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Presented by Peter Illei, M.D. and prepared by Julie M. Wu, M.D.
Case 3: 68-year-old woman with a history of melanoma in 1978 and total abdominal hysterectomy and bilateral salpingo-oophorectomy.
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1. Question
Week 342: Case 3
68-year-old woman with a history of melanoma in 1978 and total abdominal hysterectomy and bilateral salpingo-oophorectomy for an unknown tumor who had been in good health. She now presents with a dry cough, associated with increasing fatigue and generalized malaise. Multiple CAT scans of her chest demonstrated pleural thickening and were intermittently associated with a small right-sided pleural effusion. They also did show moderately sized mediastinum lymph nodes that had increased slowly in size. She has no known history of asbestos exposure.images/jmw031008/3.1.jpg
images/jmw031008/3.1.jpgCorrect
Answer: Malignant mesothelioma, epithelioid type
Histology: This pleural biopsy shows sheets and cords of large atypical epithelioid cells infiltrating desmoplastic stroma. The tumor cells have pink, somewhat fibrillar cytoplasm and large rounded nuclei with small nucleoli that are cytologically similar to the prior case.
Discussion: Immunohistochemical stains for calretinin, WT-1 and cytokeratin 5/6 are positive, whereas immunostains for monoclonal-CEA, BerEP4 and TTF-1 are negative. This staining pattern is diagnostic for an epithelioid mesothelioma and excludes other tumors in the differential diagnosis (melanoma and non-small cell carcinoma). The tumor cells exhibit diffuse and prominent cytologic atypia and are associated with a desmoplastic reaction and thus excluding a benign reactive mesothelial proliferation.
Incorrect
Answer: Malignant mesothelioma, epithelioid type
Histology: This pleural biopsy shows sheets and cords of large atypical epithelioid cells infiltrating desmoplastic stroma. The tumor cells have pink, somewhat fibrillar cytoplasm and large rounded nuclei with small nucleoli that are cytologically similar to the prior case.
Discussion: Immunohistochemical stains for calretinin, WT-1 and cytokeratin 5/6 are positive, whereas immunostains for monoclonal-CEA, BerEP4 and TTF-1 are negative. This staining pattern is diagnostic for an epithelioid mesothelioma and excludes other tumors in the differential diagnosis (melanoma and non-small cell carcinoma). The tumor cells exhibit diffuse and prominent cytologic atypia and are associated with a desmoplastic reaction and thus excluding a benign reactive mesothelial proliferation.
