Sarcomatoid mesothelioma: unusual findings and literature review

Our plain-English summary of Sarcomatoid mesothelioma: unusual findings and literature review, by B. Clopton, W. Long, M. Santos, et al (Journal of Surgical Case Reports, 2022).

The study

• Authors: B. Clopton, W. Long, M. Santos, A. Asarian, R. Genato, P. Xiao
• Journal: Journal of Surgical Case Reports
• Published: 2022;2022(11):rjac512
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Sarcomatoid mesothelioma is an aggressive disease secondary to its propensity to undergo rapid growth, show inconsistent expression of tumor markers and invade surrounding tissues. Therefore, there are numerous obstacles that clinical researchers face as they look for new methods to diagnose and treat the malignancy. We present a case of sarcomatoid mesothelioma, originally thought to be metastasis from renal cell carcinoma.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2022.

In plain English

This article was a case report with a short literature review. It described one patient, a 74-year-old man, who came to the emergency department with a worsening cough and shortness of breath on exertion lasting 2 weeks. A chest X-ray showed a 12.8 × 9.6 × 8.1 cm mass in the lower left lung and malignant pleural thickening encasing the left side of the chest. He also had a previously known 9.0 × 7.6 cm mass on the left kidney, so the lung disease was first thought to be cancer spread from the kidney (renal cell carcinoma). A guided biopsy of the lung mass instead showed malignant sarcomatoid mesothelioma. The tumor cells were positive for vimentin, CD10, WT1 and D2–40. They were negative for keratin and calretinin, which the authors called unusual for mesothelioma. Negative results for cytokeratin and PAX8 ruled out spread from the kidney. The article did not report any asbestos exposure for this patient, nor his treatment or outcome. The authors concluded that sarcomatoid mesothelioma has the worst prognosis of the mesothelioma types.

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 a single patient, with a discussion reviewing published literature on diagnosis and treatment
• Who was studied: One 74-year-old male patient with a history of hypertension, type II diabetes, alpha thalassemia trait, monoclonal gammopathy, chronic lymphocytic leukemia, a left kidney mass and a left pleural effusion. Location and date are not stated.
• Exposure: Not reported. The article gives no asbestos or occupational exposure history for the patient. Asbestos is mentioned only as general background in the introduction.
• Main results:
  • A chest X-ray showed a heterogeneous 12.8 × 9.6 × 8.1 cm mass suspicious for neoplasm in the patient's left lower lobe, with malignant pleural thickening encasing the left hemithorax.
  • The patient also had a previously known 9.0 × 7.6 cm soft tissue mass arising from the upper pole of the left kidney, earlier hypothesized to be renal cell carcinoma versus lymphoma.
  • An IR-guided biopsy of the left lung mass was consistent with malignant sarcomatoid mesothelioma.
  • The patient's tumor cells were positive for vimentin and CD10, and for WT1 and D2–40.
  • The tissue was negative for keratin and calretinin, which the authors described as unusual for mesothelioma.
  • Negative results for cytokeratin (CK) and PAX8 ruled out metastatic renal cell carcinoma.
  • Malignant solitary fibrous tumor was considered because of staghorn-like vessels, but was ruled out because the tumor lacked STAT6 expression.
• The authors' conclusion: The authors concluded that the patient's pleural lung mass, first thought to be a metastasis from renal cell carcinoma, was a biopsy-proven sarcomatoid mesothelioma. They stated that sarcomatoid mesothelioma has the worst prognosis because of inconsistent expression of common tumor markers and rapid progression.

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Mesothelioma, Tumor Marker, Metastasis, Carcinoma.

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