Primary malignant gonadal mesotheliomas and asbestos

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Primary malignant gonadal mesotheliomas and asbestos"

Transcription

1 Histopathology 2000, 37, 150±159 Primary malignant gonadal mesotheliomas and asbestos R L Attanoos & A R Gibbs Department of Histopathology, University Hospital of Wales and Llandough Hospital, Cardiff, Wales, UK Date of submission 27 October 1999 Accepted for publication 20 December 1999 Attanoos R L & Gibbs A R (2000) Histopathology 37, 150±159 Primary malignant gonadal mesotheliomas and asbestos Aims: The clinicopathological, immunohistochemical and aetiological aspects, with respect to asbestos, of seven primary gonadal mesotheliomas (three intratesticular, four ovarian) are described and compared. These tumours are extremely rare, poorly described and the knowledge of their natural history is very limited. Methods and results: The cases were collated from the UK Health and Safety Executive Mesothelioma Register over a 24-year period (1968±91). Primary mesotheliomas of the tunica vaginalis and ovary comprised 0.09% (10 cases) and 0.03% (three cases) of mesothelioma deaths, respectively. No primary intratesticular (non-tunica vaginalis) malignant mesotheliomas have been described. In this study, we present seven (three intratesticular, four ovarian) primary malignant gonadal mesotheliomas. In both genders the tumours show a similar age distribution (with median onset in the sixth decade), a similar association with asbestos (in Keywords: asbestos, malignant mesothelioma, ovary, testis approximately 50% cases), a diverse histological spectrum (with predominantly tubulopapillary epithelial subtype tumours) and an immunophenotype that is comparable with malignant pleural and peritoneal mesothelioma. The clinical course appears variable (mean, 26 months; range, 9±50 months). All tumours in the study presented as localized masses and their prognosis appeared more favourable than that of diffuse pleural and peritoneal cases. Conclusions: An awareness of the existence of these rare forms of malignant mesothelioma is important to prevent misdiagnosis. Immunohistochemistry has an important role in confirmation of the diagnosis. The accurate diagnosis of primary gonadal mesothelioma has potentially important medicolegal compensation considerations as a significant proportion of these cases are associated with asbestos. Introduction Approximately 85% of malignant mesotheliomas arise within the pleural cavities, with a further 10±15% originating from the peritoneum. 1,2 In comparison, meotheliomas arising from both the pericardium and tunica vaginalis are rare, in total representing less than 1% of all cases. 3,4 Despite the common embryological association between peritoneal mesothelium and ovarian surface epithelium, `true' ovarian mesotheliomas are very rare. 5±7 In this study, a comparative clinicopathological analysis of seven cases of malignant mesothelioma arising as localized neoplasms from the ovarian (four cases) and testicular (three cases) parenchyma are Address for correspondence: Dr R L Attanoos, Department of Histopathology, Llandough Hospital, Penlan Road, Cardiff CF64 2XX, UK. described. The differential diagnoses and relationship with prior asbestos exposures are discussed. Materials and methods CASES STUDIED The demographic data was obtained from death certificates filed in the UK Health and Safety Executive Mesothelioma Register. Cases of malignant mesothelioma arising from the tunica vaginalis testis and parenchyma, ovary and peritoneum were reviewed over the study period 1968±91. One further case of malignant mesothelioma arising from the testicular parenchyma was found during routine surgical practice. Additional clinical data including occupational history and followup information was obtained from the medical records. q 2000 Blackwell Science Limited.

2 Primary malignant gonadal mesotheliomas and asbestos 151 Table 1. Clinicopathological aspects of gonadal mesothelioma Case Sex Age (years) Symptoms Size (mm) Asbestos exposure Treatment Survival (months) 1 M 71 Hydrocoele, right testis, mass, chylous ascites 15 Yes Orchidectomy Died (not known) 2 M 77 Left testis mass (5 mm) 5 No Orchidectomy Died (50) 3 M 33 Left testis mass (40 mm) 40 No Orchidectomy Alive (37) 4 F mm ovarian mass Right abdominal pain Peritoneal implants 5 F 61 Weight loss Left ovarian mass 70 mm 6 F 66 Ascites, 20 mm mass Left ovary 7 F 66 Right ovarian and adnexal mass 30 mm, ascites (localized disease) 70 No Chemotherapy Died (11) NK Yes Palliative care Died (not known) 10 No Conservative Alive and well (38) 30 Yes Palliative care Died (9) The criteria for selection of `ovarian' mesotheliomas were taken from a previous study and included the presence of unilateral or bilateral ovarian enlargement and/or parenchymal replacement in the absence of significant peritoneal disease. 7 As in the earlier study, the presence of a minor component of extra-ovarian disease did not exclude cases from the study. HISTOLOGICAL ASSESSMENT In all cases the histological diagnosis of malignant mesothelioma was confirmed by following established criteria. Mesotheliomas were subtyped as: epithelial, biphasic or sarcomatous and the prominent architectural patterns were documented as: tubulopapillary, adenomatoid, solid epithelioid, pleomorphic, deciduoid, fibroblastic, leiomyoid (with immunohistochemical confirmation with actin and desmin immunoreactivity), chondroid, osseous and/or desmoplastic. In addition, mucin stains (alcian blue ph 2.5, and periodic acid±schiff with and without diastase) and immunohistochemistry were performed as adjunct analyses. IMMUNOHISTOCHEMISTRY Immunohistochemistry was performed by use of the ABC method with antibodies to: AE1/AE3 (prediluted: Dako, Copenhagen, Denmark); CEA (polyclonal 1:1000 Dako, and monoclonal 1:50; Dako), Leu-M1 (1:10; Becton Dickinson, Sunnyvale, CA), Ber-EP4 (1:10; Dako), thrombomodulin (1:75; Dako); CD44H (1:80; Novocastra, Newcastle, UK); calretinin (1:8000; Swant, Switzerland) and cytokeratin 5/6 (1:80; Dako). For cases with possible leiomyoid differentiation antibodies to alpha smooth muscle actin (1:256; Sigma, Poole, Dorset, UK) and desmin (1:10; Dako) were employed. ELECTRON MICROSCOPY In cases where the diagnosis was equivocal and tissue available, transmission electron microscopy was performed on a Phillips 11 electron microscope. Results Of the 883 cases of peritoneal mesothelioma registered in the United Kingdom over the study period 1968±92, 10 cases of `mesothelioma of the tunica vaginalis' or `scrotal mesothelioma' were identified and three cases of `ovarian mesothelioma' were found from data on the death certificate. Biopsy tissue and/or post-mortem material was available in two of the 10 tunica vaginalis

3 152 R L Attanoos & A R Gibbs Figure 1. Low-power appearance of an intratesticular malignant mesothelioma ( 8). mesotheliomas, and a further biopsy case was found during routine surgical practice. Two of the three cases of `ovarian mesotheliomas' were retrieved and two additional cases were identified on review of autopsy reports and tissue material. Although death was originally assigned to peritoneal mesothelioma, in both cases, post mortem did not reveal significant extra-ovarian disease and therefore they were included in the study. CLINICAL FEATURES The main clinical features are presented in Table 1. The age range for men was 33±77 years (mean, 62 years) and for women was 47±66 years (mean, 60 years). The most common symptoms in both sexes related to a mass lesion with associated serosal effusion (hydrocoele or ascites). In one female patient, weight loss was the most significant clinical feature. Occupational details were available in six cases. A history of prior asbestos exposure was evident in one Figure 3. Tubulopapillary epithelial subtype mesothelioma (case 1). male (case 1: dockyard crane driver of over 20 years duration) and one female (case 5: cleaner in asbestos factory for 7 years over the period 1945±1951). A possible domestic asbestos exposure was noted in another female (case 7: housewife, husband was a builders' labourer). No known asbestos exposure was evident for case 2 (publican licensee) or 3 (student) with testicular mesothelioma, or for case 4 (housewife, husband clerical officer) with ovarian mesothelioma. No details were available for case 6. All male subjects underwent an orchidectomy and received no adjuvant therapy. In case 2, 28 months after orchidectomy and a disease-free interval, the patient developed chest pain and dyspnoea and following biopsy a pleural mesothelioma was diagnosed. In this case the subject subsequently died of bronchopneumonia secondary to the pleural mesothelioma. All female patients were treated conservatively after the biopsy diagnosis of malignant mesothelioma was made. Follow-up was available in five cases. For two patients, survival was in excess of 3 years. In those patients who died the mean survival time was 23 months (ranged 9±50 months) PATHOLOGICAL FINDINGS Figure 2. Low-power appearance of case 6 demonstrating periadnexal disease and minimal paranchymal involvement ( 8). Grossly the testicular tumours formed primary parenchymal nonencapsulated lesions which were pale

