Acta Oncologica

ISSN: 0284-186X (Print) 1651-226X (Online) Journal homepage: http://www.tandfonline.com/loi/ionc20

Mucin-negative Pseudomesotheliomatous
Adenocarcinoma of the Lung: Report of Three
Cases

Kuniyuki Kuniyuki Oka, Shinichi Otani, Takao Yoshimura, Toshio Hashimoto,

Tomomi Tobita, Sumiko Koyamatsu, Hando Hakozaki, Yasushi Yatabe

To cite this article: Kuniyuki Kuniyuki Oka, Shinichi Otani, Takao Yoshimura, Toshio Hashimoto,
Tomomi Tobita, Sumiko Koyamatsu, Hando Hakozaki, Yasushi Yatabe (1999) Mucin-negative
Pseudomesotheliomatous Adenocarcinoma of the Lung: Report of Three Cases, Acta Oncologica,
38:8, 1119-1121, DOI: 10.1080/028418699432473

To link to this article: http://dx.doi.org/10.1080/028418699432473

Published online: 08 Jul 2009.

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 CASE REPORT

Mucin-negative Pseudomesotheliomatous
Adenocarcinoma of the Lung
Report of Three Cases
Kuniyuki Oka, Shinichi Otani, Takao Yoshimura, Toshio Hashimoto, Tomomi Tobita,
Sumiko Koyamatsu, Hando Hakozaki and Yasushi Yatabe

From the Departments of Pathology (K. Oka, T. Tobita, S. Koyamatsu), Cardiac and Thoracic Surgery (S.
Otani, T. Yoshimura), Internal Medicine (T. Hashimoto), Mito Saiseikai General Hospital, Mito, Ibaraki, the
Department of Pathology, Fukushima Rosai Hospital, Iwaki, Fukushima (H. Hakozaki), and the Department of
Pathology, Nagoya University School of Medicine, Nagoya, Aichi (Y. Yatabe), Japan

Correspondence to: Kuniyuki Oka, MD, Department of Pathology, Mito Saiseikai General Hospital, 3-3-10
Downloaded by [36.76.125.151] at 05:57 05 September 2017

Futabadai, Mito, Ibaraki 311-4145, Japan. Tel.: + 81 29 254 9049. Fax: + 81 29 254 9099. E-mail: oka-k@gb3.so-
net.ne.jp

