Pleomorphic Epithelioid Diffuse Malignant Pleural Mesothelioma: A Clinicopathological Review and Conceptual Proposal to Reclassify as Biphasic or Sarcomatoid.

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Pleomorphic Epithelioid Diffuse Malignant Pleural Mesothelioma: A Clinicopathological Review and Conceptual Proposal to Reclassify as Biphasic or Sarcomatoid Mesothelioma Kyuichi Kadota, MD, PhD, Kei Suzuki, MD, Camelia S. Sima, MD, MS, Valerie W. Rusch, MD, Prasad S. Adusumilli, MD, William D. Travis, MD Journal of Thoracic Oncology Volume 6, Issue 5, Pages 896-904 (May 2011) DOI: 10.1097/JTO.0b013e318211127a Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Histologic subtypes of epithelioid diffuse malignant pleural mesothelioma (DMPM) (hematoxylin and eosin [H&E] stain; original magnification, ×200: A, B, C, and D and ×400: E). A, Trabecular subtype is composed of relatively small, uniform cells infiltrating in thin cord arrangement. B, Tubulopapillary subtype exhibits varying combinations of tubules and papillary structures lined by relatively bland flat, cuboidal, or polygonal tumor cells. C, Micropapillary subtype was defined as papillary structures with tufts lacking a central fibrovascular core. D, Solid subtype consists of sheets or nests of polygonal to round tumor cells. E, Pleomorphic subtype is composed of anaplastic or prominent giant cells. Journal of Thoracic Oncology 2011 6, 896-904DOI: (10.1097/JTO.0b013e318211127a) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Overall survival by five histologic subtypes in patients with epithelioid diffuse malignant pleural mesothelioma (DMPM). Patients with the pleomorphic subtype had significantly worse overall survival (A) in 232 all-stage patients (8.1 months), (B) in 68 early-stage (stages I–II) patients (14.7 months), and (C) in 130 stage III patients (4.9 months). Journal of Thoracic Oncology 2011 6, 896-904DOI: (10.1097/JTO.0b013e318211127a) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Overall survival by histologic type (epithelioid, biphasic, and sarcomatoid) in 305 patients with diffuse malignant pleural mesothelioma (DMPM). (A) Patients with epithelioid DMPM had a significantly better median survival (16.2 months) compared with biphasic (7.0 months) and sarcomatoid (3.8 months). (B) The pleomorphic subtype (8.1 months) showed no significant difference on overall survival compared with biphasic and sarcomatoid DMPM. Journal of Thoracic Oncology 2011 6, 896-904DOI: (10.1097/JTO.0b013e318211127a) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Overall survival by combined group with histologic subtypes in 232 all-stage patients with epithelioid diffuse malignant pleural mesothelioma (DMPM). Patients with trabecular and tubulopapillary combined group had significantly better overall survival (23.3 months) compared with the solid subtype (13.7 months). Journal of Thoracic Oncology 2011 6, 896-904DOI: (10.1097/JTO.0b013e318211127a) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5 Time to recurrence by five histologic subtypes in 159 patients who underwent R1 resection. Patients with pleomorphic subtype had the shortest median time to recurrence (13.7 months). Journal of Thoracic Oncology 2011 6, 896-904DOI: (10.1097/JTO.0b013e318211127a) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions