Malignant vascular tumours of the pleura in "asbestos" workers and endothelial differentiation in malignant mesothelioma
R L Attanoosa, S K Suvarnab, E Rheadc, M Stephensc, T J Lockee, M N Sheppardd, F D Pooleyf, A R Gibbsa
a Department of
Histopathology, Llandough Hospital, Cardiff, UK, b Department of Histopathology,
Northern General Hospital, Sheffield, UK, c Department of Histopathology, North
Staffordshire General Hospital, Stoke on Trent, UK, d Department
of Histopathology, Royal Brompton Hospital, London, UK, e Department of Surgery, Northern General
Hospital, Sheffield, UK, f Division of Materials and Minerals, University
of Wales, Cardiff, UK
Correspondence to: Dr R L Attanoos, Department of Histopathology, Llandough Hospital, Cardiff CF64 2XX, UK
Received 11 November 1999; Returned to authors 20 March 2000; Revised version received 11 July 2000; Accepted for publication 12 July 2000
BACKGROUND
Three cases
of diffuse malignant vascular tumours of the pleura are described which
mimicked malignant mesothelioma clinically and pathologically (so
called "pseudomesothelioma"). All had occupational histories of
exposure to asbestos. The relationship of these tumours to mesothelioma
and asbestos exposure is discussed.
METHODSTo examine the
histogenetic relationship between mesothelioma and these three tumours
an immunohistochemical analysis of vascular marker (CD31, CD34, and Von
Willebrand factor) expression was undertaken in 92 cases of pleural
mesothelioma, in addition to these three tumours. Electron microscopic
fibre analysis of lung tissue was performed on each of the three cases
to assess asbestos fibre content.
RESULTSDiffuse
pleural epithelioid haemangioendotheliomas may closely resemble
malignant mesothelioma clinically and pathologically but, of the 92 pleural mesotheliomas tested, none showed expression of CD31, CD34,
and Von Willebrand factor. Although all three cases had claimed
exposure to asbestos, ferruginous bodies typical of asbestos were only
seen by light microscopy in case 2, and only in this subject was the
asbestos fibre content raised in comparison with the range seen in a
non-exposed background population. The latent period in the pleural
epithelioid haemangioendotheliomas ranged from 18 to 60 years.
CONCLUSIONSEndothelial
differentiation does not appear to occur in mesothelioma and therefore
should be clearly separated from it. No definite association between
pleural epithelioid haemangioendothelioma and exposure to asbestos can
be made from this small series but further investigation is warranted.
Keywords: pleura; epithelioid haemangioendothelioma; asbestos; mesothelioma
© 2000 by Thorax
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