Malignant mesothelioma: diagnosis by skin biopsy

Our plain-English summary of Malignant mesothelioma: diagnosis by skin biopsy, by R.K. Berkowitz, J. Longley, M.R. Buchness, et al (Journal of the American Academy of Dermatology, 1989).

The study

• Authors: R.K. Berkowitz, J. Longley, M.R. Buchness, D.N. Silvers, L. Ozzello, M.E. Grossman
• Journal: Journal of the American Academy of Dermatology
• Published: 1989;21(5 Pt 2):1068-73
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a case of malignant mesothelioma in which the tissue diagnosis was established by examination of a skin biopsy specimen. We also review the cutaneous manifestations of malignant mesothelioma. To our knowledge this is only the second reported case diagnosed primarily by examination of tissue from the skin.

In plain English

This article was a case report, with a short review of how malignant mesothelioma can involve the skin. The authors described a 47-year-old man seen at the Columbia-Presbyterian Medical Center in New York. He had six months of appetite loss, fatigue and weight loss, then shortness of breath and a growing abdomen. He had emigrated from Puerto Rico in the 1950s and worked as a printing press operator. His only known chemical exposure was to cleaning fluids containing acetone. He had no known personal asbestos exposure, but his father had worked in construction as a bricklayer, which the authors called a potential source of exposure. A chest x-ray showed fluid around both lungs and densities suggesting pleural plaques or trapped fluid on the left. Small punch biopsies of thickened abdominal wall skin, studied with microscopy and special stains, established the diagnosis of malignant mesothelioma. The authors could not determine where the tumor began but considered a start in the pleura more plausible. The authors concluded this was the second reported case diagnosed by skin biopsy, and that the biopsy avoided the need for extensive invasive surgery.

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 review of the skin (cutaneous) manifestations of malignant mesothelioma
• Who was studied: One 47-year-old man seen at the Columbia-Presbyterian Medical Center, New York. He emigrated from Puerto Rico in the 1950s and worked in the United States as a printing press operator.
• Exposure: No known personal asbestos exposure. The only known chemical exposure was to cleaning fluids containing acetone. The patient's father had worked in the construction industry as a bricklayer. No fiber type was identified.
• Main results:
  • In this patient, a chest x-ray showed bilateral pleural effusions, larger on the right, and densities on the left side suggesting pleural plaques or loculated fluid.
  • In this patient, computed tomography showed the tumor thickening the abdominal wall, without definite peritoneal involvement, and trace ascites.
  • In this patient's skin biopsy specimens, the tumor cells stained strongly positive for epithelial membrane antigen, keratin (polyclonal) and vimentin.
  • Electron microscopy of this patient's tumor cells showed tortuous microvilli without rootlets. The authors judged the findings diagnostic of mesothelioma.
  • The patient was accepted into the Eastern Cooperative Oncology Group treatment protocol for malignant mesothelioma without further biopsy. No treatment outcome was reported.
  • The authors could not determine where this patient's tumor began. They considered a pleural primary site with direct extension to the chest and abdominal wall more plausible than a peritoneal origin, and said a dual origin was possible.
  • The authors regarded the father's work as a bricklayer in construction as a potential source of asbestos exposure for the patient.
• The authors' conclusion: The authors concluded that this was, to their knowledge, the second case of malignant mesothelioma diagnosed by skin biopsy. They also concluded that a simple punch biopsy, combined with special staining and imaging, avoided the need for extensive invasive surgery in this patient.
• Limitations the authors state:
  • The authors could not obtain a direct history of asbestos exposure from the patient.
  • The authors could not determine the precise site where the tumor originated.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Biopsy.

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