4 Primary malignant gonadal mesotheliomas and asbestos 153 Table 2. Pathology of gonadal mesotheliomas Case Subtype Architecture Mucin Asbestos bodies (lung) 1 Biphasic Tubulopapillary; myxoid Fibroblastic stroma Psammoma bodies Alcian blue 1 Yes, occasional 2 Epithelial Tubulopapillary; solid Alcian blue 1 3 Epithelial Solid epithelioid Alcian blue 1 4 Biphasic Pleomorphic myxochondroid Alcian blue ± Not seen Lung tissue not reviewed Not seen 5 Epithelial Tubulopapillary Adenomatoid Alcian blue ± Yes, easily seen in clusters 6 Epithelial Solid epithelioid Alcian blue ± 7 Epithelial Tubulopapillary Alcian blue ± Lung tissue not reviewed No asbestos bodies seen Pleural plaque present grey in colour and firm in consistency (Figure 1). In cases 1 and 2, the tumour formed intratesticular masses (ranging 5±15 mm) and demonstrated invasion of the tunica vaginalis as a minor component via the hilum. In case 3, the tumour was purely intraparenchymal and measured 40 mm in diameter. The tunica albuginea was not involved by tumour in any of the cases. The ovarian tumours were poorly defined and of similar colour and consistency to the testicular counterparts. The tumours ranged from 10 to 70 mm in size and usually replaced the ovary. In case 6 (Figure 2), the ovary was encased by tumour but showed no unequivocal parenchymal involvement. There was no evidence of necrosis or haemorrhage. Figure 4. Loose aggregates of polygonal epithelioid cells with adundant eosinophilic cytoplasm set in a myxoid stroma (case 6). Figure 5. Adenomatoid pattern with `lace-like' appearance of vacuolated cells (case 5).

5 154 R L Attanoos & A R Gibbs Figure 6. Case 1 demonstrates a focal sarcomatous stroma with haphazard arrangement of pleomorphic and mitotically active spindle cells. The morphological features of primary gonadal mesotheliomas are shown in Table 2. By light microscopy, two of the three (67%) testicular mesotheliomas and three of four (75%) ovarian cases showed the typical histological appearances of epithelial type mesothelioma as seen in the diffuse forms of the neoplasm. In two cases, a distinct sarcomatous component was present in addition to the malignant epithelial component and these cases were morphologically similar to biphasic subtype mesothelioma. The most common architectural pattern seen in four of seven (two testicular, two ovarian) cases was tubulopapillary comprising hyaline vascular cores lined by oval or hobnail shaped cells exhibiting mild cytonuclear pleomorphism (Figure 3). Mitotic activity was inconspicuous in all four cases (, 1 per 10 hpf). In one case (case 1) numerous psammoma bodies were identified. In a further three (two testicular, one ovarian) cases, the tumour was partly or extensively composed of sheets of polygonal epithelioid cells with vesicular nuclei, prominent nucleoli and abundant eosinophilic cytoplasm set in a myxoid stroma (Figure 4). In these areas mitotic figures were more frequently seen. In two (one testicular, one ovarian) cases, the tumour had a prominent `adenomatoid' pattern with a lace-like appearance of vacuolated cells admixed with myxoid areas rich in alcianophilic material (Figure 5). In the biphasic tumours the epithelial component was of admixed tubulopapillary and adenomatoid patterns. The sarcomatous component comprised long haphazardly arranged cellular fascicles of pleomorphic spindle cells(figure 6) mitotic figures including atypical forms were more frequently seen (. 5 per 10 hpf). The immunohistochemical results are given in Table 3. All cases were diffusely positive for the pancytokeratin marker AE1/AE3. Conversely, there was no immunoreactivity with the `carcinoma' markers, Table 3. Immunohistochemical details of the gonadal mesotheliomas Case AE/13 PCEA MCEA Leu Ml Ber EP4 THR CD44H Calretinin CK 5/6 1 3D IF 3F 3D 2D 3D 2 3D F 3D 2D 3 3D ND 2D 3D 4 3D F 2F 0 3D ID 5 3D F 0 0 3D 3D 6 3D D 3D 2D 0 7 3D D 0 0 3D 3D ND, not done; D; diffuse staining; F, focal staining; PCEA; polyclonal CEA; MCEA, monoclonal CEA; THR, thrombomodulin; CK 5/6, cytokeratin 5/6.

6 Primary malignant gonadal mesotheliomas and asbestos 155 polyclonal or monoclonal carcinoembryonic antigen or Leu MI. The adenocarcinoma marker Ber EP4 showed focal membranous expression in one of three (33%) testicular and in three of four (75%) ovarian mesotheliomas. The `mesothelial' markers calretinin and cytokeratin 5/6 were positive in all three (100%) testicular cases and in three of four (75%) ovarian mesotheliomas. Thrombomodulin showed focal membranous expression in one of three (33%) testicular and two of four (50%) ovarian tumours. CD44H showed strong membranous expression in both testicular mesotheliomas studied and in one of four (25%) ovarian tumours. No leiomyoid differentiation was present based on actin and desmin immunoreactivity. Lung tissue was available for histological assessment in five of the seven cases. In case 1, the male dockyard worker had evidence of grade 2 (peribronchiolar and alveolar duct fibrosis) interstitial fibrosis in association with occasional asbestos bodies. In case 5, the asbestos factory cleaner had evidence of grade 4 fibrosis (honeycomb lung) and numerous asbestos bodies. In case 7 (possible domestic asbestos exposure) the lung exhibited no interstitial fibrosis or asbestos bodies, although pleural plaques were detailed in postmortem data. In cases 2 and 4, no history of asbestos exposure was stated and in both cases the lung parenchyma was normal with no asbestos bodies seen. In cases 3 and 6, the patients were alive precluding the formal assessment of the lung tissue. Discussion Primary malignant mesotheliomas arising from the ovary and testis are very uncommon. Of the malignant mesothelioma deaths registered in the UK, mesothelioma register over the 24 years' study period (1968±91), primary mesotheliomas of the tunica vaginalis and ovary comprised 0.09% and 0.03% mesothelioma deaths, respectively. In the literature there are three primary ovarian cases with a further seven cases representing periadnexal (probable localized ovarian peritoneal mesotheliomas). 6±8 Similarly the largest published study of tunica vaginalis mesotheliomas comprises 11 cases and the authors identified approximately 75 further cases from the literature. 4 However, this is not an accurate representation of the prevalence of these tumours for a number of reasons. First, cases identified at surgical resection are not counted unless the patient has died and `mesothelioma' was recorded on the death certificate. Secondly, on account of the aetiological association with asbestos and potential for medicolegal litigation, most mesothelioma studies are prone to selection bias. In this way, subjects working with, or exposed to asbestos via a nonoccupational means are more likely to have a tumour diagnosed as mesothelioma, than individuals developing neoplasms in a non-asbestos exposed cohort. To support this, the authors note that in five of eight (63%) registered testicular mesotheliomas, and in two of three (67%) registered ovarian mesotheliomas there was a history of asbestos exposure. This association with asbestos is stronger than in other series collated from surgical resections. Thirdly, on account of the morphological diversity of malignant mesothelioma there is potential for misdiagnosis. The World Health Organization classification of ovarian and testicular tumours each recognize `mesothelioma' as a diagnostic category although an awareness of the occurrence of the tumour at these sites is not widely known. Two of 10 (20%) testicular mesotheliomas and two of three (67%) ovarian mesotheliomas present in the mesothelioma register were available for diagnostic confirmation by use of adjunct techniques. In contrast to pleural and peritoneal mesothelioma, where some 85±90% cases are associated with prior amphibole asbestos exposure, the association between asbestos and gonadal mesotheliomas has not been well made. In the largest series of mesotheliomas of the tunica vaginalis testis, 4 only one of 11 (9%) cases had a history of asbestos exposure and many single case reports document no asbestos history. 9 In one review of 64 cases of tunica vaginalis mesothelioma, asbestos exposure was detailed in 11 of 27 (41%) and a long latent period (similar to pleural and peritoneal cases) of up to 40 years was noted. 10 However, with respect to ovarian mesothelioma, no asbestos exposure was identified in a total of 26 localized peritoneal mesotheliomas in women. 7,8 In this study with cases identified from the mesothelioma register, approximately one-half of the all gonadal mesotheliomas (33% testicular and 67% ovarian) had alleged prior asbestos exposure of occupational origin. The difference in the proportion of asbestos-related gonadal mesotheliomas in this series from others, can be partially explained by selection bias. Clearly, a life-long asbestos history is difficult to ascertain from case series collated from surgical referral specimens. In contrast, most of our cases were occupationally exposed to asbestos and therefore `recall' of exposure is high. It is possible that in a significant proportion of the reported cases where no asbestos history is documented, exposure had occurred in the past but because of the long latency from initial exposure to asbestos and the development of the tumour and subsequent death of the patient, exposure has been forgotten or not enquired into. Nevertheless, the link with asbestos exposure appears

