Pseudocarcinomatous Mesothelioma: A Hitherto Unreported Presentation closely simulating primary lung cancer

Malignant mesothelioma (MM) has a wide range of clinical, radiologic, and pathologic presentations, mimicking lung cancer or interstitial lung diseases when predominantly involving the lung parenchyma. The case herein refers to a 79-year-old man, active smoker without asbestos exposure, incidentally discovered to have a pulmonary nodule in the right upper lobe (1.5 cm). The lesion was misinterpreted as primary lung adenocarcinoma at the frozen section in light of the predominant lepidic growth pattern. Definitive examination confirmed neoplastic proliferation along alveolar structures. However, the unusual globous shape of tumor cells along the alveoli abruptly merging with normal pneumocytes prompted us to perform some immunostains that surprisingly revealed a mesothelial differentiation (positive staining with calretinin, cytokeratins (CK5/6), D2-40, and negativity with BRCA-associated protein 1 (BAP1), Thyroid Transcription Factor 1 [TTF-1], claudin-4, carcinoembryonic antigen [CEA], and napsin). MM represents the pathologic counterpart of so-called pseudomesotheliomatous carcinoma, since it appears as a localized pulmonary neoplastic nodule displaying a predominant lepidic growth pattern (pseudocarcinomatous mesothelioma). The challenging diagnostic features of this unique case and a review of similar cases in the literature are discussed.

Download Full-text

Challenge of treating cancer amid the COVID-19 pandemic: case of skeletal muscle metastasis from primary carcinoma of the lung mistaken as sarcoma

10.21203/rs.3.rs-88875/v1 ◽

2020 ◽

Author(s):

Maria Gloria Elisha Casas ◽

Mamer Rosario ◽

Geoffrey Battad ◽

Adrienne Camille Mercado ◽

Trisha Ann Hermogenes ◽

...

Keyword(s):

Lung Cancer ◽

Skeletal Muscle ◽

Radial Nerve ◽

Frozen Section ◽

Tumor Resection ◽

Primary Lung Cancer ◽

Histopathological Analysis ◽

Intraoperative Frozen Section ◽

Skeletal Muscle Metastasis ◽

Muscle Metastasis

Abstract Background. The authors report on an extremely rare case of skeletal muscle metastasis from primary lung cancer that involved the radial nerve and humerus, which was “overtreated” with wide tumor resection and frozen autograft reconstruction upon misdiagnosis of sarcoma by intraoperative frozen section, amid pressure of expediting hospital care during the COVID-19 pandemic. Case presentation. A 61-year-old male living outside Metro Manila presented with painful mass in his left distal arm during the enhanced community quarantine, and requested admission upon testing negative for COVID-19. Imaging studies suggested a diagnosis of soft tissue sarcoma involving the radial nerve and humerus, and intending to prevent nosocomial SARS-CoV-2 infection of patient, treatment was expedited by foregoing biopsy and opting for intraoperative frozen section prior to resection. Frozen section findings suggested malignancy intraoperatively, and we proceeded with wide tumor resection and frozen autograft reconstruction of the humerus using plates and screws. However, permanent sections revealed metastatic carcinoma from primary non-small cell lung cancer, with PET scan confirming lung mass in the right apical lobe. Conclusion. The report concludes that establishment of a definite tumor diagnosis by final histopathological analysis is indispensable, even when planning for emergent surgery in the time of COVID-19 pandemic.

Download Full-text

Does multiplicity of synchronous multiple lung primaries (SMLPs) affect prognosis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e20530 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e20530-e20530

Author(s):

RuoBing Xue ◽

Satish Maharaj ◽

Rohit Kumar ◽

Goetz H. Kloecker

Keyword(s):

