Immunohistochemical and Ultrastructural Features of Mesothelioma

Immunohistochemical and Ultrastructural Features of Mesothelioma

Another interesting study is called, “Lymph Node Metastasis: as the Initial Manifestation of: Malignant Mesothelioma: Report of Six Cases” by Sussman, Jeffrey M.D.; Rosai, Juan M.D.  Here is an excerpt: “Abstract – We present six cases in which lymphadenopathy was the initial manifestation of malignant mesothelioma. In five cases, the primary tumor was located in the peritoneum; it was located in the pleura in the sixth. The involved lymph nodes were cervical in four cases, mediastinal in one, and inguinal in one. The morphologic, immunohistochemical, and ultrastructural features were typical of malignant epithelial mesothelioma. A review of the literature disclosed only one previously documented example of this phenomenon. When confronted with a lymph node involved by metastatic tumor, pathologists should be aware that malignant mesothelioma can present initially in the form of lymphadenopathy and include this possibility in the differential diagnosis.”

Another interesting study is called, “Induction Chemotherapy, Extrapleural Pneumonectomy, and Postoperative High-Dose Radiotherapy for Locally Advanced Malignant Pleural Mesothelioma: A Phase II Trial” by Flores, Raja M. MD; Krug, Lee M. MD; Rosenzweig, Kenneth E. MD; Venkatraman, Ennapadam PhD; Vincent, Alain BS; Heelan, Robert MD; Akhurst, Tim MD; Rusch, Valerie W. MD – Journal of Thoracic Oncology: May 2006 – Volume 1 – Issue 4 – pp 289-295.  Here is an excerpt: “Abstract – Introduction: Extrapleural pneumonectomy (EPP) and adjuvant high-dose radiation therapy (RT) are associated with a median survival of 3 years in early-stage malignant pleural mesothelioma (MPM) but of less than 1 year in locally advanced disease. Although local control after EPP and RT is excellent, most patients die of distant metastases. We designed this clinical trial to test the feasibility of induction chemotherapy followed by EPP and RT in locally advanced MPM with the ultimate aim of improving survival.

Methods: Patients with MPM and stage III or IV disease were eligible. Induction therapy was four cycles of gemcitabine and cisplatin. Patients without disease progression by computed tomography underwent EPP followed by adjuvant hemithoracic RT (54 cGy).

Results: From January 2002 to January 2004, 21 patients (17 men, four women; median age 60 years) were entered into the study. Histology was epithelioid in 14 patients and mixed or sarcomatoid five patients. Pretreatment disease stage was III in 13 patients and IV in six patients. Nineteen patients received induction chemotherapy. Response to induction therapy was complete in zero patients, partial in five patients, stable disease in six patients, and progression of disease in eight patients. Eight of nine patients undergoing surgical exploration had EPP. The median survival of all patients was 19 months. Patients who had an EPP had a median survival of 33.5 months. Patients with unresectable tumors had a median survival of 9 months (p = 0.01).”

Another interesting study is called, “Prognosis in malignant mesothelioma related to MIB 1 proliferation index and histological subtype.” By Beer TW, Buchanan R, Matthews AW, Stradling R, Pullinger N, Pethybridge RJ. – Department of Histopathology, The Royal Hospital, Haslar, Hampshire, England.  Hum Pathol. 1998 Mar;29(3):246-51.
Here is an excerpt: “Abstract – The aims of this study were to evaluate the use of the proliferation marker MIB 1 and histological subtype as indicators of prognosis in malignant mesothelioma. Sections from 41 cases of malignant mesothelioma were histologically subtyped on hematoxylin and eosin sections and stained immunohistochemically for the proliferation marker MIB 1. A proliferation index was derived and the results compared with patient survival data. A statistically significant difference was found between the survival of patients having a low and high MIB 1 index (P < .001). Patients with tumors having a low MIB 1 index lived significantly longer than those with a high MIB 1 index. Patients with the spindle cell histological subtype of malignant mesothelioma had significantly shorter survival times than those with the epithelioid or mixed tumors (P < .01). The MIB 1 proliferation index and histological tumor subtype are useful markers of prognosis in malignant mesothelioma.”

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


Monty Wrobleski is the author of this article.  For more information please click on the following links

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