7 156 R L Attanoos & A R Gibbs to be less strong than with pleural and peritoneal mesothelioma. The mechanisms by which inhaled asbestos fibres reach the peritoneal mesothelium and produce their tumorigenic effects are poorly understood. Asbestos fibres have been noted in the peritoneum and are considered to have originated from either inhaled fibres passing through the lung, pleura and diaphragm, or via migration across the gastrointestinal tract wall from swallowed expectorated mucus. 11 In addition, asbestos fibres within the bladder may potentially traverse the bladder wall. In the female, the peritoneum is `open' at the ostia of the fallopian tubes providing an additional means of access of asbestos to the pelvic peritoneum and ovarian surface. An association between asbestos and gastrointestinal, pancreatic and ovarian carcinoma has also been made in some series 12 but the case is far from confirmed. To date, no consistent link has been demonstrated between asbestos and intra-abdominal malignancy other than peritoneal mesothelioma. The results of this study strongly suggest an additional association between asbestos exposure and localized primary ovarian and testicular mesothelioma. Further multicentre studies with formal mineral analysis are considered essential to address issues pertaining to dose-response effect and tumour latency. In this study of primary malignant gonadal mesotheliomas, a number of clinicopathological features are shared between the cases in the different genders. The localized gonadal malignant mesotheliomas have a similar age distribution with peak onset on the sixth decade and presentation with masses or effusions. In both testicular and ovarian types of gonadal mesothelioma the epithelial subtype of mesothelioma is predominant (67% men, 75% women) and sarcomatoid variants are not identified. This compares closely with the findings of one large series of malignant peritoneal mesotheliomas in which the epithelial subtype accounted for 75%, biphasic 22% and sarcomatous variant 2.4% cases, respectively. 2 Similarly in the series of 19 genital and peritoneal mesotheliomas in women, 85% were epithelial and 15% were biphasic subtype tumours. 8 The spectrum of architectural patterns are similarly diverse in primary gonadal mesotheliomas with tubulopapillary (58%) and solid epithelioid (28%) patterns being most common. The socalled deciduoid peritoneal mesothelioma 13 described exclusively in peritoneal mesotheliomas in women was not seen but in the authors' experience it does not represent either a gender or site specific morphological appearance in malignant mesothelioma. The differential diagnoses in malignant gonadal mesothelioma are similar in both genders, and include mesothelial hyperplasia, adenomatoid tumour, well differentiated papillary mesothelioma, malignant germ cell neoplasia (embryonal carcinoma, yolk sac tumour), neoplasms of MuÈ llerian-type and rete (testis/ovarii) origin, desmoplastic small round cell tumour and metastatic tumours. Diagnostic distinction of primary gonadal mesothelioma from diffuse peritoneal mesothelioma may not be possible in small biopsies, as the spectrum of histological and immunophenotypic profiles are identical and confirmation requires radiological or surgical information pertaining to the tumour site and distribution. Diffuse peritoneal mesothelioma may invade the tunica vaginalis and present as a testicular mass although this is very rare. Similarly, ovarian parenchymal involvement in diffuse peritoneal mesothelioma in uncommon. From the 25 years analysis of the Health and Safety Executive Mesothelioma Register, 59 peritoneal mesotheliomas in women were identified (unpublished results). Ovarian involvement was seen in only four (7%) cases and was confined to the serosa and superficial cortex. In contrast, in one other study of 13 diffuse peritoneal mesotheliomas in women, ovarian involvement was seen in 10 patients. These authors reported a further five localized mesotheliomas although none was identified as a primary ovarian tumour. 8 The immunohistochemical features of gonadal mesotheliomas appear similar in both genders and compare closely to that found in diffuse peritoneal mesothelioma. 14,15 The tumours are consistently immunoreactive for pan-cytokeratin and negative with the carcinoma markers, carcinoembryonic antigen and Leu M1. The adenocarcinoma marker Ber EP4 shows some immunoreactivity in 58% gonadal mesotheliomas precluding its use as a first line antibody in the distinction of adenocarcinoma from mesothelioma. The mesothelial markers cytokeratin 5/6 and calretinin were found to be most uniformally expressed in epithelial subtypes of mesothelioma although the stromal component in both biphasic gonadal mesotheliomas was negative with both markers. Thrombomodulin expression was seen in approximately 42% mesotheliomas in this series. Comparative immunohistochemical studies of ovarian and testicular (tunica vaginalis) mesotheliomas are limited but support the notion that the immunophenotype in these anatomical locations are similar to those in the pleura and peritoneum. Particularly in small biopsy specimens, florid reactive mesothelial hyperplasia may mimic malignant mesothelioma. Benign mesothelial proliferation is a common response to serosal injury and may be seen in

8 Primary malignant gonadal mesotheliomas and asbestos 157 hernia sacs 16 in the adnexae of women with chronic salpingitis, endometriosis and in response to adjacent ovarian neoplasia. 17 A diagnosis of reactive mesothelial hyperplasia is favoured if macroscopically there is no tumour mass and light microscopy reveals small sheets of mesothelial cells which lack marked cytonuclear atypia, necrosis, papillary formation and deep stromal invasion. Superficial extension of mesothelial cells arranged in parallel and linear layers may be seen in benign mesothelial proliferations. Inflammation per se is unreliable as an indicator of benignancy. The role of immunohistochemistry in the distinction of benign and malignant mesothelial proliferation is limited although epithelial membrane antigen, 18 p53, 19 platelet-derived growth factor-beta chain 20 and p have been reported to be of use. A lack of staining with the stated markers is considered to favour a benign process, although their reliability requires further scrutiny before use in routine surgical practice. In the ovarian and testicular adnexa, benign mesothelial tumours such as adenomatoid tumour and well-differentiated papillary mesothelioma have been reported. 6, 22±23 In this series, morphological features simulating both these lesions were seen in both sexes, although the diagnosis of malignant mesothelioma was favoured by the presence of tumour necrosis, marked cytological atypia, focal biphasic growth pattern and infiltrative growth pattern. Large tumour size and a diffuse serosal growth pattern are useful diagnostic features although for primary intragonadal mesotheliomas this important diagnostic feature has less utility. In the ovary, the main neoplastic differential diagnosis of primary gonadal tubulopapillary epithelial subtype mesothelioma is with primary serous papillary carcinoma and is important because of the different aetiological considerations, clinical course and treatment. 24,25 Despite occasional claims there is no clear association between ovarian carcinoma and asbestos. Macroscopically, the two tumours may be indistinguishable, although in this study and in one other study on ovarian mesothelioma the tumours did not exceed 150 mm and showed no cystic appearance as is common in serous carcinomas. By light microscopy, serous papillary carcinomas have broader papillae, may demonstrate cellular stratification and budding and are lined by columnar cells exhibiting more marked nuclear atypia than are commonly seen in tubulopapillary mesotheliomas. Psammoma bodies are more frequent in serous ovarian neoplasms although they can be seen in about 5% of peritoneal mesotheliomas and they were identified in one case (14%) of seven gonadal mesotheliomas. Clear cell carcinoma of the ovary and peritoneum 26 may also mimic malignant mesothelioma with tubulopapillary areas, hyaline cores and hobnail cells. Nuclear atypia is usually more marked in clear cell carcinoma and neutral mucin may be present which would make a diagnosis of mesothelioma very unlikely. Rarely, morphologically similar MuÈ llerian-type neoplasms have been described in the paratesticular region. 27 In both ovary and testis certain forms of germ cell neoplasia may produce diagnostic difficulty with primary gonadal mesothelioma. Yolk sac tumours demonstrate a prominent fine reticulated `lacy' pattern and tubulopapillary areas are also seen. These morphological patterns may mimic tubulopapillary or adenomatoid pattern epithelial subtype mesothelioma. Yolk sac tumour is favoured by its occurence in a younger age group. The typical Schiller±Duval bodies are not seen in malignant mesothelioma. Immunohistochemical expression of alpha fetoprotein would further support the diagnosis of yolk sac tumour. Malignant teratoma (and malignant mixed MuÈ llerian tumours) are considered as favoured differential diagnoses in the differential diagnosis of biphasic cases of gonadal mesothelioma. In each case careful attention to the morphological and immunophenotypic appearances of the epithelial component in each tumour should allow for adequate distinction from malignant mesothelioma. In none of the primary testicular mesotheliomas was there evidence of intratubular germ cell neoplasia. Tumours of rete (ovarii or testis) origin are extremely uncommon although morphologically produce tubulopapillary structures and may mimic epithelial mesothelioma. 28 Limited immunohistochemical studies suggest that the tumour are cytokeratin and epithelial membrane antigen positive and 25% expressed CEA. However, ultrastructural studies allowed for distinction from malignant mesothelioma on account of the shorter microvillous structure and lack of dense perinuclear tonofilaments seen in neoplasms of rete origin. Metastatic tumour may invade the ovarian and testicular parenchyma. In most ovarian cases diffuse gastric adenocarcinoma (Krukenberg tumour), colonic, breast or pulmonary carcinoma are the primary tumour sites and are clinically apparant prior to the diagnosis of an ovarian tumour. 29 In the testis, prostatic and pulmonary carcinoma metastases are most frequently documented and form intraparenchymal lesions. 30,31 In contrast, most cases of malignant mesothelioma at this site form a diffuse serosal growth within the tunica vaginalis. Further distinction should

