CASE REPORT

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CASE REPORT

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An Autopsy Case of Pseudomesotheliomatous Adenocarcinoma of the Lung

Yuichi Tambo

¹

; Toshiyuki Kita

¹

; Yoshinori Kibe

¹

; Kazuo Kasahara

²

; Masaki Fujimura

²

; Shinji Nakao

²

ABSTRACT

XX

Background.

Pseudomesotheliomatous carcinoma of the lung ) PMCL * is characterized by diffuse pro- gression along visceral pleura, and has been confirmed histologically as a peripheral lung cancer. We report our expe- rience of an autopsy case of PMCL.

Case.

A 71 year-old Japanese man presented with right chest pain and dyspnea in May 2003. A chest X ray film showed right massive pleural effusion. Adenocarcinoma was detected from pleural effu- sion and we diagnosed lung cancer ) cT4N3M0 stage IIIB * by other detailed examinations. Although we attempted many different kinds of chemotherapies after insertion of a chest drainage tube in the right pleural space, he died 16 months after the diagnosis. At autopsy, no primary lesion was detected in the right lung, but the entire right lung was enclosed with thickened visceral pleura. Cancer tissue was detected along the pleura. Immunohistological examina- tions showed positive results for CEA and TTF-1, but negative for calretinin, so we finally diagnosed PMCL.

Conclu- sion.

We considered that not only cytological examination of pleural fluid but also histological examination is needed for a diagnosis of PMCL in a case of malignant pleural effusion when the primary lesion cannot be detected in the lungs. )JJLC. 2006;46:145-150 *

KEY WORDS

XX Pseudomesotheliomatous carcinoma of the lung, Malignant pleural mesothelioma, Autopsy, Immuno- histology

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kanazawa-u.ac.jp*"

1Department of Respiratory Medicine, Kanazawa Medical Cen- ter, Japan;²Respiratory Medicine , Cellular Transplantation Biol-

ogy, Kanazawa University Graduate School of Medicine, Japan.

Reprints: Yuichi Tambo, Respiratory Medicine, Cellular Trans- plantation Biology, Kanazawa University Graduate School of Medi- cine , 13-1 Takaramachi, Kanazawa , Ishikawa 920-8641, Japan)e- mail: tanbo@med3.m.kanazawa-u.ac.jp*.

Received September 26, 2005; accepted February 13, 2006.

!2006 The Japan Lung Cancer Society

Japanese Journal of Lung Cancer(Vol 46, No 2, Apr 20, 2006(www.haigan.gr.jp 145

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Table 1. Laboratory Data on Admission

Biochemistry Hematology

mg/dl 107 BS

mg/dl 0.9 T-Bil

/μl 7700 WBC

mm/hr 69 ESR

mg/dl 6.8 TP

% 62.5 　Neutrophils

mg/dl 1.3 CRP

IU/l 288 ALP

% 29.2 　Lymphocytes

IU/l 19 AST

% 7.3 　Monocytes

Tumor markers IU/l

14 ALT

% 0.7 　Eosinophils

ng/ml 7.6 CEA

IU/l 184 LDH

% 0.3 　Basophils

ng/ml 1 CYFRA

IU/l 53 γ-GTP

/μl 390×10⁴ RBC

ng/ml 0.1 SCC

mEq/l 139 Na

g/dl 13.3 Hb

pg/ml 15.7 proGRP

mEq/l 3.8 K

% 39.3 Ht

mEq/l 103 Cl

/μl 34.3×10⁴ Plt

mg/dl 14.3 BUN

mg/dl 0.6 Cr

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>?=3!¢ô0FCEAEIBVCh}3D2?=6 Autopsy Case of Pseudomesotheliomatous Carcinoma of the Lung&Tambo et al

146 Japanese Journal of Lung Cancer&Vol 46, No 2, Apr 20, 2006&www.haigan.gr.jp

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Figure 1. Chest radiograph taken after insertion of a chest drainage tube. The right lung collapsed and did not expand on continuous suction.

Figure 2. Chest CT scan taken after insertion of chest drainage tube showed the collapsed right lung and diffuse pleuralthickening.No primary lesion was not detected in either lung.

Table 2. Laboratory Data ofRight PleuralEffusion Pleuraleffusion

g/dl 6.9 TP

turbid Bloody, Property

IU/l 1725 LDH

1.052 Specific gravity

mg/dl 72 Sugar

7.598 pH

IU/l 14.5 ADA

Celldifferential

ng/ml 249 CEA

% 30 　Neutrophils

ng/ml 332.5 CYFRA

% 30 　Lymphocytes

pg/ml 26.8 proGRP

% 40 　Macropharges

Class V （adenocarcinoma）

cytology

% 0 　Eosinophils

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Japanese Journal of Lung Cancer$Vol 46, No 2, Apr 20, 2006$www.haigan.gr.jp 147

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Table 3. ClinicalCourse

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Autopsy Case of Pseudomesotheliomatous Carcinoma of the Lung#Tambo et al

148 Japanese Journal of Lung Cancer#Vol 46, No 2, Apr 20, 2006#www.haigan.gr.jp

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Figure 4. Hematoxylin and eosin stain of the right lung. Cancer tissue was found along the visceral pleura in the specimens obtained from autopsy.

