Primary epithelial malignant mesothelioma of the pericardium with deciduoid features: Cytohistologic and immunohistochemical study

Abstract

Malignant mesothelioma with deciduoid features (MMWDF) is a recently characterized morphologic variant of epithelioid malignant mesothelioma, which frequently is misdiagnosed as peritoneal deciduosis or florid mesothelial hyperplasia. We report on the cytological, histological, immunohistochemical, and autopsy findings of a case of MMWDF arising in the pericardium of a 71-yr-old female patient. Cytology showed large, polygonal to round cells with pale to bright, eosinophilic cytoplasm, occasionally showing xantomatous pattern, containing a pleomorphic and vesicular nucleus with a single prominent nucleolus. Autopsy examination showed a neoplasm encasing the heart and great vessels. No other primary neoplasm was found. The histological analysis disclosed the typical features of MMWDF. Immunohistochemistry showed diffuse immunoreactivity for cytokeratin MNF116, HBME-1, and calretinin in the neoplastic cells, as well as focal positivity for epithelial membrane antigen positivity in a brush border-like pattern. All other markers were negative. We would like to stress that pathologists must be aware of the cytological and histological features of this rare variant of epithelioid malignant mesothelioma in order to avoid a misdiagnosis of a benign process or a metastatic malignancy.

Comparative genomic hybridisation in malignant deciduoid mesothelioma

“…Only in one case was the pericardium found to be affected. 19 A review of the literature does not show a worse prognosis in patients affected by the deciduoid mesothelioma variant.…”

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Initially, this variant was described by Nascimento et al, 7 Talerman et al 6 and Orosz et al 8 in the peritoneum of younger women, as mimicking a florid ectopic decidual reaction. The tumour mainly affected women (female:male ratio 20:12) and exposure to asbestos was well documented in 12 cases.…”

“…6 7 It has since been observed also in the pleura and pericardium, in both sexes and at all ages, with these forms having a worse prognosis. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Only a few studies have been conducted to identify the molecular changes responsible for the carcinogenesis of mesothelioma. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Comparative genomic hybridisation (CGH) is currently the most widely used technique for genetic analysis of mesothelioma because it enables the analysis of wide genomic amplifications, gains and losses (deletions) in the tumour cells in a single experiment.…”

La déciduose ectopique : variabilités de présentation pendant la grossesse et diagnostics différentiels

“…Ce sous-type de mé sothé liome é pithé lioïde repré sente 2 [43] à 5 % [40] des mé sothé liomes avec des localisations essentiellement pé ritoné ales, mais aussi pé ricardiques et pleurales [39,44,45]. Son incidence est de 0,2 à deux par million chez la femme [46] et sa pré valence croit dans les pays industrialisé s [47].…”

“…Son incidence est de 0,2 à deux par million chez la femme [46] et sa pré valence croit dans les pays industrialisé s [47]. L'é tiologie lé sionnelle reste peu connue, mais l'exposition à l'amiante [24] et l'influence hormonale [44] sont peu probables.…”