9 158 R L Attanoos & A R Gibbs be straight forward by use of mucin stains and appropriate immunohistochemical studies. Malignant gonadal mesotheliomas appear to follow a variable clinical course with mean survival from diagnosis of 26 months and survival times over 3 years recorded in three (42%) of the seven cases. In some of our cases the tumour behaviour was found to be similar to that seen in diffuse pedtoneal mesothelioma. Survival for longer than 5 years is exceptional in bone fide cases of diffuse peritoneal mesothelioma although rare cases have been reported. 31,32 Extent of disease at presentation is important prognostically with localized tumours conferring a more favourable prognosis. In one series only localized mesothelial tumours with a uniform benign morphological appearance were found to predictably have a benign clinical behaviour, and diffuse or multifocal tumours were invariably associated with more malignant cytonuclear features and a progressive clinical course. 8 In the two gonadal mesotheliomas associated with prolonged survival, no histopathological features were identified which may be considered to be associated with an indolent course. Furthermore neither case represented an adenomatoid tumour, multicystic mesothelioma or well-differentiated papillary mesothelioma. The presence of ascites and abdominal mass formation or recurrent hydrocele are often associated with malignant forms of mesothelioma but are not specific clinical findings. In summary, we present seven primary malignant gonadal mesotheliomas. These tumours represent a poorly described tumour category in both sites. An awareness of their existence is important to prevent misdiagnosis. In both genders the tumours show a similar age distribution (with median onset in the sixth decade), an association with asbestos (in approximately 50% cases), a diverse histological spectrum (with predominantly tubulopapillary epithelial subtype tumours) and immunophenotype that is comparable with malignant pleural and peritoneal mesothelioma. The clinical course appears variable (mean, 26 months; range, 9±50 months). All tumours in the study presented as localized masses and their prognosis appeared more favourable than diffuse pleural and peritoneal cases. The accurate diagnosis of primary gonadal mesothelioma has potentially important medicolegal compensation considerations. References 1. Enzinger FM, Weiss SW. Soft Tissue Tumours, 3rd edn. St Louis: Mosby, 1995: 787± Kannerstein M, Churg J. Peritoneal mesothelioma. Hum. Pathol. 1977; 8; 83± Roggli VL. Pericardial mesothelioma after exposure to asbestos. N. Engl. J. Med. 1981; 304; Jones MA, Young RH, Scully RE. Malignant mesothelioma of the tunica vaginalis. Am. J. Surg. Pathol. 1995; 19; 815± Parmley TH, Woodruff JD. The ovarian mesothelioma. Am. J. Obstet. Gynaecol. 1974; 120; 234± Addis BJ, Fox H. Papillary mesothelioma of ovary. Histopathology 1983; 7; 287± Clement PB, Young RH, Scully RE. Malignant mesotheliomas presenting as ovarian masses. A report of nine cases, including two primary ovarian mesotheliomas. Am. J. Surg. Pathol. 1996; 20; 1067± Goldblum J, Hart WR. Localised and diffuse mesotheliomas of the genital tract and peritoneum in women. A clinicopathological study of nineteen true mesothelial neoplasms, other than adenomatoid tumours, multicystic mesotheliomas and localised fibrous tumours. Am. J. Surg. Pathol. 1995; 19; 1124± Barbera V, Rubino M. Papillary mesothelioma of the tunica vaginalis. Cancer 1957; 10; 182± Antman K, Cohen S, Dimitrov NV et al. Malignant mesothelioma of the tunica vaginalis testis. J. Clin. Oncol. 1984; 2; 447± Enticknap JB, Smither J. Peritoneal tumours in asbestosis. Br. J. Ind. Med. 1964; 21; 20± Acheson ED, Gardner MJ, Pippard EC et al. Mortality of two groups of women who manufactured gas masks from chryostile and crocidolite asbestos: a 40 year follow-up. Br. J. Ind. Med. 1982; 39; 344± Nascimento AG, Keeney GL, Fletcher CDM. Deciduiod peritoneal mesothelioma. An unusual phenotype affecting young females. Am. J. Surg. Pathol. 1994; 18; 439± Bollinger DJ, Wick MR, Dehner LP et al. Peritoneal malignant mesothelioma versus serous papillary adenocarcinoma. A histochemical and immunohistochemical comparison. Am. J. Surg. Pathol. 1989; 13; 659± Attanoos RL, Gibbs AR. Pathology of malignant mesothelioma. Histopathology 1997; 30; 403± Rosai J, Dehner LP. Nodular mesothelial hyperplasia in hernia sacs. A benign reactive condition simulating a neoplastic process. Cancer 1975; 35; 165± Clement PB, Young RH. Florid mesothelial hyperplasia associated with ovarian tumours: a potential source of error in tumour diagnosis and staging. Int. J. Gynaecol. Pathol. 1993; 12; 51± Walts AE, Said JW, Shintaku IP. Epithelial membrane antigen in the cytodiagnosis of effusions and aspirates: Immunocytochemical and ultrastructural localisation in benign and malignant cells. Diagn. Cytol. Pathol. 1987; 3; 41± Mayall FG, Goddard H, Gibbs AR. An assessment of p53 immunostaining in the distinction between benign and malignant mesothelial proliferation using formalin fixed paraffin sections. J. Pathol. 1993; 168; 337± Ramael M, Buysse C, Van den Bossche J et al. Immunoreactivity for the B chain of the platelet-derived growth factor receptor in malignant mesothelioma and non-neoplastic mesothelium. J. Pathol. 1992; 167; 1± Ramael M, Van den Bossche J, Buysse C et al. Immunoreactivity for P-170 glycoprotein in malignant mesothelioma and in nonneoplastic mesothelium of the pleura using the monoclonal antibody JSB-1. J. Pathol. 1992; 167; 5± Chetty R. Well differentiated (benign) papillary mesothelioma of the tunica vaginalis. J. Clin. Pathol. 1992; 42; 1029± Daya D, McCaughey WTE. Well differentiated papillary mesothelioma of the peritoneum: a clinicopathological study of 22 cases. Cancer 1990; 65; 292±296.

10 Primary malignant gonadal mesotheliomas and asbestos Foyle AA, ]-Jabi M, McCaughey WTE. Papillary peritoneal tumours in women. Am. J. Surg. Pathol. 1981; 5; 241± Kannerstein M, Churg J, McCaughey WTE. Papillary tumours of the peritoneum in women: mesothelioma or papillary carcinoma. Am. J. Obstet. Gynaecol. 1977; 127; 306± Lee KR, Venna U, Belinson J. Primary clear cell carcinoma of the peritoneum. Gynaecol. Oncol. 1991; 41; 259± Young RH, Scully RE. Testicular and paratesticular tumours and tumour-like lesions of ovarian common epithelial and MuÈllerian types. Am. J. Clin. Pathol. 1986; 86; 146± Nochomowitz LE, Orenstein JM. Adenocarcinoma of the rete testis. Review and regrouping of reported cases and a consideration of miscellaneous entities. J. Urogen. Pathol. 1991; 1; 11± Young RH, Scully RE. Metastatic tumours in the ovary: a problem oriented approach and review of the literature. Senlin. Diagn. Pathol. 1991; 8; 250± Haupt HM, Mann RB, Trump DL et al. Metastatic carcinoma involving the testis. Clinical and pathological distinction from primary testicular neoplasms. Cancer 1984; 54; 10± Antman KH, Klegar KL, Pomfret EA et al. Early peritoneal mesothelioma: a treatable malignancy. Lancet 1985; 2; 977± Geary WA, Mills SE, Frierson HF et al. Malignant peritoneal mesothelioma in childhood with long-term survival. Am. J. Surg. Pathol. 1991; 95; 493±498.

Update on Mesothelioma

Update on Mesothelioma November 8, 2012 Update on Mesothelioma Intro incidence and nomenclature Update on Classification Diagnostic specimens Morphologic features Epithelioid Histology Biphasic Histology Immunohistochemical

More information

MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY

MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY MALIGNANT MESOTHELIOMA CLASSIFICATION MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY Sisko Anttila, MD, PhD Jorvi Hospital Laboratory of Pathology Helsinki University Hospital Espoo,

More information

MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY

MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY Sisko Anttila, MD, PhD Jorvi Hospital Laboratory of Pathology Helsinki University Hospital Espoo, Finland 2nd Nordic Conference on Applied

More information

Today s Topics. Tumors of the Peritoneum in Women

Today s Topics. Tumors of the Peritoneum in Women Today s Topics Tumors of the Peritoneum in Women Charles Zaloudek, M.D. Department of Pathology 505 Parnassus Ave., M563 University of California, San Francisco San Francisco, CA USA charles.zaloudek@ucsf.edu

More information

TUMORS OF THE TESTICULAR ADNEXA and SPERMATIC CORD

TUMORS OF THE TESTICULAR ADNEXA and SPERMATIC CORD TUMORS OF THE TESTICULAR ADNEXA and SPERMATIC CORD Victor E. Reuter, MD Memorial Sloan-Kettering Cancer Center reuterv@mskcc.org 66 th Annual Pathology Seminar California Society of Pathologists Short

More information

Case of the. Month October, 2012

Case of the. Month October, 2012 Case of the Month October, 2012 Case The patient is a 47-year-old male with a 3-week history of abdominal pain. A CT scan of the abdomen revealed a suggestion of wall thickening at the tip of the appendix

More information

Protocol applies to all primary borderline and malignant epithelial tumors, and malignant mesothelial neoplasms of the peritoneum.

