Sarcomatoid Mesothelioma - Diagnosing Sarcomatoid Mesothelioma

Sarcomatoid Mesothelioma
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Diagnosing Sarcomatoid Mesothelioma.

Properly identifying mesothelioma cell type is an important aspect of the diagnostic process. Sarcomatoid malignant mesothelioma is difficult to accurately diagnose because of its rarity and resemblance to other conditions.

Diagnosis typically begins with imaging tests, including an X-ray and CT scan. These tests will identify any visible tumors or excess fluid in the chest cavity. If cancer is suspected, doctors may order a blood test. This test identifies biomarkers that can differentiate mesothelioma from other conditions.

A biopsy is the most important step in making an accurate sarcomatoid mesothelioma diagnosis. Cell type can be determined through a tissue biopsy and analyses of the sample, such as immunohistochemistry. This is a staining method that uses specific antibodies to isolate antigens or proteins in the tissue sample.

Through an immunohistochemical stain, a pathologist can identify if a tumor is benign or malignant, as well as determine cell type, stage and prognosis.

Several immunohistochemical markers can indicate mesothelioma. Studies have found stains that test positive for proteins calretinin and D2-40, in combination with the antibody pancytokeratin, are the most accurate indicator of sarcomatoid mesothelioma.

Multiple biopsies may be necessary to determine if a patients’ tumors solely exhibit sarcomatoid cells. In some cases, epithelioid cells may also be present, indicating biphasic mesothelioma. Additional tests may also be needed to make an accurate differential diagnosis.

Common misdiagnoses of sarcomatoid mesothelioma include:

Fibrous pleurisy.
Fibrous tumors.
Fibrosarcoma.
Metastasized renal sarcoma.
Non-Hodgkin’s lymphoma.
Pleural liposarcoma.
Sarcomatoid carcinoma.
Soft tissue sarcomas.

Rare Sarcomatoid Cell Types.

In some cases, sarcomatoid mesothelioma may also be differentiated as several rare cell types. These cell types are known for rapid metastasis and poor prognosis. These subtypes may have even more limited treatment options than standard sarcomatoid tumors.

Desmoplastic mesothelioma: Desmoplastic cells often form without a defined pattern. Desmoplastic mesothelioma is most common in the pleura (lining of the lungs), but has also presented in cases of peritoneal and testicular mesothelioma. It accounts for about 5% of all diagnoses. Studies have found an average life expectancy of 3.8 months.

Lymphohistiocytoid mesothelioma: This rare form accounts for less than 1% of all diagnoses. It typically forms in the pleura. Lymphohistiocytoid mesothelioma indicates tumors are made of a variety of cells, including epithelial cells and immune cells, such as lymphocytes and plasma cells. Studies have found an average survival time of two to 20 months.

Transitional mesothelioma: Transitional cells develop similarly to other subtypes, but are characterized by a plump spindle shape. The cells sometimes closely resemble epithelial cells, making diagnosis difficult. These tumors are rare, with only a few case reports referencing the subtype.

Prognosis - Sarcomatoid Mesothelioma Prognosis.

Sarcomatoid mesothelioma has the least favorable prognosis compared to the other common cell types. Studies have shown life expectancies ranging from one month to about 28 months. The majority of patients face a median survival of six months or less.

An individual’s prognosis will also depend on the type of mesothelioma and stage at diagnosis, as well as the patient’s age, gender and overall health.

Patients with biphasic mesothelioma may face a worse prognosis if sarcomatoid cells are more dominant than epithelioid. Biphasic mesothelioma patients typically have a life expectancy of about one year. However, if sarcomatoid cells make up more than 10% of the tumor, patients may have more limited treatment options and a worse prognosis.

Treatment - Sarcomatoid Mesothelioma Treatment.

Research shows sarcomatoid mesothelioma is the most difficult to treat of all cell types. Studies suggest the cells are resistant to many standard therapies. Because malignant sarcomatoid mesothelioma spreads quickly throughout the body, surgery may not be a viable option for many patients.

Sarcomatoid Mesothelioma - Diagnosing Sarcomatoid Mesothelioma
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