Understanding Desmoplastic Mesothelioma: An Elusive Subtype
Desmoplastic mesothelioma is a rarer, and notably more lethal, variant of the sarcomatoid type of mesothelioma cancer. Sarcomatoid mesothelioma is characterized by long, spindle-shaped cells. In the desmoplastic subtype, tumors are primarily composed of dense fibrous tissues, making them difficult to diagnose. The lack of defining cellular features or patterns contributes to the diagnostic challenge, as desmoplastic cells often form dense nodules of connective tissue within tumors. While asbestos exposure remains the key cause for the disease, this rare form accounts for just 5% to 10% of all malignant mesothelioma cases.
The Challenges in Diagnosing Desmoplastic Mesothelioma
Diagnosis of this elusive disease relies heavily on a biopsy of tumor tissue. A large sample is crucial for physicians to accurately determine the cell type and potential treatment options. However, fibrous regions in the tumor often conceal cell variations, resulting in misdiagnoses such as fibrous pleurisy, pleural fibrosis, or even rheumatoid disease. The criteria for diagnosing desmoplastic mesothelioma include the presence of dense fibrous tissue comprising at least 50% of the tumor and neoplastic spindle cells spreading to the lung or chest wall. Advanced imaging techniques like CT and MRI scans can assist in identifying metastasis.
Treatment and Prognosis: A Dim Outlook
Desmoplastic mesothelioma is generally not treated with surgery due to its high recurrence rate. Instead, treatment options usually involve immunotherapy, chemotherapy, and radiation therapy. For example, first-line treatment often consists of immunotherapy agents like nivolumab (Opdivo) and ipilimumab (Yervoy), followed by chemotherapy agents such as cisplatin and pemetrexed (Alimta). Radiation can be used to shrink painful chest wall tumors. Therapeutic measures like pleurodesis or paracentesis are recommended to relieve symptoms like fluid buildup in the lungs or abdomen. However, the prognosis for this subtype remains poor. A study from the 1980s revealed that the mean survival rate for patients with the desmoplastic variant ranged from 5.8 months for those with the sarcomatoid subtype to 6.8 months for those with the biphasic subtype, confirming the devastating impact of this particular form of mesothelioma.
If you or a loved one has been diagnosed with mesothelioma, call the Halpern Law Firm at (800) 505-6000. With over 30 years of experience and over $100 million won for our clients, we are here to help get you the compensation you deserve.
Sources:
Https://www.medscape.com/viewarticle/938530
https://www.researchgate.net/publication/51614621_Desmoplastic_malignant_mesothelioma_of_the_pericardium_Description_of_a_case_and_review_of_the_literature
https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1440-1827.2003.01488.x
https://academic.oup.com/ajcp/article/110/2/191/1758299?login=false
https://journals.lww.com/ajsp/abstract/1982/04000/desmoplastic_diffuse_mesothelioma.3.aspx
https://jcp.bmj.com/content/45/4/295
Written By Jeff Nelson
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