Protocol applies to all primary borderline and malignant epithelial tumors, and malignant mesothelial neoplasms of the peritoneum. Peritoneum Protocol applies to all primary borderline and malignant epithelial tumors, and malignant mesothelial neoplasms of the peritoneum. Protocol revision date: January 2004 No AJCC/UICC staging system

More information

The develpemental origin of mesothelium

The develpemental origin of mesothelium Mesothelioma Tallinn 14.12.06 Henrik Wolff Finnish Institute of Occupational Health The develpemental origin of mesothelium Mesodermal cavities (pleura, peritoneum and pericardium ) are lined with mesenchymal

More information

Diagnostic Challenge. Department of Pathology,

Diagnostic Challenge. Department of Pathology, Cytology of Pleural Fluid as a Diagnostic Challenge Paavo Pääkkö,, MD, PhD Chief Physician and Head of the Department Department of Pathology, Oulu University Hospital,, Finland Oulu University Hospital

More information

PATHOLOGY OF THE PLEURA: Mesothelioma and mimickers Necessity of Immunohistochemistry. M. Praet

PATHOLOGY OF THE PLEURA: Mesothelioma and mimickers Necessity of Immunohistochemistry. M. Praet PATHOLOGY OF THE PLEURA: Mesothelioma and mimickers Necessity of Immunohistochemistry M. Praet Pathology of the Pleura Normal serosa: visceral and parietal layers Inflammation Neoplasia: Primary: mesothelioma

More information

Case presentation: Mesothelioma of the tunica vaginalis. Dr Ben Shepherd Pathology Queensland Princess Alexandra Hospital Brisbane

Case presentation: Mesothelioma of the tunica vaginalis. Dr Ben Shepherd Pathology Queensland Princess Alexandra Hospital Brisbane Case presentation: Mesothelioma of the tunica vaginalis Dr Ben Shepherd Pathology Queensland Princess Alexandra Hospital Brisbane A 76 year old man presented June 2011 with a 6 month history of painless

More information

Cytology : first alert of mesothelioma? Professor B. Weynand, UCL Yvoir, Belgium

Cytology : first alert of mesothelioma? Professor B. Weynand, UCL Yvoir, Belgium Cytology : first alert of mesothelioma? Professor B. Weynand, UCL Yvoir, Belgium Introduction 3 cavities with the same embryologic origin the mesoderme Pleura Exudates Pleura Peritoneum Pericardium 22%

More information

3-F. Pathology of Mesothelioma

3-F. Pathology of Mesothelioma 3-F. Pathology of Mesothelioma Kouki Inai Professor of Department of Pathology, Graduate School of Biomedical Science, Hiroshima University Introduction Mesothelioma is a peculiar type of malignancy, which

More information

Case presentation. Awatif Al-Nafussi

Case presentation. Awatif Al-Nafussi Case presentation Awatif Al-Nafussi Case History 49 year old DVT & small PE June 08, Pelvic mass Ca125 33 Laparotomy-TAHBSO, drainage of ascites Ovarian carcinoma Clinical diagnosis Multiple specimens

More information

Practical Effusion Cytology

Practical Effusion Cytology Practical Effusion Cytology A Community Pathologist s Approach to Immunocytochemistry in Body Fluid Cytology Emily E. Volk, MD William Beaumont Hospital Troy, MI College of American Pathologists 2004.

More information

Disclosures. Learning Objectives. Effusion = Confusion. Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell!

Disclosures. Learning Objectives. Effusion = Confusion. Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell! Disclosures Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell! No Relevant Financial Relationships with Commercial Interests Syed Z. Ali, M.D. Syed Z. Ali, M.D. Associate Professor of

More information

Académie internationale de Pathologie - Division arabe XX ème congrès 24-26 novembre 2008 Alger. Immunohistochemistry in malignant mesotheliomas

Académie internationale de Pathologie - Division arabe XX ème congrès 24-26 novembre 2008 Alger. Immunohistochemistry in malignant mesotheliomas Académie internationale de Pathologie - Division arabe XX ème congrès 24-26 novembre 2008 Alger Immunohistochemistry in malignant mesotheliomas Françoise Thivolet-Béjui Groupement Hospitalier Est Lyon-Bron

More information

Diagnosis of Mesothelioma Pitfalls and Practical Information

Diagnosis of Mesothelioma Pitfalls and Practical Information Diagnosis of Mesothelioma Pitfalls and Practical Information Mary Beth Beasley, M.D. Mt Sinai Medical Ctr Dept of Pathology One Gustave L Levy Place New York, NY 10029 (212) 241-5307 mbbeasleymd@yahoo.com

More information

Effusions: Mesothelioma and Metastatic Cancers

Effusions: Mesothelioma and Metastatic Cancers Effusions: Mesothelioma and Metastatic Cancers Malignant Mesothelioma Incidence: 2,500 cases/year ~60-80% pts with pleural MM relationship with asbestos exposure Other risk factors: radiation, other carcinogens,

More information

Protocol for the Examination of Specimens From Patients With Tumors of the Peritoneum

Protocol for the Examination of Specimens From Patients With Tumors of the Peritoneum Protocol for the Examination of Specimens From Patients With Tumors of the Peritoneum Protocol applies to all primary borderline and malignant epithelial tumors and malignant mesothelial neoplasms of the

More information

Notice of Faculty Disclosure

Notice of Faculty Disclosure The Diagnosis of Malignant Mesothelioma Andrew Churg, MD Department of Pathology University of British Columbia Vancouver, BC, Canada achurg@mail.ubc.ca Notice of Faculty Disclosure In accordance with

More information

Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell! Effusion = Confusion

Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell! Effusion = Confusion Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell! Effusion = Confusion Syed Z. Ali, M.D. Professor of Pathology and Radiology The Johns Hopkins Hospital Baltimore, Maryland Diagnostic

More information

Pathology of the Female Peritoneum, Common and Uncommon Problems

Pathology of the Female Peritoneum, Common and Uncommon Problems Pathology of the Female Peritoneum, Common and Uncommon Problems An Update on Gynecologic Pathology Florence, Italy Anaís Malpica, M.D. Professor of Pathology Pathology of the Female Peritoneum Keratin

More information

Malignant Peritoneal Mesothelioma in Women A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis

Malignant Peritoneal Mesothelioma in Women A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis Anatomic Pathology / MALIGNANT PERITONEAL MESOTHELIOMA IN WOMEN Malignant Peritoneal Mesothelioma in Women A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis Patricia

More information

P L E U R A L M E S O T H E L I O M A

P L E U R A L M E S O T H E L I O M A For media outside the US, UK and Canada only P L E U R A L M E S O T H E L I O M A 1. Overview 2. What is pleural mesothelioma? 3. How common is pleural mesothelioma? 4. What are the risk factors for pleural

More information

PRIMARY SEROUS CARCINOMA OF PERITONEUM: A CASE REPORT

PRIMARY SEROUS CARCINOMA OF PERITONEUM: A CASE REPORT PRIMARY SEROUS CARCINOMA OF PERITONEUM: A CASE REPORT Dott. Francesco Pontieri (*) U.O. di Anatomia Patologica P.O. di Rossano (CS) Dott. Gian Franco Zannoni Anatomia Patologica Facoltà di Medicina e Chirurgia

More information

Survey of Mesothelioma Associated with Asbestos Exposure in Japan

Survey of Mesothelioma Associated with Asbestos Exposure in Japan The research and development and the dissemination projects related to the 13 fields of occupational injuries and illnesses Survey of Mesothelioma Associated with Asbestos Exposure in Japan Clinical characteristics

More information

HKCPath Anatomical Pathology Peer Review and Scores : PDF version for download

HKCPath Anatomical Pathology Peer Review and Scores : PDF version for download AP2003R1 http://hkcpath.org. Correspondence: pkhui@ha.org.hk 1of 10 07/08/2003 HKCPath Anatomical Pathology Peer Review and Scores : PDF version for download AP141 Bone Marrow: Metastatic Carcinoma from

More information

Outline. Workup for metastatic breast cancer. Metastatic breast cancer

Outline. Workup for metastatic breast cancer. Metastatic breast cancer Metastatic breast cancer Immunostain Update: Diagnosis of metastatic breast carcinoma, emphasizing distinction from GYN primary 1/3 of breast cancer patients will show metastasis 1 st presentation or 20-30

More information

Effusions of the Serous Cavities

Effusions of the Serous Cavities Effusions of the Serous Cavities Annika Dejmek Professor/Consultant in Cytopathology Clinical Pathology; Department of Laboratory Medicine, Malmö, Lund University 5th EFCS Tutorial Trondheim 2012 Pleura

More information

A Cytokeratin- and Calretinin-negative Staining Sarcomatoid Malignant Mesothelioma

