Deciduoid type malignant pleural mesothelioma: a case report

Our plain-English summary of Deciduoid type malignant pleural mesothelioma: a case report, by R. Okita, Y. Nojima, S. Saisho, et al (AME Case Reports, 2018).

The study

• Authors: R. Okita, Y. Nojima, S. Saisho, K. Shimizu, R. Shirai, N. Kanomata, M. Oka, M. Nakata
• Journal: AME Case Reports
• Published: 2018;2:43
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Here, we report a patient with deciduoid type malignant pleural mesothelioma (MPM), which rapidly progressed. A 55-year-old man who might have been exposed to asbestos a few decades ago had severe back pain. The chest X-ray scanning and computed tomography (CT) revealed pleural thickness on his right thoracic space, without the presence of a lung mass. A pleural biopsy was performed and the patient was histologically diagnosed with deciduoid type MPM. Although he received two cycles of chemotherapy, his disease rapidly progressed and he died within two months of the diagnosis of deciduoid type MPM.

In plain English

This case report comes from Kawasaki Medical School in Kurashiki, Japan. It describes one patient with deciduoid type malignant pleural mesothelioma, a rare subtype of epithelioid mesothelioma according to the authors. The patient was a 55-year-old man who might have been exposed to asbestos a few decades earlier. The authors' table lists his asbestos exposure as environmental. He came to the hospital with two weeks of severe right back pain. Imaging showed fluid around the lung and right pleural thickening, without a lung nodule. A pleural biopsy found a tumor that mimicked decidua, with 13 mitotic figures (dividing cells) per 10 high-power fields. It was staged T3N1M0, stage IIIA. After two cycles of cisplatin with pemetrexed, his disease progressed rapidly, and he died within 2 months of diagnosis. The authors also reviewed published reports and found 6 cases, including this one, treated with chemotherapy alone. In their table, the four moderate-count cases had survival or follow-up of 12 to 43 months; the two high-count cases died at 4 and 2 months. The authors suggested mitotic count is a promising predictor of survival.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of one patient, with a short review of published cases treated with chemotherapy alone
• Who was studied: one 55-year-old man treated at Kawasaki Medical School, Kurashiki, Japan; article published 2018
• Exposure: possible asbestos exposure a few decades before; listed as environmental in the authors' table; fiber type not stated
• Main results:
  • Imaging showed pleural effusion and right pleural thickening, without a lung nodule
  • Hyaluronic acid in the pleural fluid was 36,400 ng/mL. Blood soluble mesothelin was slightly high at 1.5 nmol/L. CEA and CYFRA were normal
  • Biopsy showed tumor cells mimicking decidua that invaded fatty tissue, with a mitotic count of 13 per 10 HPF. The tumor was diagnosed as deciduoid type MPM, clinical stage T3N1M0, IIIA
  • Tumor cells were positive for calretinin, D2-40, IMP3, GLUT-1 and CAM5.2, and negative for BerEP4, CEA, desmin, TTF1 and CD146
  • Despite two cycles of cisplatin with pemetrexed, the patient's disease progressed rapidly and he died within 2 months of diagnosis
  • In the authors' review of 6 deciduoid MPM cases treated with chemotherapy alone (5 from other published reports plus this case), the discussion states that cases with moderate mitotic counts (2 to 5 per 10 HPF) survived more than 1 year and cases with high counts (more than 5 per 10 HPF) died within 4 months
  • Table 1 gives survival or follow-up for the four moderate-count cases as 43 months (dead of disease), 38 months (alive), 24 months (alive) and 12 months (dead of disease). The two high-count cases died at 4 months and at 2 months (the present case)
• The authors' conclusion: The authors suggested that mitotic count is a promising predictor of survival in deciduoid mesothelioma. They called for prospective registration studies in national or worldwide settings for rare tumors such as variant-type MPM
• Limitations the authors state:
  • The authors state that current diagnostic markers for deciduoid type MPM are immature
  • IMP3 status was not available for the other 5 reviewed cases
  • The effect of chemotherapy was not available for the other 5 reviewed cases

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Chest X-Ray, Pleural Thickening, Pleural Biopsy, Chemotherapy.

Related studies

• Lapatinib enhances trastuzumab-mediated antibody-dependent cellular cytotoxicity via upregulation of HER2 in malignant mesothelioma cells — R. Okita, K. Shimizu, et al. (2015)
• Mesotheliomas with deciduoid morphology: a morphologic spectrum and a variant not confined to young females — J.H. Shanks, M. Harris, et al. (2000)
• Deciduoid mesothelioma: report of 21 cases with review of the literature — N.G. Ordóñez (2012)
• Deciduoid mesothelioma: a report of 5 cases and literature review — J. Shia, R.A. Erlandson, et al. (2002)
• Epithelial mesothelioma with deciduoid features: report of four cases — N.G. Ordóñez (2000)
• Deciduoid pleural mesothelioma affecting a young female without prior asbestos exposure — K. Gloeckner-Hofmann, X.Z. Zhu, et al. (2000)

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