Lung Cancer ◽

Adjuvant Therapy ◽

Early Stage ◽

Primary Lung Cancer ◽

Case Series ◽

Current Recommendation ◽

Lung Cancers ◽

T Stage ◽

Wide Range ◽

Common Risk Factors

e20530 Background: SMLPs are detected more commonly due to advancements in screening technology. Their workup and classification; however, are still lacking a clear standard. T stage of the largest lesion has been used as the major prognostic marker. This; however, does not take the number of SMLPs and their genomic drivers into consideration. This study aims to identify and review common risk factors associated with SMLPs and determine whether the number of primaries influence the prognosis. Methods: A systematic review of the literature published between 2000 and 2021 was conducted through PubMed and Medline by using the combination of keywords, including: “synchronous multiple primary lung cancer”, “simultaneous multifocal lung cancer”, “synchronous solitary lung metastasis”, “risk factor” and “prognosis”. A total of fifty studies were identified, among them only sixteen retrospective research articles and two review articles were relevant to the study at hand. Results: Sixteen retrospective studies including a total of 1685 eligible patients were reviewed. Thirteen of these studies reported the main histology type to be adenocarcinoma with a ratio ranging from 35% to 96.8%. Eight studies have reported the numbers of synchronous primary lung cancers, including one study found 11 SMLPs. Among these, one study by van Rens found number of SMLPs impact prognosis adversely compared to a single lung cancer. However, three other studies demonstrated multiple SMPLs do not adversely affect survival (Finley et al, 2010; Kocaturk et al, 2011; Li et al, 2020). Four of the sixteen studies analysed the effect of multiple lobes involvement and distance between tumors, with varying conclusions; two studies reported no difference in prognosis while one study revealed worse survival with multiple lobe involvement and one study found favorable outcome. Most studies confirm the usual prognostic factors for SMLPs, including: gender, smoking, type of surgery, comorbidities and adjuvant therapy. The median 5 year OS reported for SMLPs is 66%, with a wide range from 19% to 95.8%.The 3 year OS is 75% in most studies. Conclusions: The data on how the number of SMLPs affects the prognosis is uncertain. The current recommendation to base the decision for adjuvant therapy on the highest T stage is not supported by prospective evidence or consistent among published case series. Considering the recent approval of targeted therapies in early stage lung cancers, a better prognostic scoring system for SMLPs is required.

Download Full-text

Pulmonary Endogenous Fluorescence Allows the Distinction of Primary Lung Cancer from the Perilesional Lung Parenchyma

PLoS ONE ◽

10.1371/journal.pone.0134559 ◽

2015 ◽

Vol 10 (8) ◽

pp. e0134559 ◽

Cited By ~ 3

Author(s):

Lucile Gust ◽

Alexis Toullec ◽

Charlotte Benoit ◽

René Farcy ◽

Stéphane Garcia ◽

...

Keyword(s):

Lung Cancer ◽

Primary Lung Cancer ◽

Lung Parenchyma ◽

Endogenous Fluorescence

Download Full-text

P-141 * INTERSTITIAL GROWTH PATTERN AS ONE OF THE INDICATORS OF MALIGNANCY IN PRIMARY LUNG CANCER

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivu167.141 ◽

2014 ◽

Vol 18 (suppl 1) ◽

pp. S37-S37

Author(s):

S. Suzuki ◽

G. Ishii ◽

K. Aokage ◽

T. Hishida ◽

J. Yoshida ◽

...

Keyword(s):

Lung Cancer ◽

Growth Pattern ◽

Primary Lung Cancer ◽

Interstitial Growth

Download Full-text

Surgical treatment of pulmonary metastases in the Netherlands: data from the Dutch Lung Cancer Audit for Surgery

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa090 ◽

2020 ◽

Vol 58 (4) ◽

pp. 768-774 ◽

Cited By ~ 4

Author(s):

Martijn van Dorp ◽

Naomi Beck ◽

Willem Hans Steup ◽

Wilhelmina Hendrika Schreurs

Keyword(s):

Lung Cancer ◽

Surgical Treatment ◽

The Netherlands ◽

Current Practice ◽

Pulmonary Metastases ◽

Primary Lung Cancer ◽

Postoperative Mortality ◽

Hospital Variation ◽

Wide Range ◽

Complicated Course

Abstract OBJECTIVES Surgical resection is widely employed as a potential curative treatment option for patients with limited lung metastases originating from a wide range of primary tumours. However, there are no clear national or international practice guidelines and, thereby, the risk for potential practice variation exists. This study aims to define the current practice for the surgical treatment of pulmonary metastases in the Netherlands by using data from the Dutch Lung Cancer Audit for Surgery (DLCA-S). METHODS Data from the DLCA-S were used to analyse patients undergoing a parenchymal lung resection for the treatment of pulmonary metastases between 2012 and 2017. Volume of metastasectomies per hospital was calculated as a proportion of the volume of primary lung cancer resection. Studied outcomes were overall complications and postoperative mortality and complicated course. For the latter, both the national average and between-hospital variation were calculated. RESULTS A total of 2090 patients, distributed over 45 Dutch hospitals, were included for analysis. The most common primary cancer was colorectal carcinoma (N = 1087, 52.0%) followed by the urogenital carcinoma (N = 296, 14.2%). The most common type of parenchymal resection was a wedge resection (N = 1477, 70.7%) followed by a lobectomy (N = 424, 20.3%). Resection was performed minimally invasively in 1548 patients (74.1%) with a conversion rate of 3.8%. Resection of a solitary metastasis was performed in 1663 patients (79.6%). In 40 patients (1.9%), 4 or more metastases were resected. A postoperative complicated course was noted in 3.6%, and the 30-day mortality rate was 0.7%. The variety between hospitals in the volume of metastasectomies in proportion to the volume of primary lung cancer resections was 3.4–41.5%. CONCLUSIONS This analysis of the DLCA-S registry provides a unique insight into current practice on pulmonary metastasectomies in the Netherlands over a 6-year period. The rate of postoperative adverse outcome was limited, and the morbidity and mortality were lower compared to primary lung cancer resections in the DLCA-S database.