A Cytokeratin- and Calretinin-negative Staining Sarcomatoid Malignant Mesothelioma A Cytokeratin- and Calretinin-negative Staining Sarcomatoid Malignant Mesothelioma MICHAEL G. HURTUK and MICHELE CARBONE Cardinal Bernadin Cancer Center, Cancer Immunology Program, Department of Pathology,

More information

MESOTHELIAL LESIONS OF THE PERITONEUM

MESOTHELIAL LESIONS OF THE PERITONEUM 1 MESOTHELIAL LESIONS OF THE PERITONEUM Philip B. Clement, MD Departments of Pathology, Vancouver General Hospital and the University of British Columbia 2 Mesothelial lesions are commonly encountered

More information

Diseases. Inflammations Non-inflammatory pleural effusions Pneumothorax Tumours

Diseases. Inflammations Non-inflammatory pleural effusions Pneumothorax Tumours Pleura Visceral pleura covers lungs and extends into fissures Parietal pleura limits mediastinum and covers dome of diaphragm and inner aspect of chest wall. Two layers between them (pleural cavity) contains

More information

Mesothelioma. 1. Introduction. 1.1 General Information and Aetiology

Mesothelioma. 1. Introduction. 1.1 General Information and Aetiology Mesothelioma 1. Introduction 1.1 General Information and Aetiology Mesotheliomas are tumours that arise from the mesothelial cells of the pleura, peritoneum, pericardium or tunica vaginalis [1]. Most are

More information

Uses and Abuses of Pathology in Asbestos-exposed Populations

Uses and Abuses of Pathology in Asbestos-exposed Populations Uses and Abuses of Pathology in Asbestos-exposed Populations Jerrold L. Abraham, MD Department of Pathology State University of New York Upstate Medical University Syracuse, NY, 13210 USA The term: Asbestosis,

More information

A. Pericardial smear. Examination of the pericardial aspirate can provide useful diagnostic information.

A. Pericardial smear. Examination of the pericardial aspirate can provide useful diagnostic information. 5. PERICARDIUM Heart is encased by the pericardium which has a visceral layer (a) covering the heart and the parietal layer (b). In normal states it is thin, transparent and the myocardium can be seen

More information

ASBESTOS EXPOSURE AND SARCOMATOID MALIGNANT PLEURAL MESOTHELIOMA Gorantla Sambasivarao 1, Namballa Usharani 2, Tupakula Suresh Babu 3

ASBESTOS EXPOSURE AND SARCOMATOID MALIGNANT PLEURAL MESOTHELIOMA Gorantla Sambasivarao 1, Namballa Usharani 2, Tupakula Suresh Babu 3 ASBESTOS EXPOSURE AND SARCOMATOID MALIGNANT PLEURAL MESOTHELIOMA Gorantla Sambasivarao 1, Namballa Usharani 2, Tupakula Suresh Babu 3 HOW TO CITE THIS ARTICLE: Gorantla Sambasivarao, Namballa Usharani,

More information

Immunohistochemistry on cytology specimens from pleural and peritoneal fluid

Immunohistochemistry on cytology specimens from pleural and peritoneal fluid Immunohistochemistry on cytology specimens from pleural and peritoneal fluid Dr Naveena Singh Consultant Pathologist Bart health NHS Trust London United Kingdom Disclosures and Acknowledgements I have

More information

J of Evidence Based Med & Hlthcare, pissn- 2349-2562, eissn- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 5063

J of Evidence Based Med & Hlthcare, pissn- 2349-2562, eissn- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 5063 PERITONEAL MALIGNANT MESOTHELIOMA: A RARE S. R. Dhamotharan 1, S. Shanthi Nirmala 2, F. Celine Foustina Mary 3, M. Arul Raj Kumar 4, R. Vinothprabhu 5 HOW TO CITE THIS ARTICLE: S. R. Dhamotharan, S. Shanthi

More information

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH How to cite this article: DEBNATH S, MISRA V, SINGH PA, SINGH M. LOW GRADE CYSTIC MESOTHELIOMA OF RECTUS SHEATH.Journal of Clinical and Diagnostic Research [serial

More information

Clinicopathological Study on Malignant Pleural Mesotheliomas

Clinicopathological Study on Malignant Pleural Mesotheliomas Table of Contents Clinicopathological Study on Malignant Pleural Mesotheliomas PL-4-03 Kenzo Hiroshima Kenzo Hiroshima 1, Akira Iyota 1, Kiyoshi Sibuya 1, Toshikazu Yusa 2, Takehiko Fujisawa 1 and Yukio

More information

Case Report Predominantly Fibrous Malignant Mesothelioma in a Cat

Case Report Predominantly Fibrous Malignant Mesothelioma in a Cat SAGE-Hindawi Access to Research Volume 2010, Article ID 396794, 4 pages doi:10.4061/2010/396794 Case Report Predominantly Fibrous Malignant Mesothelioma in a Cat Alexander Th. A. Weiss, Afonso B. da Costa,

More information

Mesothelioma: Questions and Answers

Mesothelioma: Questions and Answers CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Mesothelioma: Questions

More information

20 Diagnostic Cytopathology, Vol 36, No 1 ' 2007 WILEY-LISS, INC.

20 Diagnostic Cytopathology, Vol 36, No 1 ' 2007 WILEY-LISS, INC. Utility of WT-1, p63, MOC31, Mesothelin, and Cytokeratin (K903 and CK5/6) Immunostains in Differentiating Adenocarcinoma, Squamous Cell Carcinoma, and Malignant Mesothelioma in Effusions Robert T. Pu,

More information

ISOLATED PANCREATIC METASTASIS OF A MALIGNANT PLEURAL MESOTHELIOMA

ISOLATED PANCREATIC METASTASIS OF A MALIGNANT PLEURAL MESOTHELIOMA ISOLATED PANCREATIC METASTASIS OF A MALIGNANT PLEURAL MESOTHELIOMA Yi-Ting Lin, 1 Bing-Shiun Wu, 2 Sheau-Fang Yang, 3 and Huang-Chi Chen 4 Departments of 1 Family Medicine, 2 Internal Medicine, and 3 Pathology,

More information

MALIGNANT MESOTHELIOMA: A TYPICAL PRESENTATION IN AN ATYPICAL PATIENT

MALIGNANT MESOTHELIOMA: A TYPICAL PRESENTATION IN AN ATYPICAL PATIENT MALIGNANT MESOTHELIOMA: A TYPICAL PRESENTATION IN AN ATYPICAL PATIENT Written by: Karyn Varley MS, SCT(ASCP) The donating laboratory would like to remain anonymous. PATIENT HISTORY 28 year old female Lived

More information

Primary -Benign - Malignant Secondary

Primary -Benign - Malignant Secondary TUMOURS OF THE LUNG Primary -Benign - Malignant Secondary The incidence of lung cancer has been increasing almost logarithmically and is now reaching epidemic levels. The overall cure rate is very low

More information

Cytopathology Case Presentation #8

Cytopathology Case Presentation #8 Cytopathology Case Presentation #8 Emily E. Volk, MD William Beaumont Hospital, Troy, MI Jonathan H. Hughes, MD Laboratory Medicine Consultants, Las Vegas, Nevada Clinical History 44 year old woman presents

More information

Abstract. Introduction. Material and Methods

Abstract. Introduction. Material and Methods Original Article Expression of Mesothelial Markers in Malignant Mesotheliomas: an Immunohistochemical Evaluation of 173 Cases I.N. Soomro, R. Oliveira*, J. Ronan, Z. R. Chaudry, J. Johnson Department of

More information

Diagnostic Slide Session Case Jennifer Ziskin MD, PhD, and Edward D Plowey MD, PhD Stanford University, Stanford, CA

Diagnostic Slide Session Case Jennifer Ziskin MD, PhD, and Edward D Plowey MD, PhD Stanford University, Stanford, CA Diagnostic Slide Session Case 2015-2 Jennifer Ziskin MD, PhD, and Edward D Plowey MD, PhD Stanford University, Stanford, CA Clinical History: 18 year old woman with right facial pain and hyperalgesia Past

More information

Something Old, Something New.