Acta Oncologica Vol. 38, No. 8, pp. 1119–1121, 1999

Recei6ed 18 January 1999

Accepted 10 March 1999

Pleural malignant mesothelioma is a diffuse lesion that spreads
widely in the pleural space. The affected lung is ensheathed by a
thick layer of tumor tissue. The papillary epithelial type of malignant
mesothelioma resembles adenocarcinoma. The pleural metastases of
pulmonary adenocarcinoma show rarely a solid rind of tumor of
variable thickness that mimics malignant mesothelioma. The distinc-
tion between metastatic tumors of adenocarcinoma and malignant
mesothelioma can sometimes be difficult (1, 2). If no or few mucins
are demonstrated, a further diagnostic approach is needed to rule
out non-mucin-producing adenocarcinoma of the lung (3). Harwood
et al. (4) coined the term pseudomesotheliomatous adenocarcinoma
of the lung (PMAL) to identify a distinct variant of peripheral lung
cancer characterized by extensive pleural growth with slight par-
enchymal involvement. The tumor is clinically, radiologically,
macroscopically, and morphologically indistinguishable from malig-
nant pleural mesothelioma.
We reported 3 cases that were initially diagnosed as malignant
mesothelioma, then finally diagnosed as mucin-negative PMAL.
Case reports and pathological results
Case 1. An 80-year-old man developed epigastralgia in May 1992.
He had smoked about one pack of cigarettes per day for 60 years.
Chest roentgenogram and computed tomographic scan (Fig. 1a)
showed right pleural tumor. He underwent a right upper lobectomy
and both visceral and parietal pleural thickening were noted, but
no tumor was found in the resected lung tissue. Neoplastic cells
showed a tubular and papillary growth pattern in the hyalinous and
myxoid fibrous tissue of the thickened pleural tumor but no invasion
of the lung parenchyma. The patient died 1 year and 3 months after
the onset of symptoms; an autopsy was not performed.
Case 2. A 47-year-old man developed gradually progressive
lumber pain in August 1995. He complained of chest pain and general
fatigue in January 1996. Right thoracic effusion and subcutaneous
nodules were detected and a skin biopsy was performed on January
29. We diagnosed adenocarcinoma metastasis to the skin. The
primary site was not detected. The patient died on February 5, 1996.
At autopsy, a soft, fragile, confluent-multinodular mass was located
in the right upper to middle pleural cavity, with diffuse encasement
and marked compression of the right lung (1570 g in weight) by
the tumor (Fig. 1b). Similar nodules were located over the visceral
pleura of the right lung. Neoplastic cells showed a trabecular or
tubular growth pattern. Confluent multinodules were scattered
widely throughout both the pleural and peritoneal spaces. Subcu-
taneous tumors, multiple tumor emboli in the kidneys, pancreas, and
the lungs, and marked peribronchial and perivascular metastases in
the lungs were observed.
Case 3. In January 1997, a 44-year-old man was admitted to our
department and a left upper pleural tumor was detected. On
February 27 the patient was treated by partial resection of the upper
lobe of the left lung. A tumor measuring 10 × 4.5 ×6.5 cm was found
adhering to the mediastinal and visceral pleura. Neoplastic cells
showed a papillary growth pattern. The patient was treated with
radiotherapy of 40 Gy to the mediastinum. In January 1998, he
noticed a right hip tumor, which was resected on February 24. The
tumor was diagnosed as cancer metastasis to the right gluteus
maximus muscle. The patient has shown no evidence of disease as
of September 1998.
Histochemical and immunohistochemical findings. The neoplastic
cells were negative for PAS, alcian blue, and mucicarmine stains,
Leu-M1 (CD15), and CD34 but were positive for carcinoembryonic
antigen (CEA) (Fig. 2a) in 3 cases, and E-cadherin (Fig. 2b) and
epithelial membrane antigen (EMA) in cases 1 and 3.
Discussion. Our cases demonstrated diffuse, multinodular, and
nodular pleural tumors. The primary tumor in the lungs was
inconspicuous. The neoplastic cells proliferated with a tubulopap-

© Scandinavian University Press 1999. ISSN 0284-186X Acta Oncologica

 1120 K. Oka et al. Acta Oncologica 38 (1999)

illary pattern and were negative for epithelial mucin. These fea-
tures were similar to those of pleural mesothelioma. However,
the neoplastic cells were positive for CEA in all 3 cases, and
E-cadherin and EMA in 2 cases. Therefore, the 3 cases were
finally diagnosed as mucin-negative PMAL.
Anti-CEA reacted with 74–97% of lung adenocarcinomas, in
contrast, to 0 – 3% of mesotheliomas (5, 6). All mesotheliomas
expressed N-cadherin, regardless of their histologic type,
whereas lung adenocarcinomas expressed E-cadherin but not N-
cadherin (7). Therefore, we considered CEA and E-cadherin to
be useful markers in distinguishing PMAL from pleural malig-
nant mesothelioma.
Because of the extensive pleural involvement, the prognosis
for PMAL is poor. The average survival of 12 PMAL cases
previously reported (4, 8–11) was 6 months after admission.
Koss et al. (12) reported that all PMAL patients dies with/of
tumor, with a mean survival of 4.7 months for those reported
in the medical literature and of 7 months for those in the
Armed Forces Institute of Pathology files.
Friedman et al. (13) commented that mucin-positive epithelial
mesothelioma described by MacDougall et al. (14) might be
compatible with PMAL. Mucin was identified in all 6 cases
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described by Harwood et al. (4). In all 12 PMAL cases previ-

ously reported (4, 8 –11), epithelial mucin was demonstrated in

Fig. 2. Pleural tumor of Case 3. (a) Neoplastic cells positive for

carcinoembryonic antigen showed a papillary pattern × 240.
Pleural tumor of Case 1. (b) Neoplastic cells positive for E-cad-
herin show a tubular or trabecular pattern in the fibrous tissue
×240.

the neoplastic cells. Koss et al. (12) also observed that PMAL
contained mucin. In our 3 cases, neoplastic cells were negative
for mucin, demonstrating the existence of cases of mucin-nega-
tive PMAL.