Download Full-text

Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020591 ◽

2020 ◽

Vol 17 (2) ◽

pp. 591 ◽

Cited By ~ 2

Author(s):

Anna Suraya ◽

Dennis Nowak ◽

Astrid Widajati Sulistomo ◽

Aziza Ghanie Icksan ◽

Elisna Syahruddin ◽

...

Keyword(s):

Lung Cancer ◽

Case Control Study ◽

Risk Model ◽

Asbestos Exposure ◽

Primary Lung Cancer ◽

Case Control ◽

Mean Value ◽

Primary Data ◽

Primary Data Analysis ◽

Control Study

Indonesia has limited data on asbestos-related diseases despite abundant use. This study investigated the risk of occupational asbestos exposure for lung cancer development, utilizing a hospital-based case-control study. Subjects were patients who received a thoracic CT scan at Persahabatan Hospital, Jakarta. The cases had primary lung cancer confirmed by histology, the controls were negative for lung cancer. The cumulative occupational asbestos exposure was calculated by multiplying the exposure intensity by the years of exposure. The exposure intensity was obtained by adopting the weighted arithmetic mean value of asbestos exposure from a job-exposure matrix developed in Korea. The primary data analysis was based on logistic regression. The study included 696 subjects, with 336 cases and 360 controls. The chance of lung cancer for subjects exposed to asbestos was doubled (OR = 2.04, 95% CI = 1.21–3.42) compared with unexposed, and subjects with a cumulative asbestos exposure of 10 fiber-years or more even showed an OR of 3.08 (95% CI = 1.01–9.46). The OR of the combined effect between smoking and asbestos was 8.7 (95% CI = 1.71–44.39); the interaction was consistent with an additive and multiplicative risk model. Asbestos exposure is associated with a higher chance of lung cancer. Improved policies are needed to protect the population from asbestos hazards.

Download Full-text

Asbestos Exposure Among Primary Lung Cancer Patients In Japan

10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a1732 ◽

2010 ◽

Author(s):

Narufumi Suganuma ◽

Akihiko Tamura ◽

Mitsuhiko Funakoshi ◽

Kichinori Hasegawa ◽

Atsushi Ishimine ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Asbestos Exposure ◽

Primary Lung Cancer ◽

Lung Cancer Patients

Download Full-text

Interstitial growth as an aggressive growth pattern in primary lung cancer

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-016-2168-6 ◽

2016 ◽

Vol 142 (7) ◽

pp. 1591-1598 ◽

Cited By ~ 2

Author(s):

Shigeki Suzuki ◽

Keiju Aokage ◽

Tomoyuki Hishida ◽

Junji Yoshida ◽

Takeshi Kuwata ◽

...

Keyword(s):

Lung Cancer ◽

Growth Pattern ◽

Primary Lung Cancer ◽

Interstitial Growth

Download Full-text

Asbestos-related diseases

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0645 ◽

2020 ◽

Vol 24 (6) ◽

pp. 562-567 ◽

Cited By ~ 2

Author(s):

A. W. Musk ◽

N. de Klerk ◽

A. Reid ◽

J. Hui ◽

P. Franklin ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Asbestos Exposure ◽

Lung Parenchyma ◽

Lung Compliance ◽

Pleural Diseases ◽

Pleural Plaques ◽

Pleural Fibrosis ◽

Benign Pleural Effusion ◽

Low Dose Computed Tomography

Knowledge of asbestos-related diseases has been accumulating for over one hundred years as the industrial value of asbestos was recognised for the strength of its fibres and their resistance to destruction, resulting in increasing production and use until the multiple health effects have become apparent. Deposition in the lung parenchyma results in an inflammatory/progressively fibrotic response, with impaired gas exchange and reduced lung compliance (‘asbestosis'), causing progressive dyspnoea and respiratory failure for which only palliation is indicated, although anti-fibrotic agents used for idiopathic usual interstitial pneumonitis remain to be evaluated. Benign pleural effusion, diffuse pleural fibrosis (occasionally with associated rolled atelectasis) and pleural plaques are the non-malignant pleural diseases that result from fibres reaching the pleura. But the main issues that led to the ban on asbestos in industry are those of malignancy: lung cancer, malignant mesothelioma (MM) of the pleura and MM of the peritoneum. Bronchogenic carcinoma risk from asbestos exposure is dose-dependent and multiplies the risk attributable to tobacco smoking. The principles of treatment are as for all cases of lung cancer. Low-dose computed tomography screening of exposed people can detect early-stage, non-small cell cancers, with improved survival. The amphibole varieties of asbestos are much more potent causes of MM than chrysotile, and the risk increases exponentially for 40–50 years following first exposure. As MM is non-resectable and poorly responsive to chemotherapy and radiotherapy, curative treatment is not possible and screening not justified.

Download Full-text