Desmoplastic malignant mesothelioma of the pleura: autopsy reveals asbestos exposure.
Desmoplastic mesothelioma is a rare subtype of diffuse malignant mesothelioma, and is often difficult to distinguish from reactive pleural fibrosis because of associated extensive collagen fibrosis. An 82-year-old woman with a severe cough was revealed to have pleural effusion and diffuse pleural thickening on the right side. Antibiotics were ineffective, and a compression fracture of the ninth and tenth thoracic vertebral bodies was recognized on X-ray. Autopsy revealed a diffuse pleural thickening with hyalinized collagen tissue in the central part of the pleura. However, the peripheral part of the fibrous tissue was composed of spindle and polygonal cell proliferation that were immunohistochemically positive for antibodies against cytokeratin and vimentin. In addition, the ninth and tenth thoracic spines were infiltrated by similar cells. The condition was diagnosed as desmoplastic mesothelioma with bone metastases. Asbestos bodies were detected in the thickened pleura and fibrosed alveolar septa, and it was suggested retrospectively that the patient had been exposed to asbestos. Thus, autopsy analyses of fibrous pleurisy are necessary to detect a desmoplastic variant of mesothelioma of the pleura and its association with asbestos exposure.
Ishikawa
Ryoichi
R
Laboratory of Molecular and Cellular Pathology and Department of Surgical Pathology, Hokkaido University School of Medicine, Sapporo, Japan.
Kikuchi
Eiki
E
Jin
Mulan
M
Fujita
Miri
M
Itoh
Tomoo
T
Sawa
Hirofumi
H
Nagashima
Kazuo
K
Kikuchi
Hidetake
H
D000368:Aged; D000369:Aged, 80 and over; D017638:Asbestos, Crocidolite / Q000009:adverse effects* / Q000302:isolation & purification; D001859:Bone Neoplasms / Q000556:secondary; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007633:Keratins / Q000378:metabolism; D008654:Mesothelioma / Q000209:etiology* / Q000378:metabolism / Q000556:secondary*; D010997:Pleural Neoplasms / Q000209:etiology* / Q000378:metabolism / Q000473:pathology*; D013902:Radiography, Thoracic; D014746:Vimentin / Q000378:metabolism
D014746:Vimentin; D017638:Asbestos, Crocidolite; D007633:Keratins