REFERENCES
Fig. 1. (a) Computed tomographic scan of the thorax of Case
1, showing marked diffuse thickening (arrowheads) of the tumor
on the right side of the pleura. (b) Right lung of Case 2,
showing confluent multinodules of tumor on the visceral pleura.
1. Battifora H, Elliot McCanghey WT. Chapter 4 diffuse malig-
nant mesothelioma. In: Tumors of the serosal membranes.
Atlas of tumor pathology, third series, fascicle 15. Washington
DC: Armed Forces Institute of Pathology, 1994: 17 – 88.
2. Colby TV, Koss MN, Travis WD. Chapter 25. Tumors
metastatic to the lung. In: Tumors of the lower respiratory tract.
Atlas of tumor pathology, third series, fascicle 13. Washington
DC: Armed Forces Institute of Pathology, 1995: 517 – 46.
3. Shimosato Y, Miller RR. Chapter 23. Mesothelioma. In:
Biopsy interpretation of the lung. Biopsy interpretation series.
New York: Raven Press, 1995: 359 – 70.
4. Harwood TR, Gracey DR, Yokoo H. Pseudomesothelioma-
tous adenocarcinoma of the lung: a variant of peripheral lung
cancer. Am J Clin Pathol 1976; 65: 159 – 67.
5. Brown RW, Clark GM, Tandon AK, Allred DC. Multiple-
marker immunohistochemical phenotypes distinguishing ma-
lignant pleural mesothelioma from pulmonary adenocar-
cinoma. Hum Pathol 1993; 24: 347 – 54.
 Acta Oncologica 38 (1999)
6. Mooch H, Oberholzer M, Dalquen P, Wegmann W, Gudat F.
Diagnostic tools for differentiating between pleural mesothe-
lioma and lung adenocarcinoma in paraffin embedded tissue.
Part 1. Virchows Arch A Pathol Anat Histopathol 1993; 423:
19 – 27.
7. Peralta Soler A, Knudsen KA, Jaurand MC, et al. The
differential expression of N-cadherin and E-cadherin distin-
guishes pleural mesotheliomas from lung adenocarcinomas.
Hum Pathol 1995; 26: 1363–9.
8. Braganza JM, Blanche Butler E, et al. Ectopic production of
salivary type amylase by pseudomesotheliomatous adenocar-
cinoma of the lung. Cancer 1978; 41: 1522–5.
9. Broghamer WL Jr, Collins WM, Mojsejenko IK. The cyto-
histopathology of a pseudomesotheliomatous carcinoma of
the lung. Acta Cytol 1978; 22: 239–42.
Downloaded by [36.76.125.151] at 05:57 05 September 2017
Case report 1121
10. Dessy E, Pietra GG. Pseuddomesotheliomatous adenocar-
cinoma of the lung. An immunohistochemical and ultrastruc-
tural study of three cases. Cancer 1991; 68: 1747 – 53.
11. Nishimoto Y, Ohno T, Saito K. Pseudomesotheliomatous
adensocarcinoma of the lung with histochemical and immuno-
histochemical study. Acta Pathol Jpn 1983; 33: 415 – 23.
12. Koss M, Travis W, Moran C, Hochholzer L. Pseudomesothe-
liomatous adenocarcinoma: a reappraisal. Semin Diagn
Pathol 1992; 9: 117 – 23.
13. Friedman HD, Litovsky SH, Abraham JL. Mucin-positive
epithelial mesothelioma and pseudomesotheliomatous adeno-
carcinoma. Arch Pathol Lab Med 1993; 117: 967.
14. MacDougall DB, Wang SE, Zidar BL. Mucin-Positive epi-
thelial mesothelioma. Arch Pathol Lab Med 1992; 116: 874–
80.