Something Old, Something New. Something Old, Something New. Michelle A. Fajardo, D.O. Loma Linda University Medical Center Clinical Presentation 6 year old boy, presented with hematuria Renal mass demonstrated by ultrasound & CT scan

More information

Rare Thoracic Tumours

Rare Thoracic Tumours Rare Thoracic Tumours 1. Epithelial Tumour of Trachea 1 1.1 General Results Table 1. Epithelial Tumours of Trachea: Incidence, Trends, Survival Flemish Region 2001-2010 Both Sexes Incidence Trend EAPC

More information

INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER Prospective Mesothelioma Staging Project

INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER Prospective Mesothelioma Staging Project INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER Prospective Mesothelioma Staging Project Data Forms and Fields in CRAB Electronic Data Capture System - Reduced Set - Pivotal data elements for developing

More information

Malignant Peritoneal Mesothelioma in Women A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis

Malignant Peritoneal Mesothelioma in Women A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis Anatomic Pathology / MALIGNANT PERITONEAL MESOTHELIOMA IN WOMEN Malignant Peritoneal Mesothelioma in Women A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis Patricia

More information

Recommendations for the Reporting of Pleural Mesothelioma

Recommendations for the Reporting of Pleural Mesothelioma Recommendations for the Reporting of Pleural Mesothelioma Association of Directors of Anatomic and Surgical Pathology * DOI: 10.1309/6A30YQHBMTHEJTEM It has been evident for decades that pathology reports

More information

Case Report Epithelioid malignant mesothelioma presenting with features of gastric tumor in a child

Case Report Epithelioid malignant mesothelioma presenting with features of gastric tumor in a child Int J Clin Exp Pathol 2014;7(5):2636-2640 www.ijcep.com /ISSN:1936-2625/IJCEP0000187 Case Report Epithelioid malignant mesothelioma presenting with features of gastric tumor in a child Qihan You 1, Jing

More information

Pathology of Ovary and Fallopian Tube Thomas C. Wright, Jr.

Pathology of Ovary and Fallopian Tube Thomas C. Wright, Jr. Pelvic Inflammatory Disease Most common diseases: Inflammation - as part of pelvic inflammatory disease Ectopic pregnancy Endometriosis Primary tumors - quite rare Most common causes of PID Chlamydia trachomatis

More information

Pleural Mesothelioma: An Institutional Experience of 66 Cases

Pleural Mesothelioma: An Institutional Experience of 66 Cases The Korean Journal of Pathology 2014; 48: 91-99 ORIGINAL ARTICLE Pleural Mesothelioma: An Institutional Experience of 66 Cases Soomin Ahn In Ho Choi Joungho Han Jhingook Kim 1 Myung-Ju Ahn 2 Departments

More information

Ovarian mucinous lesions. Ovarian mucinous lesions: Common diagnostic dilemmas. Ovarian mucinous lesions: problematic issues

Ovarian mucinous lesions. Ovarian mucinous lesions: Common diagnostic dilemmas. Ovarian mucinous lesions: problematic issues Ovarian mucinous lesions Ovarian mucinous lesions: Common diagnostic dilemmas Karuna Garg, MD University of California San Francisco Intestinal or usual type Seromucinous (Endocervical mucinous or Mullerian

More information

بسم هللا الرحمن الرحيم

بسم هللا الرحمن الرحيم بسم هللا الرحمن الرحيم Updates in Mesothelioma By Samieh Amer, MD Professor of Cardiothoracic Surgery Faculty of Medicine, Cairo University History Wagner and his colleagues (1960) 33 cases of mesothelioma

More information

The Use of Immunohistochemistry to Distinguish Reactive Mesothelial Cells From Malignant Mesothelioma in Cytologic Effusions

The Use of Immunohistochemistry to Distinguish Reactive Mesothelial Cells From Malignant Mesothelioma in Cytologic Effusions The Use of Immunohistochemistry to Distinguish Reactive Mesothelial Cells From Malignant Mesothelioma in Cytologic Effusions Farnaz Hasteh, MD 1 ; Grace Y. Lin, MD, PhD 1 ; Noel Weidner, MD 1 ; and Claire

More information

Ovarian tumors Ancillary methods

Ovarian tumors Ancillary methods Ovarian tumors Ancillary methods Ovarian tumor course Oslo, 24-25/11/14 Prof. Ben Davidson, MD PhD Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway Division of

More information

Carcinosarcoma of the Ovary

Carcinosarcoma of the Ovary Carcinosarcoma of the Ovary A Rare Finding Presented By: Kathryn Kiely Anisa I. Kanbour School of Cytotechnology of the University of Pittsburgh Medical Center Pittsburgh, PA Patient History 55 year old

More information

Malignant mesothelioma of the pleura: relation

Malignant mesothelioma of the pleura: relation Thorax 1982;37:810-815 Malignant mesothelioma of the pleura: relation between histological type and clinical behaviour MR LAW, MARGARET E HODSON, BE HEARD From the Cardiothoracic Institute and Brompton

More information

Subtle mediastinal pleural thickening on computerised tomography as a predictor of mesothelioma

Subtle mediastinal pleural thickening on computerised tomography as a predictor of mesothelioma Subtle mediastinal pleural thickening on computerised tomography as a predictor of mesothelioma Poster No.: C-1794 Congress: ECR 2011 Type: Scientific Exhibit Authors: A. Roy, S. ellis, T. Iyngkaran ;

More information

Fine Needle Aspiration Cytologic Features of Well-Differentiated Papillary Mesothelioma in the Pleura

Fine Needle Aspiration Cytologic Features of Well-Differentiated Papillary Mesothelioma in the Pleura The Korean Journal of Pathology 2009; 43: 583-8 DOI: 10.4132/KoreanJPathol.2009.43.6.583 Fine Needle Aspiration Cytologic Features of Well-Differentiated Papillary Mesothelioma in the Pleura - A Case Report

More information

The Value of Thyroid Transcription Factor-1 in Cytologic Preparations as a Marker for Metastatic Adenocarcinoma of Lung Origin

The Value of Thyroid Transcription Factor-1 in Cytologic Preparations as a Marker for Metastatic Adenocarcinoma of Lung Origin Anatomic Pathology / TTF-1 IN CYTOLOGY OF BODY FLUIDS The Value of Thyroid Transcription Factor-1 in Cytologic Preparations as a Marker for Metastatic Adenocarcinoma of Lung Origin Jonathan L. Hecht, MD,

More information

INFLAMMATORY PLEURAL EFFUSION

INFLAMMATORY PLEURAL EFFUSION PLEURA- LESIONS LESIONS OF PLEURA Primary Intra pleural bacterial infections Neoplasm (mesothelioma) Secondary A complication of some underlying disease PLEURAL EFFUSION Common manifestation of both primary

More information

Malignant Mesothelioma

Malignant Mesothelioma Malignant Malignant mesothelioma is a tumour originating from mesothelial cells. 85 95% of mesotheliomas are caused by asbestos exposure. It occurs much more commonly in the chest (malignant pleural mesothelioma)

More information

PROTOCOL OF THE RITA DATA QUALITY STUDY

PROTOCOL OF THE RITA DATA QUALITY STUDY PROTOCOL OF THE RITA DATA QUALITY STUDY INTRODUCTION The RITA project is aimed at estimating the burden of rare malignant tumours in Italy using the population based cancer registries (CRs) data. One of

More information

Malignant Mesothelioma

Malignant Mesothelioma Malignant mesothelioma is a tumour originating from mesothelial cells. 85 95% of mesotheliomas are caused by asbestos exposure. It occurs much more commonly in the chest (malignant pleural mesothelioma)

More information

The evolving pathology of solitary fibrous tumours. Luciane Dreher Irion MREH / CMFT / NSOPS

The evolving pathology of solitary fibrous tumours. Luciane Dreher Irion MREH / CMFT / NSOPS The evolving pathology of solitary fibrous tumours Luciane Dreher Irion MREH / CMFT / NSOPS Historical review Haemangiopericytoma (HPC) first described primarily as a soft tissue vascular tumour of pericytic

More information

A 70-year old Man with Pleural Effusion

A 70-year old Man with Pleural Effusion Mesothelioma Diagnosis: Pitfalls and Latest Updates S Klebe and DW Henderson Recommendations Indisputable malignant cells on cytomorphological criteria which demonstrate a mesothelial phenotype, which

More information

Malignant Mesothelioma in Body Fluids - with Special Reference to Differential Diagnosis from Metastatic Adenocarcinoma -

Malignant Mesothelioma in Body Fluids - with Special Reference to Differential Diagnosis from Metastatic Adenocarcinoma - The Korean Journal of Pathology 2009; 43: 458-66 DOI: 10.4132/KoreanJPathol.2009.43.5.458 Malignant Mesothelioma in Body Fluids - with Special Reference to Differential Diagnosis from Metastatic Adenocarcinoma

More information

More than 2,500 people are diagnosed with mesothelioma in the UK each year.

