Sarcomatoid mesothelioma: a clinical-pathologic correlation of 326 cases.

Published

Journal Article

Sarcomatoid mesothelioma is the least common, but most aggressive of the three major histological types of mesotheliomas. This study comprises 326 cases of sarcomatoid mesotheliomas among 2000 consecutive malignant mesothelioma cases received in consultation (16%). Patients included 312 men (96%) and 14 women (4%), with a median age of 70 years (range 41-94 years). Most tumors were pleural (319; 98%), and 7 were peritoneal (2%). Some desmoplastic features were identified in 110 cases (34%), and 70 (21%) were classified as desmoplastic. Rare subtypes included two cases with a lymphohistiocytoid pattern (<1%) and eight heterologous mesotheliomas (2%). Labeling for cytokeratins (CKs) was observed in 261/280 cases (93%), and for calretinin and vimentin in 31 and 91%, respectively. Pleural plaques were present in 79% of cases for which information was available, and asbestosis was diagnosed in 34/127 cases (27%). Median survival was 3.5 months. Fiber analysis was performed in 61 cases. The median asbestos body count was 1640/g wet lung tissue (by light microscopy). Amosite fibers were the most commonly identified fibers using energy-dispersive X-ray analysis and were significantly higher in the sarcomatoid cases, as were uncoated fibers using scanning electron microscopy. This study represents the largest series of sarcomatoid and desmoplastic malignant mesotheliomas to date and confirms the diagnostic usefulness of CK immunohistochemistry. The relationship with asbestos exposure--particularly amosite--and an association with pleural plaques and less often asbestosis is confirmed.

Full Text

Duke Authors

Cited Authors

  • Klebe, S; Brownlee, NA; Mahar, A; Burchette, JL; Sporn, TA; Vollmer, RT; Roggli, VL

Published Date

  • March 2010

Published In

Volume / Issue

  • 23 / 3

Start / End Page

  • 470 - 479

PubMed ID

  • 20081811

Pubmed Central ID

  • 20081811

Electronic International Standard Serial Number (EISSN)

  • 1530-0285

International Standard Serial Number (ISSN)

  • 0893-3952

Digital Object Identifier (DOI)

  • 10.1038/modpathol.2009.180

Language

  • eng