Goyal M, Kodandapani S, Sharanabasappa SN, Palanki SD.

Department of Laboratory Medicine, Indo-American Cancer Institute and Research Centre, Hyderabad, India.

Abstract

Mesothelial cell inclusions in lymph nodes are of rare occurrence and can be mistaken as metastatic adenocarcinomas, mesothelioma or sinus histiocytosis. These are usually found in mediastinal and abdominal lymph nodes and are associated with effusions. We report a case of benign mesothelial cell inclusions in cervical lymph nodes, which was associated with chylous effusion, and immunohistochemistry revealed unusual weak cytoplasmic epithelial membrane antigen positivity in the cells.

Keywords: Adenocarcinoma, chylous effusion, epithelial membrane antigen, mesothelial cell inclusions

Cavallaro A, Berretta M, Lo Menzo E, Cavallaro V, Zanghì A, Di Vita M, Cappellani A.

Department of Surgery, University of Catania, Catania, Italy.

Abstract

Benign multicystic peritoneal mesothelioma (BMPM) is a rare disease with good short-term prognosis and rare malignant transformation. However, its biological significance remains unexplained. A neoplastic origin is considered by many authors to require a surgical excision, based on the high recurrence and progressive growth rate of the tumors. However, alternative or integrative treatment options have also been proposed. A 45-year-old woman presented to our unit with a history of occasional discomfort and pain in the left hip. On physical examination, we noticed a tough-elastic, fixed mass located in the iliac fossa. Computed tomography scan detected a mass with multiseptated cystic-like areas. Due to the similarity of these findings to a primitive sarcomatous tumor of the retroperitoneum, an arteriographic study was also performed. The patient underwent en bloc resection of the mass, including a segment of the sigmoid colon. The final pathologic diagnosis was cystic mesothelioma. Further studies are needed to better understand the etiology and pathogenesis of this rare disease, and to define a more tailored treatment plan.

Keywords: Benign multicystic peritoneal mesothelioma – Calretinin – Cytokeratin

Lee JM, Pou K, Sadow PM, Chen H, Hu B, Hewison M, Adams JS, Sugarbaker DJ, Fisher ND.

Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA. jaymoonlee@mednet.ucla.edu

Abstract

Objective: To report a case of coincident hypercalcemia and Cushing syndrome arising from mesothelioma.

Methods: We describe the clinical, laboratory, imaging, and pathologic findings of a patient with malignant pleural mesothelioma and elucidate the underlying biologic mechanisms resulting in concurrent overexpression of steroid and polypeptide hormones.

Results: A 62-year-old woman presented with chest discomfort and cough. Radiologic imaging revealed a diffuse pleural-based mass encasing the right lung. There was no invasion into the chest wall, diaphragm, or mediastinum, and there was no distant disease. Laboratory analyses documented hypercalcemia and Cushing syndrome, which were due to ectopic overproduction of 1,25-dihydroxyvitamin D (1,25[OH]₂D) and corticotropin. Surgical resection resulted in normocalcemia with normalization of serum 1,25(OH)₂D and reduction in hypercortisolemia. The extrapleural pneumonectomy specimen revealed overexpression of the 1,25(OH)₂D synthetic enzyme 25-hydroxyvitamin-D-1alpha-hydroxylase (1alpha-hydroxylase) and underexpression of the 1,25(OH)₂D catabolic enzyme 24-hydroxylase. Immunohistochemistry and electron microscopy demonstrated corticotropin and secretory granules in the tumor tissue.

Conclusion: These findings support the evidence for a paracrine role of vitamin D in the resistance of the human host to antigen.

Tamiya M, Yamane H, Terada H, Matsuno O, Yamamoto S.

Respiratory Department, NHO Osakaminami Medical Center.

Abstract

A 62-year-old man with pain in his hip joints and back was admitted to our hospital. His chest radiograph and CT showed a huge mass extending from the left upper pericardium to the left hilum, but no pleural effusion or other lesions. A contrast-enhanced abdominal CT showed multiple metastases to bones and both kidneys. Bronchoscopy revealed obstruction of the left B3 by a visible tumor. The biopsy specimens of the initial immunohistochemical staining were slightly positive for calretinin. However, we diagnosed the condition as sarcomatoid carcinoma of the lung on the basis of the clinical evaluation. Although radiotherapy was administered, his condition rapidly deteriorated and he died due to progression of the disease. Autopsy revealed extensive invasion, suggesting mesothelioma. Therefore, immunohistochemical staining was performed; the findings revealed sarcomatoid malignant mesothelioma. In conclusion, we encountered a rare case of sarcomatoid malignant mesothelioma (stage IV).

Kimura T, Koyama K, Kudoh S, Kawabe J, Yoshimura N, Mitsuoka S, Shiomi S, Hirata K.

Department of Respiratory Medicine, Osaka City University, Osaka. kimutats@med.osaka-cu.ac.jp

Abstract

We report a 56-year-old man who underwent monitoring of the response to chemotherapy of malignant pleural mesothelioma (MPM). ⁸F-fluoro-2-deoxy-_D-glucose positron emission tomography (FDG-PET) and computed tomography (CT) were performed prior to chemotherapy and after the first and second courses of chemotherapy. The tumor lesion exhibited shrinkage on CT and a decrease in the standardized uptake value (SUV) max after the first course of chemotherapy, but exhibited size enlargement and an increase in SUV max after the second course of chemotherapy. These findings suggest that results of quantification of metabolic response by FDG-PET are related to the objective response as determined by CT in patients with MPM.

