Pseudomesotheliomatous angiosarcoma: a pleuropulmonary lesion simulating malignant pleural mesothelioma

Falconieri, Giovanni; Bussani, Rossana; Mirra, Maurizio; Zanella, Micaela

doi:10.1046/j.1365-2559.1997.5370782.x

Cited by 51 publications

(31 citation statements)

References 10 publications

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“…The two sarcomas with the greatest potential of being confused with pleomorphic mesotheliomas are angiosarcomas and the pleomorphic variant of malignant fibrous histiocytoma. Pleural angiosarcomas are often epithelioid and can easily be mistaken for a mesothelioma, both clinically and histologically, [27][28][29][30] and examples of epithelioid pleural angiosarcomas exhibiting marked pleomorphism that could easily be confused with pleomorphic mesotheliomas have been documented in the literature. 31 The pleural biopsy of one of the mesotheliomas cases in this study (case 1), in addition to being somewhat hemorrhagic, showed areas in which the neoplastic cells appeared to be lining irregular spaces resembling the vascular spaces seen in an angiosarcoma ( Figure 1a).…”

Section: Discussionmentioning

confidence: 99%

Pleomorphic mesothelioma: report of 10 cases

Ordóñez

2012

Modern Pathology

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Mesotheliomas with pleomorphic features are rare and only a few studies on this mesothelioma variant have been published. Little information regarding the immunoprofile of these tumors and none on their electron microscopic features was included in these studies. Herein are reported 10 cases of pleomorphic mesothelioma that were investigated using a large panel of immunohistochemical markers, 4 of which were also studied by electron microscopy. All of the patients were men and seven had a history of asbestos exposure. Nine of the cases originated in the pleura and one in the peritoneum. Histologically, the tumors were characterized by being composed of large, often discohesive, cells that varied in size and shape, had dense abundant eosinophilic cytoplasm, and single or multiple irregular nuclei, which often contained one or several large nucleoli. Mitotic activity was high and atypical mitoses frequent. Immunoreactivity for pan-keratin and keratin 7 was strong in all of the cases. Expression for calretinin, WT1, podoplanin, mesothelin and keratin 5/6 was also frequent, but variable. All cases were negative for MOC-31, carcinoembryonic antigen, CD15, TAG-72 and thyroid transcription factor-1. Electron microscopy often showed the presence of abundant long, slender microvilli on the cell membrane of the neoplastic cells. These findings demonstrate that, contrary to what has been suggested by some investigators, both immunohistochemistry and electron microscopy can be very helpful in assisting in the diagnosis of pleomorphic mesotheliomas. That the seven patients who underwent extrapleural pneumonectomy had extensive lymph node metastasis and that the median survival of those patients for whom follow-up information was available was only 8.2 months indicates that mesotheliomas with pleomorphic features are associated with highly aggressive clinical behavior. Therefore, when this subtype of epithelioid mesothelioma is present, it should be reported as it can significantly affect the prognosis and treatment of the patient.

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Section: Discussionmentioning

confidence: 99%

Pleomorphic mesothelioma: report of 10 cases

Ordóñez

2012

Modern Pathology

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“…These include epithelioid mesotheliomas, AdCAs, epithelioid nerve sheath tumors, melanomas, and pseudomesotheliomatous angiosarcomas. 45 By far, the most common tumors in this category are AdCA and mesothelioma. Therefore, our study focused on the most common differential diagnostic issue in this setting, namely, the distinction between epithelioid mesothelioma and AdCA involving serous surfaces.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of 12 antibodies for distinguishing epithelioid mesothelioma from adenocarcinoma: identification of a three-antibody immunohistochemical panel with maximal sensitivity and specificity

Yaziji

Battifora

Barry³

et al. 2006

Modern Pathology

171

136

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We evaluated the sensitivity and specificity of 10 monoclonal and two polyclonal antibodies for distinguishing epithelioid mesothelioma from adenocarcinoma (AdCA) using immunohistochemistry (IHC). The antibodies were directed against the mesothelial-associated antigens mesothelin, calretinin, cytokeratin 5, thrombomodulin, Wilms' tumor-1 (WT-1) gene product and HBME-1, and the nonmesothelial antigens Lewis-Y blood group (antibody BG8), MOC-31, BerEp4, CD15, and carcinoembryonic antigen (CEA) family. The 133 tumors evaluated included 65 malignant epithelioid mesotheliomas, 22 lung AdCAs, 27 ovarian serous carcinomas, 24 breast carcinomas, and five gastric carcinomas. Diagnoses were based on clinical, histologic, ultrastructural, and/or IHC findings. Calretinin had the best sensitivity for mesothelioma (95%), followed by HBME-1 (84%), WT-1 (78%), cytokeratin 5 (76%), mesothelin (75%), and vimentin and thrombomodulin (68%). Thrombomodulin had the best specificity for mesothelioma (92%), followed by cytokeratin 5 (89%), calretinin (87%) vimentin (84%), and HBME-1 (45%). When ovarian carcinomas were excluded from the analysis, the specificity of mesothelin and WT-1 for the diagnosis of mesothelioma increased to 90 and 81%, respectively. The sensitivity of the nonmesothelial antigens for AdCA was organ dependent, with BG8 performing best in the breast cancer group (96%), and BerEp4, BG8, MOC-31 performing best in the lung cancer group (100%). The specificity of the nonmesothelial antigens for AdCA was 98% for BG8 and CEA, 97% for CD15, 95% for BerEp4, and 87% for MOC-31. A novel statistical analysis technique employing logic regression analysis identified a three-antibody immunohistochemical panel including calretinin, BG8, and MOC-31, which provided over 96% sensitivity and specificity for distinguishing epithelioid mesothelioma from AdCA.

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“…Pleural angiosarcomas are often epithelioid (74%) (10) and can be easily mistaken for mesothelioma or carcinoma both clinically and histologically (1,2,8). In our case, focal histologic findings suggested an involvement of carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Many of these serous membrane-related angiosarcomas show histologically epithelioid feature, and the distinction from other common tumors such as mesothelioma and metastatic carcinoma is difficult (1,2). A total of 31 cases of primary malignant pleural vascular tumors were identified in the English literature (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Epithelioid Angiosarcoma of the Pleura: A Case Report

2001

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Angiosarcomas of the pleura are very rare tumors and it is difficult to differentiate them from other common pleural tumors such as mesothelioma and metastasic carcinoma clinically and pathologically. We report a case of a young Korean woman with angiosarcoma arising in the pleura. A 34-yr-old woman presented with dyspnea and chest tightness and pain for several months. A computed tomographic scan of the chest showed diffuse thickening of the left pleura and effusion with passive atelectasis. At thoracotomy the left pleura was thick and indurated. Histologically, the decorticated pleura revealed infiltration of sheets or cords of polygonal and epithelioid tumor cells showing rudimentary vascular differentiation. Immunohistochemically, the tumor cells were strongly positive for CD31, CD34, and vimentin, whereas weakly positive for factor VIII, and negative for cytokeratin, which are characteristic and specific findings of angiosarcoma.

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Pseudomesotheliomatous angiosarcoma: a pleuropulmonary lesion simulating malignant pleural mesothelioma

Cited by 51 publications

References 10 publications

Pleomorphic mesothelioma: report of 10 cases

Pleomorphic mesothelioma: report of 10 cases

Evaluation of 12 antibodies for distinguishing epithelioid mesothelioma from adenocarcinoma: identification of a three-antibody immunohistochemical panel with maximal sensitivity and specificity

Epithelioid Angiosarcoma of the Pleura: A Case Report

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