Images in Clinical Medicine
Mesothelioma
N Engl J Med 2001; 345:424August 9, 2001
- Article
Figure 1 Back pain developed in a 31-year-old man who had undergone total nodal irradiation and chemotherapy for Hodgkin's disease at the age of 15 years (when asymptomatic hilar adenopathy was found on a routine chest film) and who had received a second course of chemotherapy and radiotherapy at the age of 25 years for a recurrence of Hodgkin's disease in a cervical lymph node. Studies revealed a thoracic paravertebral mass in the previously irradiated field. After an extensive investigation revealed no other tumor sites, a thoracotomy was performed. Light-microscopical analysis of the tissue obtained showed that the tumor was composed of spindle-shaped and glandular epithelial cells. On immunoperoxidase staining, the tumor cells were positive for keratin and epithelial membrane antigen and negative for carcinoembryonic antigen, Leu-M1, S-100 protein, and melanoma-associated antigen HMB-45 — findings characteristic of mesothelioma. The findings on electron microscopy were diagnostic of mesothelioma (Panel A, ×17,000; Panel B, ×18,500). The tumor cells met all four criteria, three of which are shown: coarse bundles of cytoplasmic electron-dense tonofilaments (black arrows in Panel A), well-formed desmosomes (arrowheads in Panels A and B), and extensive elongated, wide microvilli on the apical surfaces (white arrows in Panels A and B). The basal lamina is not apparent. The patient eventually died of the disease.
Ann M. Dvorak, M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215