Keywords: FDG-PET, mesothelioma, SUV, response

Goel A, Agrawal A, Gupta R, Hari S, Dey AB.

Senior Research Associate, Medicine, AIIMS, New Delhi 110029, India. ashgoe@yahoo.com.

Abstract

Introduction:
Mesotheliomas are rare tumours that usually are seen in the pleura after asbestos exposure. Mesotheliomas have been reported around the testicular region but are even rarer following trauma, herniorrhaphy and long term hydrocoele.

Case presentation: An elderly male farmer presented to us with an insidious onset of painless swelling in his left lower limb which gradually progressive. At the time of presentation it had involved his entire limb. A hard palpable mass of size 5 * 4 cms was detected in the left iliac fossa and a testicular enlargement was noted on the left side. The ultrasound of the testes showed that the left testis was enlarged 3.9*3*3.2 cms showing diffusely heterogenous echo-texture and irregular nodular surface with irregular hypoechoic thickening of the scrotal wall with left sided hydrocele. A separate hypoechoic *1.2 cms lesion was visualized in the anterior scrotal wall. FNAC from the scrotal mass showed tumour cells of simialr morphology present singly in monolayered sheets and in three dimensional fragments. The overall immunomorphological features suggested a malignant mesothelioma likely to have arisen from the tunica vaginalis.

Conclusion: In conclusion, though a rare tumor, malignant mesothelioma of the tunica vaginalis of the testis should be considered whenever a paratesticular mass lesion is seen even without a history of trauma or asbestos exposure as is highlighted in this case. Ultrasound findings are helpful and fine needle aspiration of the tumor may assist in arrival at a diagnosis. Surgical orchidectomy remains the modality of treatment.

Maniwa Y, Yoshimura M, Takata M, Nishimura Y, Ohno Y.

Divisions of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive and fatal tumor of the pleura and its incidence has been increasing as a result of the widespread use of asbestos worldwide. Numerous chemotherapeutic agents have been tested in many clinical trials, but the response rate does not exceed 20% for most of the investigated regimens. Here we report a case of MPM in which the chemotherapy based on the chemosensitivity test was very effective on palliation with stable disease for a long time.

Keywords: chemosensitivity test, chemotherapy, malignant pleural mesothelioma

Asghar S, Qureshi N, Awan A.

Department of Gyneacology, Unit-1, Sir Ganga Ram Hospital, Lahore. samina_asghar62@yahoo.com

Abstract

A large solitary multiloculated pelvic cyst in a 40-year-old woman with chronic pelvic pain was diagnosed to be a Multicystic Benign Mesothelioma (MBM) of peritoneum at laparotomy. Operative findings showed dense adhesions between uterus and bladder anteriorly, small intestines and pouch of Douglas posteriorly, a right ovarian cyst cm containing clear serous fluid and two nodular deposits were seen in the pouch of Douglas, small multiple deposits was found over the mesentery of small intestine and parietal peritoneum. Total abdominal hysterectomy with bilateral oophorectomy and infracolic omentectomy was done. During surgery, there was injury to the small intestine hence, resection of 10 inches of small intestine with re-anastomosis was carried out. Postoperative recovery was satisfactory. At 3 years follow-up, patient is symptom-free.

Matsuzaki K, Nakajima T, Katoh T, Kitoh H, Mizoguchi K, Akakura K, Inoue T.

Department of Urology, Tokyo Kousei Nenkin Hospital.

Abstract

A 70-year-old man was referred to our hospital with a painless swelling of the light scrotal contents. Ultrasonography and computed tomographic scan revealed a hydrocele testis and irregular masses in the scrotum. The patient underwent left orchidectomy under the diagnosis of left intrascrotal tumor. Pathological diagnosis was malignant mesothelioma. The patient has not received additional therapy because there has been no evidence of metastasis. He has been free of disease 3 months postoperatively.

Washino S, Terauchi F, Matsuzaki A, Kobayashi Y.

Department of Urology, Jichi Saitama Medical Center.

Abstract

We report here a case of malignant mesothelioma presenting as a perineal and intrascrotal mass. A 42-year-old Japanese male presented with an enlarging mass in the perineum and intrascrotum. Although the initial clinical diagnosis was perineal abscess, angiography revealed a tumor in the perineum and intrascrotum. The tumor was resected, and the pathological examination revealed malignant mesothelioma. Two months after the operation, a hard irregular mass with severe hemorrhage was noticed in the perineum, and was resected. A few weeks after the second operation local recurrence and, inguinal and intrapelvic retroperitoneal lymphadenopathy were found. Radiotherapy to recurrent sites was not effective. The patient died six months after the initiation of therapy. To our knowledge, 24 cases of malignant mesothelioma in the perineum or intrascrotum were reported in Japan and this case was thought to be the 25th case in Japan.