Pemetrexed for epithelioid haemangioendothelioma of the pleura

Our plain-English summary of Pemetrexed for epithelioid haemangioendothelioma of the pleura, by S. Kanemura, K. Kuribayashi, Y. Moriya, et al (Respirology Case Reports, 2016).

The study

• Authors: S. Kanemura, K. Kuribayashi, Y. Moriya, S. Shimizu, T. Tsujimura, T. Nakano
• Journal: Respirology Case Reports
• Published: 2016;4(6):e00191
• Type of article: Case report
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 31-year-old woman presented with a 2-month history of dull left back pain. Chest roentgenography revealed pleural thickening in the left lung apex, whereas chest computed tomography showed a left pleural effusion with diffuse pleural thickening. Based on these findings, malignant mesothelioma was suspected. Video-assisted thoracoscopic pleural biopsy was performed, and subsequent staining of the specimen revealed negative results for anti-cytokeratin antibodies and positive results for vascular endothelial immunohistochemical markers. Therefore, a diagnosis of epithelioid hemangioendothelioma (EHE) was made, and chemotherapy with carboplatin, pemetrexed, and bevacizumab was initiated. After the fourth course of treatment, the disease was well controlled with a 90% reduction of the left pleural effusion. This case is very rare in that the EHE originated from the pleura. Additionally, there has been no report of pemetrexed for treatment of EHE.

In plain English

This case report described one 31-year-old Japanese woman who had a 2-month history of dull left back pain. Imaging showed left pleural thickening and fluid, and malignant pleural mesothelioma was suspected. The biopsy instead favoured epithelioid haemangioendothelioma (EHE), a rare blood-vessel tumour. The tumour cells stained positive for vascular markers such as CD34, CD31 and factor VIII, and negative for cytokeratin and for the mesothelial markers calretinin and WT-1. The patient had no relevant medical, family, occupational or smoking history, and the article does not discuss asbestos. She received carboplatin, pemetrexed and bevacizumab. After the fourth course, the chest fluid had decreased by 90%, but the pleural thickening had not changed. She then received pemetrexed and bevacizumab as maintenance. She remained stable for 6 months, had no adverse events after eight cycles, and had good pain control. The authors stated there had been no earlier report of pemetrexed for EHE. They suggested that new multitargeted antifolates should be considered for patients with advanced pulmonary EHE. This report concerns one patient only.

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 (single patient)
• Who was studied: one 31-year-old Japanese woman with a 2-month history of dull left back pain, referred to Hyogo College of Medicine, Japan
• Exposure: No asbestos or other exposure was studied. The patient had no relevant occupational history. The article concerns treatment of the tumour with carboplatin (area under the curve 6), pemetrexed (500 mg/m2) and bevacizumab (15 mg/kg).
• Main results:
  • On the biopsy, the tumour cells were negative for AE1/AE3, CAM5.2, calretinin, WT-1, CEA and TTF-1, and positive for D2-40, vimentin, CD34, CD31 and factor VIII. A diagnosis of EHE was made.
  • Intracytoplasmic lumens containing red blood cells favoured EHE over epithelioid mesothelioma.
  • PET-CT showed low-grade FDG uptake in the left pleural thickening but no metastatic lesion.
  • After the fourth course of carboplatin, pemetrexed and bevacizumab, the pleural effusion had decreased by 90%, but the pleural thickening had not changed.
  • On maintenance pemetrexed and bevacizumab, the patient remained stable for 6 months, with no adverse events after eight cycles.
  • Good pain control was obtained.
• The authors' conclusion: The authors noted that there had been no previous report of pemetrexed for EHE. They suggested that new multitargeted antifolates should be considered for patients with advanced pulmonary EHE.

Topics

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Epithelioid, Pleura, Pleural Thickening, Pleural Effusion, Diffuse Pleural Thickening, Mesothelioma, Pleural Biopsy.

Related studies

• Primary pleural epithelioid haemangioendothelioma with metastases to the skin. A case report and literature review — M. Al-Shraim, B. Mahboub, et al. (2005)
• Primary epithelioid haemangioendothelioma of the peritoneum: an unusual mimic of diffuse malignant mesothelioma — R.L. Attanoos, N.S. Dallimore, et al. (1997)
• Spontaneous bilateral haemothorax as presentation of primary pleural epithelioid haemangioendothelioma — L. Ferreiro, E. San-José, et al. (2017)
• Expression of calretinin, thrombomodulin, keratin 5, and mesothelin in lung carcinomas of different types: an immunohistochemical analysis of 596 tumors in comparison with epithelioid mesotheliomas of the pleura — M. Miettinen, M. Sarlomo-Rikala (2003)
• Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura — P.M. Cury, D.N. Butcher, et al. (2000)
• Malignant epithelioid vascular tumors of the pleura: report of a series and literature review — P.J. Zhang, V.A. Livolsi, et al. (2000)

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