Fine needle aspiration biopsy of metastatic malignant mesothelioma with myxoid change and signet ring cells: A case report and review of the literature

Our plain-English summary of Fine needle aspiration biopsy of metastatic malignant mesothelioma with myxoid change and signet ring cells: A case report and review of the literature, by M.M. Mishra, C.F. Farver, D.J. Chute (CytoJournal, 2016).

The study

• Authors: M.M. Mishra, C.F. Farver, D.J. Chute
• Journal: CytoJournal
• Published: 2016;13:4
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma (MM) is a rare neoplasm, which is most commonly encountered in cytology through effusion specimens. Fine needle aspiration biopsy of MM, particularly the epithelioid subtype, can be a source of diagnostic difficulty and may mimic sampling of an adenocarcinoma. This is the first case report to demonstrate abundant extracellular myxoid material and numerous intracellular vacuoles, including signet ring cells, in a fine needle aspirate of metastatic MM. A review of the literature for myxoid change and vacuoles in fine needle aspiration biopsies of MM discloses that vacuoles are found in up to 35% of aspirates of MM, but myxoid change is very rare, reported in <5% of the cases. Cytologists should be aware of this rare morphologic pattern of metastatic epithelioid MM.

In plain English

This article was a case report combined with a review of earlier published reports. It described a 69-year-old man, a former smoker, who had a large fluid collection around the right lung (pleural effusion) and enlarged lymph nodes in the chest. Two samples of this fluid were negative for cancer. A fine needle aspiration (a sample drawn through a thin needle) of a chest lymph node showed cells with many small bubbles (vacuoles), some 'signet ring' cells, and abundant jelly-like (myxoid) material. On site, it was first read as non-small cell carcinoma. Tissue removed from the pleura stained positive for calretinin, WT-1 and D2-40 and negative for TTF-1 and Napsin A, consistent with malignant mesothelioma. The article did not report the man's asbestos exposure. Across 102 previously published aspirates of mesothelioma, the authors found vacuoles in 36 (35%), signet ring cells in 9 (9%), and extracellular myxoid material in 4 (4%). The authors concluded that this was the first case report of this pattern in metastatic mesothelioma and that cytologists should be aware of it.

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 with a review of published literature
• Who was studied: One 69-year-old man, a former smoker, with a right pleural effusion and enlarged mediastinal lymph nodes. The literature review covered 102 previously reported fine needle aspirates of malignant mesothelioma.
• Exposure: Not reported for this patient. Asbestos is mentioned only as general background in the introduction.
• Main results:
  • In the patient, two pleural fluid cytology specimens were negative for malignancy.
  • The on-site reading of the patient's lymph node aspirate was positive for malignancy and called non-small cell carcinoma.
  • Some of the patient's aspirated cells had single large vacuoles that gave them a signet ring appearance.
  • In the patient's pleural tissue, the cell vacuoles were negative for mucin on mucicarmine and alcian blue stains.
  • The patient's tumor cells were positive for calretinin, WT-1 and D2-40 and negative for TTF-1 and Napsin A, consistent with malignant mesothelioma.
  • In the literature review of 102 aspirates, vacuoles of any type were found in 36 (35%).
  • In the literature review of 102 aspirates, signet ring cells were found in 9 (9%).
  • In the literature review, extracellular myxoid material was found in 4 aspirates (4%). The text describes this as less than 5% of reported aspirates, and in most cases the material was only present in small areas.
• The authors' conclusion: The authors concluded that this was the first case report showing abundant myxoid material and numerous vacuoles, including signet ring cells, in a fine needle aspirate of metastatic mesothelioma. They added that cytologists should be aware of this rare pattern of metastatic epithelioid mesothelioma.
• Limitations the authors state:
  • For some of the reviewed published cases, only a limited description of the cells was available.

Topics

Medical terms in this study, explained in our Lexicon: Biopsy, Mesothelioma, Neoplasm, Cytology, Epithelioid, Adenocarcinoma, Aspirate.

Related studies

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• Malignant pleural mesothelioma metastatic to the submandibular salivary gland, simulating glandular hypertrophy, diagnosed by fine-needle aspiration biopsy: a case report and literature review — M. Ambroggi, E. Orlandi, et al. (2014)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• Fine-needle aspiration biopsy of axillary lymph nodes — S. Jaffer, M. Zakowski (2002)
• Cytopathology of malignant mesothelioma of the pleura in fine-needle aspiration biopsy — G.K. Nguyen, M.R. Akin, et al. (1999)
• Clinical value of CT-guided percutaneous fine-needle aspiration biopsy for peritoneal lesions — H. Yu, C. Zhang, et al. (2020)

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