or diffuse pleural thickening (n = 8). After controlling for age, years in the trade, and pack-years of smoking, we found that sheet metal workers with diffuse pleural thickening had a lower forced vital capacity (P less than 0.001), total lung capacity (P less than 0.01), and CO-diffusing capacity of the lung (P less than 0.05) than those with normal pleura. Similarly, sheet metal workers with circumscribed plaques were found to have a reduced forced vital capacity; however, because of the small number of study subjects, this difference (regression coefficient = -11.0) was only marginally significant (P = 0.06). Although circumscribed plaque and diffuse pleural thickening were both associated with a lymphocytic alveolitis and a higher prevalence of parenchymal fibrosis on high-resolution computerized tomography (HRCT) scan, neither a lymphocytic alveolitis nor the finding of parenchymal fibrosis on HRCT scan influenced the relationship between pleural fibrosis and restrictive lung function. We conclude that pleural fibrosis is associated with restrictive lung function and abnormally low diffusion that appears to be independent of our measures of parenchymal injury (chest X-ray, bronchoalveolar lavage, and HRCT scan).(ABSTRACT TRUNCATED AT 250 WORDS)

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