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. 1992 Apr;45(4):295–298. doi: 10.1136/jcp.45.4.295

Desmoplastic malignant mesothelioma: a review of 17 cases.

G E Wilson 1, P S Hasleton 1, A K Chatterjee 1
PMCID: PMC495267  PMID: 1577967

Abstract

AIMS: To identify the histological features of desmoplastic mesothelioma, and to determine its incidence and prognosis. METHODS: Two hundred and fifty five cases of malignant mesothelioma were examined over seven years (1982-9) to identify the desmoplastic variant. Sections were cut at 5 microns and stained with haemotoxylin and eosin and with CAM 5.2 (Dakopatts). Asbestos fibre counts were carried out by light microscopy in 14 cases using the potash digestion method. RESULTS: Seventeen cases were identified as desmoplastic mesothelioma giving an incidence of 6.6%. In 11 cases the cell type in more cellular areas was sarcomatous and in six others it was biphasic. The mean survival time from onset of symptoms to death was 5.8 months for the sarcomatous variant and 6.8 months for the biphasic variant. Twelve of 16 patients had had previous occupational exposure to asbestos, ranging from five months to 43 years. The diagnosis of desmoplastic mesothelioma was only accepted if acellular connective tissue comprised 50% or more of the tumour bulk. Also seen was collagen necrosis, anastomosing bands of often hyalinised collagen with a prominent storiform pattern, and where cellular detail was present there were hyperchromatic nuclei. CONCLUSIONS: Desmoplastic mesothelioma is a rare variant of malignant mesothelioma with a storiform collagen pattern, collagen necrosis, bland acellular collagen and focal cytological features of malignancy. Though rare, it is important to recognise this variant and distinguish it from a pleural plaque, nonspecific reactive pleural fibrosis, pleurisy, rheumatoid disease, or, rarely, spindle cell sarcomas.

