Sarcomatoid Mesothelioma- Before updating you with the term Sarcomatous mesothelioma, we would first like you to understand the term. The term is also known as Sarcomatoid plural mesothelioma which is actually the state of an advanced mesothelioma.
The main reason why it is one of the dreaded forms of lung tumour is due to the fact that it is formed by a lot of sarcomatoid cells located in the linings of lungs (plural membrane or pleura).
The fact that it is called as the least common type of mesothelioma can be evident by the fact that it can affect the line of treatment as well as prognosis.
We have already explained you above that this kind of mesothelioma is an advanced type which is characterised by sarcomatoid cells. As per the findings in this regard, it has been estimated that close to 20% such cases have the presence of sarcomatoid cells that have the capability to grow at an alarming rate.
More than that, these kind of cells are quite specialised ones that are quite resistant to the different treatment options as compared to the other mesothelioma cell types. And this pose somewhat high difficulty levels to control such kind of tumours in the long run.
How Sarcomatous Mesothelioma Looks Like
As the name relates, they are made up of Sarcomatoid cells and are also known by some other names like spindled, sarcomatous or diffused tumours that are known by another term as malignant fibrous mesothelioma.
In such kind of tumours, the cells are organized in an irregular way and take the shape of spindle with plump. They are also diffused with elongated nuclei.
Most of the times, these specialized cells take the shape of sarcomatoid tumors and take less time making small nodules that starts scattering and growing along the surface of the lungs.
There are some rare forms of this kind of tumour where a single mass of tumour starts growing and most likely become harder to remove even after embarking surgeries, especially if it has started growing into the chest wall.
As you can relate yourself, a lot many complications arise after the growth of such tumours. And one such way it may create further complexity which is called plural diffusion. But this is not so common and is not found in the majority of such cases.
Talking about plural effusion, that happens to be the most common cause and symptom of initial mesothelioma that mostly accompany chest pain and shortness of breath. In most cases, these symptoms are not so much severe without the presence of plural effusion.
Other thing to be noted that most patients who have single mass of tumour growing in their chest wall complain more significant chest pain as compared to those who experience somewhat sheet like growth of tumour.
As you might know, all 3 kind of mesothelioma cell types- epithelial, sarcomatoid and biphasic is capable of affecting prognosis and treatment. In case, if a patient is diagnosed with sarcomatoid plural mesothelioma, a patient becomes more likely not to respond to the treatment.
This generally results in shorter and fewer treatment options and the survival rate also becomes lesser. However, if a patient develops such kind of growth at an early stage, he can have a lot more treatment options available that can be far more effective than above.
Diagnosis of Sarcomatous Mesothelioma
This kind of tumour is quite difficult to diagnose as they generally resemble benign and other kinds of malignant conditions.
Due to this, initial flaws are likely to happen and disrupt the route treatment along with their proper diagnosis. If you look their cells under microscope, you can see them growing just like other most common localised sarcoma tumours of the plural membrane.
Now, please take a look at some of the most common misdiagnoses for sarcomatous mesothelioma that generally include:
- · Fibrous pleurisy
- · Fibrosarcoma
- · Pleural liposarcoma
- · Localized fibrous tumours
- · Metastasized renal cell carcinoma
Best Practice to Test Sarcomatous Mesothelioma
As we have already covered that it is quite necessary to properly investigate this kind of mesothelioma which is possible only after conducting a series of vital tests.
The first step is to conduct an imaging test like an X-ray, MRI or CT scan. These tests basically help to identify the tumour visibly without undergoing any kind of hassles.
The next hurdle that comes forth is to identify the cell type. In order to make a correct diagnosis, a biopsy is done where a small mass of tumour is taken.
In general, biopsies are done to help physicians to better understand or closely examine the kind of tissue. In case, the sample tissue is too small, it becomes even harder to determine the type of cells associated in the tumour effectively. And this may lead to the initial misdiagnosis in assessing the kind of tumour.
Immunohistochemistry simply works with the help of antibodies that basically react with proteins in the sample tissue taken for biopsy.
This kind of test is quite simple and can see the result happening in a far less time. The technique is helpful as it helps in differentiating the tumour type that can readily help in determining the right line of treatment.
How Sarcomatous Mesothelioma Tissue Behave to the Stain Used in Immunohistochemistry
In general, the Sarcomatous mesothelioma tissue doesn't react to the antibody being used in this technique called Immuno-histo-chemistry. However, a plethora of antibodies like D2-40, CAM5.2, WT1 and podoplanin will simply mark the presence of sarcomatoid cells. In the same ways, these specific antibodies also stain negatively for other kind of tumours that look quite similar with the sarcomatoid tumours.
Why the Initial Diagnosis id Tough?
As you can see how the tumour containing sarcomatoid tissue behave to the stain used in the above technique, you can expect how difficult it is to properly diagnose the above anomaly.
The procedure of diagnosis also becomes hard due to the presence of as many as 3 variations of Sarcomatous mesothelioma that are desmoplastic, transitional and lymphohistiocytoid.
All three kind of variants are loaded with entirely different cell structures that make it tough to make a definitive and proper diagnosis.
Symptoms of Sarcomatous Mesothelioma
Now, take a look at the symptoms of Sarcomatous mesothelioma
Transitional Mesothelioma - Well, it's quite peculiar in shape by having spindle and plump shaped cells, instead of spindle shaped cells with plump along with elongated nuclei.
Desmoplastic Mesothelioma- This category happens to be one of the most difficult subtypes to diagnose. Also, it accounts to almost 5% of entire mesothelioma cases. The difficulty in diagnosing this kind of cell types is that it lacks a clear and defined pattern. These cell types also contain a plethora of elongated cells with collagen sheaths (bundles).
Lymphohistiocytoid Mesothelioma- These sub-types consist of even larger and spindle-shaped cells along with inflammatory and immune cells. These cells generally account for less than 1% of all such cases.
Effect of Sarcomatoid Cells Towards Prognosis and Treatment of Pleural Mesothelioma
As we have already explained you above about the kind of aggressiveness of sarcomatoid tumours to the different line of treatments, one thing that can be affirmed is that such kind of tumours hardly show response towards different treatment options.
However, the treatment basically revolves on the stage of mesothelioma along with its location. It simply means that physicians mainly go ahead with the conventional line of treatments that include chemotherapy, surgery and radiation therapy.
In case, the diagnosis is delayed, these sarcomatoid cells become even more resistant to the line of treatment.
How Sarcomatous Mesothelioma Response with Different Line of Treatments
Let’s analyse how the tumour generally response with all 3 lines of treatments.
Surgery- Well, these tumours are hard to be treated with surgery as they have a habit of penetrating to the chest wall. It becomes difficult to remove with surgery as they become more complicated.
Chemotherapy- It also have limitations towards treating the tumour.
Any Hope to Deal with Sarcomatous Mesothelioma?
There is a new drug Sodium Selenite that looks a potent chemotherapy drug suitable for all kinds of mesothelioma cell types.
As per the research done on this drug, it has been shown that it has the capacity to cause apoptosis (cell death), when combined with Doxorubicin (Anthracycline antibiotic). However, it has not been studied or practised on humans till date.
As of now, clinical trials for such kind of mesothelioma looks hard due to its rare diagnosis. In order to deal with it, a plenty of specialised mesothelioma programs are being organised to improve the resources and treatment options for patients.
Before patients go for any kind of treatment, they should first consult mesothelioma specialist before deciding for the actual line of treatment.