Invasion of the Chest Wall by Mesothelioma Cells

Invasion of the Chest Wall by Mesothelioma Cells

Another interesting study is called, “The clinical importance of magnetic resonance imaging versus computed tomography in malignant pleural mesothelioma.” – Lung Cancer. 1998 Dec;22(3):215-25 by Knuuttila A, Halme M, Kivisaari L, Kivisaari A, Salo J, Mattson K. Department of Medicine, Helsinki University Central Hospital, Finland.  Here is an excerpt: “Abstract – There is no standard therapy for malignant pleural mesothelioma (MPM), but recent reports have shown that extensive surgery combined with chemo – and radiotherapy prolongs the survival of selected patients with early stage disease. This emphasises the need for accurate staging procedures at diagnosis and reliable imaging methods to assess response to treatment. Computed tomography (CT) of the chest has been the standard imaging method for these purposes for the last decade, but it is limited in its ability to demonstrate accurately the platelike growth pattern of MPM within the thorax due to the partial volume effect on curved surfaces. In order to define the value of magnetic resonance imaging (MRI) in the imaging of MPM, we have compared the findings from 26 parallel paired CT and MRI scans of mesothelioma patients at various stages of the disease. MRI showed tumour spread into the interlobar fissures, tumour invasion of the diaphragm and through the diaphragm, and invasion of bony structures better than CT. Invasion of the chest wall and mediastinal soft tissue and tumour growth into the lung parenchyma were equally well seen on both imaging methods. CT was better for detecting the inactive pleural calcifications. MRI is a sensitive detector of the characteristic growth pattern and extension of MPM and we recommend its use more widely for the clinical management of MPM especially when evaluating tumour resectability and in research protocols when an accurate evaluation of disease extent is essential.”

Another study is called, “Thick cell membranes revealed by immunocytochemical staining: A clue to the diagnosis of Mesothelioma” by Anthony Y. Leong M.D., M.B., F.R.C.P.A., F.R.C.Path, F.C.A.P., Richard Parkinson, James Milios H.T. – Diagnostic Cytopathology – Volume 6, Issue 1, pages 9–13, January 1990.  Here is an excerpt: “
Abstract – The distinction of malignant mesothelioma from metastatic adenocarcinoma in pleural effusions and biopsies is frequently a diagnostic problem. Immunocytochemical staining of 13 malignant mesotheliomas, eight primary adenocarcinomas of the lung, five metastatic adenocarcinomas of the lung, and 20 primary adenocarcinomas in extrapulmonary sites with a monoclonal antibody to epithelial membrane antigen (EMA) revealed ‘thick’ cell membranes in all cases of mesothelioma. This distinctive pattern of staining was seen in the periphery of cell clusters and circumferentially around individual cells in cytologic preparations, cell blocks, and tissue sections. Intracel-Mar and intercellular acini were also outlined by anti-EMA, and long intraluminal microvillous projections were demonstrated. Weak cytoplasmic staining was only rarely seen in mesothelioma cells. This membranous staining pattern was not observed in adenocarcinomas, which displayed strong and diffuse cytoplasmic staining. The immunocytochemical demonstration of thick and spiky membranes circumferentially disposed around individual cells corresponds to aberrant microvilli, a diagnostic clue in the recognition of malignant mesothelioma.”

Another interesting study is called, “Malignant Peritoneal Mesothelioma in Women: A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis” by Patricia M. Baker, MD; Philip B. Clement, MD; Robert H. Young, MD – From American Journal of Clinical Pathology.  Here is an excerpt: “Abstract – Seventy-five malignant mesotheliomas of the peritoneum in women were reviewed to highlight their morphologic spectrum. The patients ranged from 17 to 92 (mean, 47.4) years of age. The clinical presentation was usually abdominal or pelvic pain, abdominal swelling (sometimes due to ascites), or a pelvic mass. On microscopic examination, the majority of the tumors had only an epithelial morphology, but 4 were biphasic and 1 was sarcomatoid. The most common epithelial patterns were tubular and papillary (which often coexisted), but 5 tumors were purely diffuse; 2 had cells with abundant glassy eosinophilic cytoplasm (so-called deciduoid mesothelioma). The cells in the tubular and papillary patterns were generally cuboidal with scant to moderate amounts of eosinophilic cytoplasm. Nuclear atypia was usually only mild, although a minority of cases had moderate or even, occasionally, severe atypia. Many tumors had foci that, viewed in isolation, resembled so-called well-differentiated papillary mesothelioma, and accordingly that diagnosis should be made cautiously. Unusual features were lymphoid follicles (13 cases), striking myxoid stroma (5 cases), prominent foamy histiocytes (5 cases), and a striking vascular proliferation (1 case). The varied morphology of peritoneal malignant mesotheliomas may raise a broad differential diagnosis, but in most cases the resemblance to other tumors is limited. Histochemistry, immunohistochemistry, and electron microscopy may provide important aid, particularly when tissue is limited, but should be needed only occasionally.”

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

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