Symptoms of Mesothelioma

One interesting study is called, Impact of lymph node metastasis on outcome after extrapleural pneumonectomy for malignant pleural Mesothelioma by Marc de Perrot, MD, Karl Uy, MD, Masaki Anraku, MD, Ming S. Tsao, MD, Gail Darling, MD, Thomas K. Waddell, MD, Andrew F. Pierre, MD, Andrea Bezjak, MD, Shaf Keshavjee, MD, Michael R. Johnston, MD – Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Canada – General Thoracic Surgery J Thorac Cardiovasc Surg 2007;133:111-116. Here is an excerpt: OBJECTIVES: Extrapleural pneumonectomy is a therapeutic option for selected patients with malignant pleural mesothelioma. The impact of lymph node metastasis on the site of recurrence and the role of mediastinoscopy in the selection of patients for extrapleural pneumonectomy, however, remain unclear. METHODS: We reviewed 50 consecutive patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma in our institution between January 1993 and March 2005. RESULTS: The median survival was 11 months, with a 3-year survival of 24%. Survival was significantly worse for patients with N2 disease than for those with no lymph node metastasis (median survival 10 months vs 29 months, respectively, P = .005). Patient sex, histologic cell type, stage, and N2 disease, but not mediastinoscopy, had significant impacts on survival according to univariate analysis. In a multivariate analysis, however, only the presence of N2 disease remained a significant predictor of poor outcome. The proportion of patients with N2 disease and the long-term survival was similar regardless of whether preoperative mediastinoscopy yielded a negative result. The initial site of recurrence was determined in 28 patients (locoregional in 10 and distant in 18). The presence of N2 disease had no impact on the site of recurrence. Adjuvant hemithoracic radiation therapy, however, significantly decreased the risk of locoregional recurrence.

CONCLUSIONS: The presence of N2 disease negatively affects the prognosis of patients with malignant pleural mesothelioma. Mediastinoscopy, however, seems to have a limited role in patient selection for extrapleural pneumonectomy. Adjuvant hemithoracic radiation therapy but not N2 disease affects the risk of locoregional recurrence.

Another interesting study is called, Malignant mesothelioma: cytologic diagnosis with histologic, immunohistochemical, and ultrastructural correlation. by Leong AS, Stevens MW, Mukherjee TM – Division of Tissue Pathology, Institute of Medical and Veterinary Science, Adelaide, South Australia. – Seminars in Diagnostic Pathology 1992, 9(2):141-50. Here is an excerpt: Abstract – The differential diagnoses of malignant mesothelioma in serous effusions include adenocarcinoma and reactive mesothelial cells. While several cytologic features are of predictive value in separating these entities, immunostaining and ultrastructural examination are important adjuncts that increase the diagnostic yield. Many of the cytomorphologic features can be correlated with immunohistochemical and ultrastructural findings. Most important among these is the ultrastructural demonstration of long, often branching microvillous processes in malignant mesothelial cells. Corresponding microvilli can be visualized by immunostaining for epithelial membrane antigen in both cell block preparations from effusions and biopsy specimens, allowing the identification of malignant mesothelioma. In addition, the circumferential distribution of these immunostained microvilli in cells dispersed in stromal connective tissue identifies them as malignant mesothelial cells, corresponding to the ultrastructural appearance of aberrant microvilli, which project through deficiencies in the basal lamina. These microvilli show interdigitation with stromal collagen fibers, a phenomena not observed in adenocarcinoma.

Another study is called, Carcinoembryonic antigen and milk-fat globule protein staining of malignant mesothelioma and adenocarcinoma of the lung. By Tron V, Wright JL, Churg A. Arch Pathol Lab Med. 1987 Mar;111(3):291-3. Here is an excerpt: Abstract – Immunohistologic markers have been of considerable value in differentiating malignant mesothelioma from adenocarcinoma. Recently, staining for milk-fat globule (MFG) protein has been suggested as a useful diagnostic test for this separation, but subsequent reports have been conflicting, with some authors finding clearcut differences, while others showed similar marking of both tumor types. To examine this technique further, we studied lung carcinomas and mesotheliomas with commercially available anti-MFG, and compared these results with those obtained with anticarcinoembryonic antigen (CEA), a commonly used immunomarker of carcinoma. We found that carcinomas showed strong cytoplasmic staining for MFG and CEA; however, a greater percentage of carcinomas were more strongly positive for CEA than for MFG. Mesotheliomas did not, for the most part, stain strongly with either antibody. In addition, carcinomas from different hospitals stained differently for MFG, but not for CEA. We conclude that although strong cytoplasmic staining for MFG is a reasonably reliable indicator of carcinoma, CEA staining provides a better separation and is considerably easier to interpret in lung cancer specimens.

We all owe a debt of gratitude to these fine researchers. If you found any of these excerpts interesting, please read the studies in their entirety.