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Selected References

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  1. Al-Izzi M., Thurlow N. P., Corrin B. Pleural mesothelioma of connective tissue type, localized fibrous tumour of the pleura, and reactive submesothelial hyperplasia. An immunohistochemical comparison. J Pathol. 1989 May;158(1):41–44. doi: 10.1002/path.1711580109. [DOI] [PubMed] [Google Scholar]
  2. Albelda S. M., Epstein D. M., Gefter W. B., Miller W. T. Pleural thickening: its significance and relationship to asbestos dust exposure. Am Rev Respir Dis. 1982 Oct;126(4):621–624. doi: 10.1164/arrd.1982.126.4.621. [DOI] [PubMed] [Google Scholar]
  3. Ashcroft T., Heppleston A. G. The optical and electron microscopic determination of pulmonary asbestos fibre concentration and its relation to the human pathological reaction. J Clin Pathol. 1973 Mar;26(3):224–234. doi: 10.1136/jcp.26.3.224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bolen J. W., Hammar S. P., McNutt M. A. Reactive and neoplastic serosal tissue. A light-microscopic, ultrastructural, and immunocytochemical study. Am J Surg Pathol. 1986 Jan;10(1):34–47. doi: 10.1097/00000478-198601000-00005. [DOI] [PubMed] [Google Scholar]
  5. Briselli M., Mark E. J., Dickersin G. R. Solitary fibrous tumors of the pleura: eight new cases and review of 360 cases in the literature. Cancer. 1981 Jun 1;47(11):2678–2689. doi: 10.1002/1097-0142(19810601)47:11<2678::aid-cncr2820471126>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  6. Cantin R., Al-Jabi M., McCaughey W. T. Desmoplastic diffuse mesothelioma. Am J Surg Pathol. 1982 Apr;6(3):215–222. doi: 10.1097/00000478-198204000-00003. [DOI] [PubMed] [Google Scholar]
  7. Carter D., Otis C. N. Three types of spindle cell tumors of the pleura. Fibroma, sarcoma, and sarcomatoid mesothelioma. Am J Surg Pathol. 1988 Oct;12(10):747–753. doi: 10.1097/00000478-198810000-00002. [DOI] [PubMed] [Google Scholar]
  8. Chailleux E., Dabouis G., Pioche D., de Lajartre M., de Lajartre A. Y., Rembeaux A., Germaud P. Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients. Chest. 1988 Jan;93(1):159–162. doi: 10.1378/chest.93.1.159. [DOI] [PubMed] [Google Scholar]
  9. Chase D. R., Enzinger F. M., Weiss S. W., Langloss J. M. Keratin in epithelioid sarcoma. An immunohistochemical study. Am J Surg Pathol. 1984 Jun;8(6):435–441. doi: 10.1097/00000478-198406000-00004. [DOI] [PubMed] [Google Scholar]
  10. Corson J. M., Pinkus G. S. Mesothelioma: profile of keratin proteins and carcinoembryonic antigen: an immunoperoxidase study of 20 cases and comparison with pulmonary adenocarcinomas. Am J Pathol. 1982 Jul;108(1):80–88. [PMC free article] [PubMed] [Google Scholar]
  11. Corson J. M., Weiss L. M., Banks-Schlegel S. P., Pinkus G. S. Keratin proteins in synovial sarcoma. Am J Surg Pathol. 1983 Jan;7(1):107–109. doi: 10.1097/00000478-198301000-00014. [DOI] [PubMed] [Google Scholar]
  12. Craighead J. E. Current pathogenetic concepts of diffuse malignant mesothelioma. Hum Pathol. 1987 Jun;18(6):544–557. doi: 10.1016/s0046-8177(87)80354-4. [DOI] [PubMed] [Google Scholar]
  13. Dervan P. A., Tobin B., O'Connor M. Solitary (localized) fibrous mesothelioma: evidence against mesothelial cell origin. Histopathology. 1986 Aug;10(8):867–875. doi: 10.1111/j.1365-2559.1986.tb02584.x. [DOI] [PubMed] [Google Scholar]
  14. Epstein J. I., Budin R. E. Keratin and epithelial membrane antigen immunoreactivity in nonneoplastic fibrous pleural lesions: implications for the diagnosis of desmoplastic mesothelioma. Hum Pathol. 1986 May;17(5):514–519. doi: 10.1016/s0046-8177(86)80042-9. [DOI] [PubMed] [Google Scholar]
  15. Hasleton P. S., Kelehan P., Whittaker J. S., Burslem R. W., Turner L. Benign and malignant struma ovarii. Arch Pathol Lab Med. 1978 Apr;102(4):180–184. [PubMed] [Google Scholar]
  16. Hillerdal G. Malignant mesothelioma 1982: review of 4710 published cases. Br J Dis Chest. 1983 Oct;77(4):321–343. [PubMed] [Google Scholar]
  17. Lagacé R., Schürch W., Seemayer T. A. Myofibroblasts in soft tissue sarcomas. Virchows Arch A Pathol Anat Histol. 1980;389(1):1–11. doi: 10.1007/BF00428664. [DOI] [PubMed] [Google Scholar]
  18. Law M. R., Hodson M. E., Heard B. E. Malignant mesothelioma of the pleura: relation between histological type and clinical behaviour. Thorax. 1982 Nov;37(11):810–815. doi: 10.1136/thx.37.11.810. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. McLoud T. C., Woods B. O., Carrington C. B., Epler G. R., Gaensler E. A. Diffuse pleural thickening in an asbestos-exposed population: prevalence and causes. AJR Am J Roentgenol. 1985 Jan;144(1):9–18. doi: 10.2214/ajr.144.1.9. [DOI] [PubMed] [Google Scholar]
  20. Montag A. G., Pinkus G. S., Corson J. M. Keratin protein immunoreactivity of sarcomatoid and mixed types of diffuse malignant mesothelioma: an immunoperoxidase study of 30 cases. Hum Pathol. 1988 Mar;19(3):336–342. doi: 10.1016/s0046-8177(88)80529-x. [DOI] [PubMed] [Google Scholar]
  21. Raftery A. T. Regeneration of parietal and visceral peritoneum: an electron microscopical study. J Anat. 1973 Sep;115(Pt 3):375–392. [PMC free article] [PubMed] [Google Scholar]
  22. Roggli V. L., Kolbeck J., Sanfilippo F., Shelburne J. D. Pathology of human mesothelioma. Etiologic and diagnostic considerations. Pathol Annu. 1987;22(Pt 2):91–131. [PubMed] [Google Scholar]
  23. Said J. W., Nash G., Banks-Schlegel S., Sassoon A. F., Shintaku I. P. Localized fibrous mesothelioma: an immunohistochemical and electron microscopic study. Hum Pathol. 1984 May;15(5):440–443. doi: 10.1016/s0046-8177(84)80077-5. [DOI] [PubMed] [Google Scholar]
  24. Seemayer T. A., Lagacé R., Schürch W., Tremblay G. Myofibroblasts in the stroma of invasive and metastatic carcinoma: a possible host response to neoplasia. Am J Surg Pathol. 1979 Dec;3(6):525–533. doi: 10.1097/00000478-197912000-00005. [DOI] [PubMed] [Google Scholar]
  25. Spirtas R., Beebe G. W., Connelly R. R., Wright W. E., Peters J. M., Sherwin R. P., Henderson B. E., Stark A., Kovasznay B. M., Davies J. N. Recent trends in mesothelioma incidence in the United States. Am J Ind Med. 1986;9(5):397–407. doi: 10.1002/ajim.4700090502. [DOI] [PubMed] [Google Scholar]
  26. Stephens M., Gibbs A. R., Pooley F. D., Wagner J. C. Asbestos induced diffuse pleural fibrosis: pathology and mineralogy. Thorax. 1987 Aug;42(8):583–588. doi: 10.1136/thx.42.8.583. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Whitwell F., Rawcliffe R. M. Diffuse malignant pleural mesothelioma and asbestos exposure. Thorax. 1971 Jan;26(1):6–22. doi: 10.1136/thx.26.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]

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