More than 2,500 people are diagnosed with mesothelioma in the UK each year. This information is an extract from the booklet Understanding mesothelioma. You may find the full booklet helpful. We can send you a free copy see page 5. Contents Introduction Pleural mesothelioma Peritoneal

More information

MAJOR PARADIGM SHIFT IN EARLY 1990S IN UNDERSTANDING RENAL CANCER

MAJOR PARADIGM SHIFT IN EARLY 1990S IN UNDERSTANDING RENAL CANCER Renal tumours WHO 4 MAJOR PARADIGM SHIFT IN EARLY 1990S IN UNDERSTANDING RENAL CANCER Molecular differential pathology of renal cell tumours G. KOVACS A CLASSIFICATION BASED ON UNDERSTANDING THE GENETIC

More information

Diagnostic Pitfalls In Thoracic Tumors

Diagnostic Pitfalls In Thoracic Tumors 1376 Diagnostic Pitfalls In Thoracic Tumors Neda Kalhor, MD Cesar A. Moran, MD, FASCP WEEKEND OF PATHOLOGY AMERICAN SOCIETY FOR CLINICAL PATHOLOGY 33 W Monroe Ste 1600 Chicago, IL 60603 Program Content

More information

Role of immunohistochemistry

Role of immunohistochemistry Tumors of serous membranes of difficult diagnosis: Dr. Hector Battifora Role of immunohistochemistry Abstract: The most common differential diagnosis of tumors involving serosal surfaces is adenocarcinoma

More information

NHS Barking and Dagenham Briefing on disease linked to Asbestos in Barking & Dagenham

NHS Barking and Dagenham Briefing on disease linked to Asbestos in Barking & Dagenham APPENDIX 1 NHS Barking and Dagenham Briefing on disease linked to Asbestos in Barking & Dagenham 1. Background 1.1. Asbestos Asbestos is a general name given to several naturally occurring fibrous minerals

More information

Pathology of the Endometrium. Thomas C. Wright Columbia University, New York, NY. Most common diseases:

Pathology of the Endometrium. Thomas C. Wright Columbia University, New York, NY. Most common diseases: Pathology of the Endometrium Thomas C. Wright Columbia University, New York, NY Endometrium Most common diseases: Abnormal uterine bleeding Inflammatory conditions Benign neoplasms Endometrial cancer Page

More information

Original Article Differential diagnosis of sarcomatoid mesothelioma from true sarcoma and sarcomatoid carcinoma using immunohistochemistry

Original Article Differential diagnosis of sarcomatoid mesothelioma from true sarcoma and sarcomatoid carcinoma using immunohistochemistry Pathology International 2008; 58: 75 83 doi:10.1111/j.1440-1827.2007.02193.x Original Article Differential diagnosis of sarcomatoid mesothelioma from true sarcoma and sarcomatoid carcinoma using immunohistochemistry

More information

What is Mesothelioma?

What is Mesothelioma? What is Mesothelioma? Mesothelioma is a rare type of cancer that develops in the mesothelial cells found in one s body. These cells form membranous linings that surround and protect the body s organs and

More information

Testicular Disease Henry Yao HMO2, Royal Melbourne Hospital

Testicular Disease Henry Yao HMO2, Royal Melbourne Hospital Testicular Disease Henry Yao HMO2, Royal Melbourne Hospital Vitals 1 Overview! Testicular cancer! Case Study! Epidemiology! Risk factors! Types! Presenting symptoms! Examination findings! Investigations!

More information

Male. Female. Death rates from lung cancer in USA

Male. Female. Death rates from lung cancer in USA Male Female Death rates from lung cancer in USA Smoking represents an interesting combination of an entrenched industry and a clearly drug-induced cancer Tobacco Use in the US, 1900-2000 5000 100 Per Capita

More information

Case Report Mesothelioma of the tunica vaginalis testis with prominent adenomatoid features: a case report

Case Report Mesothelioma of the tunica vaginalis testis with prominent adenomatoid features: a case report Int J Clin Exp Pathol 2014;7(10):7082-7087 www.ijcep.com /ISSN:1936-2625/IJCEP0001992 Case Report Mesothelioma of the tunica vaginalis testis with prominent adenomatoid features: a case report Lian-He

More information

Immunohistochemical differentiation of metastatic tumours

Immunohistochemical differentiation of metastatic tumours Immunohistochemical differentiation of metastatic tumours Dr Abi Wheal ST1. TERA 3/2/14 Key points from a review article written by Daisuke Nonaka Intro Metastatic disease is the initial presentation in

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1557/14

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1557/14 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1557/14 BEFORE: M. Crystal: Vice-Chair HEARING: August 20, 2014 at Toronto Written DATE OF DECISION: December 4, 2014 NEUTRAL CITATION: 2014

More information

Histologic Classification and Differential Diagnosis of Mesothelioma

Histologic Classification and Differential Diagnosis of Mesothelioma THE YALE JOURNAL OF BIOLOGY AND MEDICINE 54 (1981), 173-180 Histologic Classification and Differential Diagnosis of Mesothelioma DARRYL CARTER, M.D. Department of Pathology, Yale University School of Medicine,

More information

Seattle. Case Presentations. Case 1. 76 year old female with a history of breast cancer 12 years ago. Now presents with a pleural effusion.

Seattle. Case Presentations. Case 1. 76 year old female with a history of breast cancer 12 years ago. Now presents with a pleural effusion. Seattle Montreal IAP September 2006 Case Presentations Allen M. Gown, M.D. Medical Director and Chief Pathologist PhenoPath Laboratories Clinical Professor of Pathology University of British Columbia Case

More information

Cytological Diagnosis of Malignant Pleural Mesothelioma: A Cautionary Note for Lawyers in Asbestos Litigation

Cytological Diagnosis of Malignant Pleural Mesothelioma: A Cautionary Note for Lawyers in Asbestos Litigation Cytological Diagnosis of Malignant Pleural Mesothelioma: A Cautionary Note for Lawyers in Asbestos Litigation Edward Casmere and Joshua Lee Law360 March 7, 2014 For a variety of reasons, lawyers in asbestos

More information

Diagnosis of Synovial Sarcoma of the Pleura and Differentiation from Malignant Mesothelioma

Diagnosis of Synovial Sarcoma of the Pleura and Differentiation from Malignant Mesothelioma 36 Diagnosis of Synovial Sarcoma of the Pleura and Differentiation from Malignant Mesothelioma Amy Powers and Michele Carbone Synovial sarcomas (SSs) are soft tissue tumors that occur primarily in adolescents

More information

Metastatic Lobular Carcinoma of the Breast Presenting as a Frontal Scalp Mass and

Metastatic Lobular Carcinoma of the Breast Presenting as a Frontal Scalp Mass and Metastatic Lobular Carcinoma of the Breast Presenting as a Frontal Scalp Mass and Masquerading as Lymphoma: A Potential Pitfall in Aspiration Cytology Lauren Altman 1, Summer Student; Raptis George 2,

More information

I would like to discuss risk factors and multi-steps involved in breast carcinogenesis and mechanisms of invasion and metastasis of breast cancer.

I would like to discuss risk factors and multi-steps involved in breast carcinogenesis and mechanisms of invasion and metastasis of breast cancer. Hello. My name is Ayse Sahin. I m a Professor of Pathology at University of Texas MD Anderson Cancer Center. I would like to review Pathology of Breast Cancer. Upon completion of this lecture, participants

More information

Anatomic Pathology / PERITONEAL MESOTHELIOMA AND SEROUS CARCINOMA

Anatomic Pathology / PERITONEAL MESOTHELIOMA AND SEROUS CARCINOMA Anatomic Pathology / PERITONEAL MESOTHELIOMA AND SEROUS CARCINOMA Immunohistochemical Analysis of Peritoneal Mesothelioma and Primary and Secondary Serous Carcinoma of the Peritoneum Antibodies to Estrogen

More information

DESMOPLASTIC SMALL ROUND CELL TUMOR: A RARE PATHOLOGY PUZZLE

DESMOPLASTIC SMALL ROUND CELL TUMOR: A RARE PATHOLOGY PUZZLE DESMOPLASTIC SMALL ROUND CELL TUMOR: A RARE PATHOLOGY PUZZLE Ryan Granger University of Rhode Island Cytotechnology program May 2, 2015 ASCT Annual Meeting Nashville, Tennessee DESMOPLASTIC SMALL ROUND

More information

Video Microscopy Tutorial 5

Video Microscopy Tutorial 5 Video Microscopy Tutorial 5 Lool Alikes in Effusion Cytology:Review of Diagnostic Challenges Claire Michael, MD There are no disclosures necessary. Look-Alikes in Effusion Cytology: Review of Diagnostic

More information

Distinguishing benign from malignant mesothelial

Distinguishing benign from malignant mesothelial ORIGINAL ARTICLE IMP3 and GLUT-1 Immunohistochemistry for Distinguishing Benign From Malignant Mesothelial Proliferations Anna F. Lee, MDCM, PhD,*w Allen M. Gown, MD,wz and Andrew Churg, MD*w Abstract:

More information

Asbestos Related Diseases

Asbestos Related Diseases Asbestos Related Diseases Asbestosis Mesothelioma Lung Cancer Pleural Disease Asbestosis and Mesothelioma (LUNG CANCER) Support Group 1800 017 758 www.amsg.com.au ii Helping you and your family through

More information

ATLAS OF HEAD AND NECK PATHOLOGY THYROID PAPILLARY CARCINOMA

ATLAS OF HEAD AND NECK PATHOLOGY THYROID PAPILLARY CARCINOMA Papillary carcinoma is the most common of thyroid malignancies and occurs in all age groups but particularly in women under 45 years of age. There is a high rate of cervical metastatic disease and yet

More information

Lessons learned from the Western Australian experience with mesothelioma

Lessons learned from the Western Australian experience with mesothelioma Lessons learned from the Western Australian experience with mesothelioma Alison Reid, Western Australian Institute for Medical Research In partnership with Nick de Klerk, Nola Olsen, Jan Sleith, Geoffrey

More information