p53 Expression in a Malignant Mesothelioma Patient during Seven-Year Follow-up

Our plain-English summary of p53 Expression in a Malignant Mesothelioma Patient during Seven-Year Follow-up, by S.M. Koo, S.T. Uh, D.W. Kim, et al (Tuberculosis and Respiratory Diseases, 2014).

The study

• Authors: S.M. Koo, S.T. Uh, D.W. Kim, K.U. Kim, Y.K. Kim
• Journal: Tuberculosis and Respiratory Diseases
• Published: 2014;76(6):284-8
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma (MM) is the aggressive tumor of serosal surfaces. There are crude pathogenetic results regarding the biology of MM. Coordinated upregulations of p53 gene expression are shown in malignancies. We believed that there are changes in the p53 expression with transformation from reactive hyperplasia to MM. A 65-year-old male was admitted the hospital because of left pleuritic chest pains in 2004. Chest computed tomography (CT) results showed left pleural effusions with loculation and pleural thickening. Pathologic findings revealed reactive mesothelial hyperplasia. In 2008, the patient again felt left pleuritic chest pains. Chest CT showed progressive thickening of the left pleura. Pathologic diagnosis was atypical mesothelial hyperplasia. In 2011, chest CT showed progressive thickening of his left pleura. He was diagnosed with well-differentiated papillary mesothelioma. Serial change was analyzed by immunohistochemical staining for p53 of pleural tissues. There were no remarkable changes in p53 expressions during the transformation to MM.

In plain English

This article was a case report from a university hospital in Seoul, Korea, about one man followed from 2004 to 2011. In 2004 he was 65 years old, had left-sided chest pain, and had worked for 20 years as a factory supervisor of asbestos-containing products. Pleural tissue removed in 2004 was diagnosed as reactive mesothelial hyperplasia. In 2008, after CT scans showed the left pleura thickening, tissue was diagnosed as atypical mesothelial hyperplasia. In 2011 the diagnosis was well-differentiated papillary mesothelioma, made because of a superficial microinvasion. The authors stained tissue from all three dates for p53, a tumor suppressor protein used as a marker for mesothelioma. All three samples showed focal p53 staining, with no overt change when mesothelioma was diagnosed. The authors concluded that p53 overexpression may exist not only in mesothelioma but also in reactive or atypical hyperplasia, and that larger studies are needed. They noted that their staining method had limitations and that, judged by 2009 diagnostic guidelines, their results were ambiguous. No asbestos fiber count was done on the tissue.

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: serial p53 staining of pleural tissue from one patient over seven years
• Who was studied: One man, aged 65 at first presentation in 2004 with left chest pain, seen at Soonchunhyang University Hospital, Seoul, Korea, and followed to 2011. He had hypertension and diabetes mellitus and was a former smoker.
• Exposure: Twenty years of work as a factory supervisor of asbestos-containing products. Fiber type was not stated, and no asbestos fiber count was performed on pleural tissue.
• Main results:
  • 2004 pleural tissue was diagnosed as reactive mesothelial hyperplasia, with no definite evidence of malignant mesothelioma
  • 2008 tissue, taken after CT showed progressive left pleural thickening with nodularity, was judged more suggestive of atypical mesothelial hyperplasia than malignant mesothelioma
  • 2011 tissue was diagnosed as well-differentiated papillary mesothelioma, based on superficial microinvasion rather than p53 staining
  • p53 staining was focal positive in the 2004 tissue (reactive mesothelial hyperplasia) and in the 2008 tissue (atypical mesothelial hyperplasia)
  • The 2011 tissue (well-differentiated papillary mesothelioma) also showed focal p53 staining, with no overt change in p53 staining at the time mesothelioma was diagnosed
  • After diagnosis in 2011 the patient received nine cycles of Alimta/cisplatin chemotherapy and radiotherapy to the left pleura
• The authors' conclusion: The authors concluded that p53 overexpression may exist not only in malignant mesothelioma but also in reactive or atypical hyperplasia. They suggested p53 staining may help diagnosis when mesothelioma is suspected with atypical microscopic findings, and said further studies in a larger population are needed.
• Limitations the authors state:
  • The quantitative immunohistochemistry method was limited
  • Under 2009 guidelines, which treat weak or focal staining of under 10% of cells as negative, the three serial samples gave ambiguous conclusions
  • p53 staining has low sensitivity and specificity, and commonly used antibodies may also stain wild-type p53, which limits interpretation

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Serosal Surface, Pleuritic Chest Pain, Pleural Effusion, Pleural Thickening, Reactive Mesothelial Hyperplasia, Pleura, Atypical Mesothelial Proliferation.

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