Pathology of Human Malignant Mesothelioma

Our plain-English summary of Pathology of Human Malignant Mesothelioma, by Yasunosuke Suzuki (1981).

The study

• Author: Yasunosuke Suzuki
• Published: Seminars in Oncology (Grune & Stratton, Inc.); copyright 1981; ISSN 0093-7754/81/0803; volume and pages not shown on these pages
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 000868. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article, by a single author at the Mount Sinai School of Medicine in New York, reviewed the pathology of human malignant mesothelioma. It described how the tumor looks to the naked eye and under the microscope. It also discussed stains, tests for hyaluronic acid, fluid samples and immune-based tests as aids to diagnosis. It reported data from Mount Sinai Hospital: of 210 consecutive malignant mesotheliomas, 67% were epithelial, 26% biphasic (mixed) and 7% fibrous (mesenchymal). Of these, 177 cases were classed as definite and 33 as probable. The author gave two examples in which electron microscopy indicated that a pleural tumor was not a mesothelioma. One pointed to adenocarcinoma and the other to malignant fibrous histiocytoma. The review cited other researchers' work linking asbestos to mesothelioma. It said that other agents, some studied only in animals, might also be involved. It did not study exposures itself. The author concluded that these special techniques help tell primary mesothelial tumors apart from tumors spread from elsewhere. The author also noted that electron microscopy of cell blocks from fluid samples could not yet tell reactive mesothelial cells from well-differentiated epithelial mesothelioma cells.

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: Review of the pathology and diagnosis of malignant mesothelioma, illustrated with the author's laboratory case material and a case series of 210 tumors from Mount Sinai Hospital
• Who was studied: 210 consecutive malignant mesotheliomas from Mount Sinai Hospital, New York: 177 definite (104 pleural, 66 peritoneal, 2 pericardial, 5 both pleural and peritoneal) and 33 probable (16 pleural, 17 peritoneal). The years of collection are not stated.
• Exposure: This article's own data did not study exposure. The review cites other studies linking asbestos exposure to malignant pleural mesothelioma. It mentions other agents reported by others, including fibrous erionite (linked to pleural mesothelioma in Turkey) and, in animal studies, fibrous glass, brucite and some organic and radioactive substances. The author suggested that such agents might be involved alone or as cocarcinogens and said further studies were needed.
• Main results:
  • Among the 210 consecutive Mount Sinai mesotheliomas, 67% were epithelial, 26% biphasic (mixed) and 7% fibrous (mesenchymal).
  • Of the 210 cases, 177 were classed as definite (104 pleural, 66 peritoneal, 2 pericardial, 5 both pleural and peritoneal) and 33 as probable (16 pleural, 17 peritoneal).
  • In material submitted to the author's laboratory, 39.5% of mesotheliomas were peritoneal. The site of origin could not be determined for 2.4% because both pleura and peritoneum were extensively involved. The pleural and pericardial percentages are garbled in the scanned text.
  • One pleural tumor could not be classed by light microscopy as either epithelial mesothelioma or metastatic adenocarcinoma. Stains and electron microscopy then led to the conclusion that it was not a malignant mesothelioma.
  • A pleural tumor was first diagnosed as fibrous-form mesothelioma. Electron microscopy findings were not consistent with mesothelioma and suggested malignant fibrous histiocytoma.
  • Tissue culture studies at Mount Sinai found that cultured mesothelioma cells changed strikingly, from cells containing hyaluronic acid to cells without it.
• The authors' conclusion: The author concluded that special techniques such as histochemistry and electron microscopy are of value in distinguishing primary mesothelial tumors from metastatic deposits.
• Limitations the authors state:
  • Electron microscopy of cell blocks made from effusions could show whether cells were of mesothelial origin. It could not yet distinguish reactive mesothelial cells from well-differentiated epithelial mesothelioma cells.
  • The changes seen in cultured cells may have been caused by artificial conditions in the culture medium.
  • Data were still lacking on how normal mesothelium becomes malignant and on the role of hyaline plaque.

Topics

Medical terms in this study, explained in our Lexicon: Pathology, Mesothelioma, Hyaluronic Acid, Biphasic Mesothelioma, Adenocarcinoma, Cell Block, Reactive Mesothelial Hyperplasia, Well-Differentiated.

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