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  • Biphasic malignant mesothelioma with epithelioid and sarcomatoid components (dedifferentiated mesothelioma) and intrapulmonary growth: a rare entity mimicking desquamative interstitial pneumonia

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Virtual case of the month
Biphasic malignant mesothelioma with epithelioid and sarcomatoid components (dedifferentiated mesothelioma) and intrapulmonary growth: a rare entity mimicking desquamative interstitial pneumonia
  1. Juan Laforga1,
  2. Alejandro Gonzalez Garcia2
  1. 1 Pathology, Hospital de Denia, Denia, Alicante, Spain
  2. 2 Thoracic Surgery, Hospital de Denia, Denia, Alicante, Spain
  1. Correspondence to Dr Juan Laforga, Pathology, Hospital de Denia, 03700 Dénia, Spain; jblaforga{at}gmail.com

http://dx.doi.org/10.1136/jclinpath-2019-206379

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    Clinical question

    The patient was a 54-year-old man with symptoms of chronic obstructive pulmonary disease (COPD) who had smoked for many years. A thoracic CT showed bilateral bullae and a tumour measuring 35×25 mm in the right upper lobe (figure 1). Radiological features were consistent with an intraparenchymatous lung tumour. A right upper lobectomy was performed. Gross examination of the surgically excised specimen revealed a nodular lesion measuring 5×5 cm in diameter.

    Figure 1

    (A) CT scan showing bilateral bullae and a tumour in the right upper lobe. (B) Microscopic appearance showing epithelioid cells filling alveolar spaces and heavy interstitial lymphocytic infiltrate (H&E ×100). (C) Alveolar spaces containing epithelioid cells mixed with lymphocytes (H&E ×200). (D) Atypical epithelioid atypical cells showing round nuclei and large eosinophilic cytoplasms mimicking desquamative pneumonitis (H&E ×400). (E) Epithelioid cells filling pre-existing air spaces lined by TTF-1 positive epithelium (TTF-1 stain …

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    Footnotes

    • Handling editor Iskander Chaudhry.

    • Contributors JL prepared the manuscript and diagnosed the case. AG provided critical clinical information.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.