Figure 3. Autopsied lungs.The right lung weighted 230 g and the left 780 g.The right lung was collapsed and the right visceralpleura was thickened throughout.No primary adenocarcinoma lesion was detected in either lung.

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REFERENCES

1"Harwood TR, Gracey DR, Yokoo H, et al. Pseudomeso- theliomatous carcinoma of the lung . Am J Clin Pathol . 1976;65:159-167.

2"Koss M, Travis W, Moran C, et al. Pseudomesothelioma- Autopsy Case of Pseudomesotheliomatous Carcinoma of the Lung&Tambo et al

Japanese Journal of Lung Cancer&Vol 46, No 2, Apr 20, 2006&www.haigan.gr.jp 149

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tous adenocarcinoma: a reappraisal.Semin Diagn Pathol . 1992;9:117-123.

3"Koss MN, Fleming M, Przygodzki RM, et al. Adenocarci- noma simulating mesothelioma: a clinicopathologic and immunohistochemical study of 29 cases.Ann Diagn Pathol.

1998;2:93-102.

4"Attanoos RL, Gibbs AR.%Pseudomesotheliomatous&car- cinomas of the pleura: a 10-year analysis of cases from the Environmental Lung Disease Reserch Group , Car- diff.Histopathology.2003;37:444-452.

5"Boutin C , Rey F . Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. Part 1: Diagnosis.Cancer.1993;72:389-393.

6"Battifora H, McCaughey WTE. Secondary tumor of the serosal membranes. In:Tumors of thr serosal membranes.

AFIP, Third series, Fascicle 15.Washinton DC: 1995:111.

7"4V U!S7JB!=M/Y5!Q"3RZEX2#2

`9e+^>)\:T<@",A1-[c;60C"

1989;26:55-61.

8"Ordonez NG. Mesothelioma!adenocarcinoma antibodies.

Am J Surg Pathol.1997;21:1399-1408.

9"Leers MPG , Aarts MMJ , Theunissen PHMH . E- cardherin and calretinin: a useful combination of immu-

nohistochemical markers for differentiation between mesothelioma and metastatic adenocarcinoma . Histopa- thology.1998;32:209-216.

10"Clover J, Oates J, Edwards C. Anti-cytokeratin 5!6: ap- positive marker for epithelioid mesothelioma.Histopathol- ogy.1997;31:140-143.

11"Attanoos RL , Goddard H , Gibbs AR . Mesothelioma- binding antibodies: thrombomodulin, OV632 and HBME- 1 and their use in the diagnosis of malignant mesothelioma.Histopathology.1996;29:209-215, 241.

12"Moran CA, Suster S, Koss MN. Smooth muscle tumors presenting as pleural neoplasms.Histopathology.1995;27:

227-234.

13"Attanoos RL, Suvarna SK, Rhead E, et al. Malignant vas- cular tumors of the pleura in%asbestos&workers and en- dothelial differentiation in malignant mesothelioma.Tho- rax.2000;55:860-863.

14"Moran CS, Travis WD, Rosado-de-Christenson M, et al.

Thymomas presenting as pleural tumors: report of 8 cases.Am J Surg Pathol.1992;16:138-144.

15"bPHG!WPNF!KV ]!Q".OL8aRZE*

dD'(XI?_2+1e"X2"1994;34:1075-1079"

Autopsy Case of Pseudomesotheliomatous Carcinoma of the Lung$Tambo et al

150 Japanese Journal of Lung Cancer$Vol 46, No 2, Apr 20, 2006$www.haigan.gr.jp

CASE REPORT

CASE REPORT

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XX qºÌ¥Ên!Y¥uÛºÌ!Ú{!Þb®m¿{

An Autopsy Case of Pseudomesotheliomatous Adenocarcinoma of the Lung

Yuichi Tambo

; Toshiyuki Kita

; Yoshinori Kibe

; Kazuo Kasahara

; Masaki Fujimura

; Shinji Nakao

XX

Pseudomesotheliomatous carcinoma of the lung ) PMCL * is characterized by diffuse pro- gression along visceral pleura, and has been confirmed histologically as a peripheral lung cancer. We report our expe- rience of an autopsy case of PMCL.

We considered that not only cytological examination of pleural fluid but also histological examination is needed for a diagnosis of PMCL in a case of malignant pleural effusion when the primary lesion cannot be detected in the lungs. )JJLC. 2006;46:145-150 *

XX Pseudomesotheliomatous carcinoma of the lung, Malignant pleural mesothelioma, Autopsy, Immuno- histology

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