Epithelioid Mesothelioma – Diagnosis and Treatment

What is Epithelioid Mesothelioma?

Epithelial cells are not cancerous and can mutate into the deadly cancerous form when exposed to asbestos. Mesothelium membrane is made up of the epithelial cells, and when mutation take place mesothelioma epithelioid cells develop. Epithelioid cell type occurs in 70 percent of all mesothelioma cases. Best Life expectancy of epithelioid mesothelioma in patients because more options of treatment are available.

The epithelioid cells behave at a cellular level and make them responsive to treatment, the more curative treatment like surgery than other cell types.

It shows better prognosis than any other cell types because is the least aggressive cell types. The potential of epithelioid cells is slow it doesn’t spread quickly through the body as different cell types, so patients with this diagnosis live longer on an average.

Characteristics of Epithelial Cells

Cell description

Epithelial cell appear flat and thin with elongated shapes like cubes, square, hexagon depending upon their subtypes and visible nuclei make it easier to distinguish. When it turns cancerous, they transform into several visual patterns.

Cell prevalence

Epithelioid cells are very commonly diagnosed in pleural mesothelioma than peritoneal mesothelioma. The ratio is about 70:60. It occurs more commonly in women and is known as well-differentiated papillary mesothelioma.

Cell behavior

Epithelial cells divide faster than mesothelioma a cancer cell type which is faster in tumor growth. Epithelial cells spread nearly the lymph nodes and migrate via the lymphatic system.

epithelioid mesothelioma
mesotheliomahelp.org

Epithelioid Subtypes

Epitheloid mesothelioma has many subtypes distinguish between most common and least common types with their unique characteristics having different sizes, shapes, and structures. These subtypes react differently according to their certain diagnosis and treatment. Some of the epitheloid subtypes are rare and benign and also non-asbestos related.

The most common subtypes include:

  • Adenomatoid
  • Solid mesothelial cell
  • Tubulopapillary
  • Acinar

The least common subtypes include:

  • Deciduoid
  • Adenoid Cystic
  • Clear cell
  • Small cell

Adenomatoid Mesothelioma

A gland-like structure like a genital gland, the tumors are made up of cells that are flat or cube-shaped cell pattern with lace-like metastasis. It is also known as glandular or micro-glandular mesothelioma it’s about 6 percent of all pleural mesothelioma cases.

Cystic Mesothelioma

Cystic mesothelioma is very rare and most commonly develop in the peritoneal or pleural cavity. The cystic cells are often benign though malignancies and form cystic cancer. It is most commonly diagnosed in women, particularly childbearing age. Asbestos is not the cause of multicystic mesothelioma. This can be treat with surgery, radiotherapy, and chemotherapy

Deciduoid Mesothelioma

This is very rare type of cancer, it develops in the abdomen and the lining of lungs. The cell patterns are large round to polygonal cells with sharp borders. Forming nodulated tumors with distant metastasis. The exact cause is unknown other than asbestos, and its most often diagnosed in women abdominal cavity. The average life span is about 5 to 6 months.

Well-Differentiated Papillary Mesothelioma (WDPM)

This type of mesothelioma is noncancerous and related to asbestos exposure, papillae lined by a single layer or flat mesothelial cells. This usually affects young women, it can form in the peritoneum, pleura, and in the tunica vaginalis of both men and women, but the ratio is higher in women. It slow to metastasise and average survival is of only 36 to 180 month.

epithelioid mesothelioma
Pathologyoutlines.com

Small Cell Mesothelioma

This mesothelioma is distinct in a pattern of a shape of the cells. It can form in the lining of peritoneum and pleural cavity. Sometimes it is misdiagnosed as small cell lung cancer. It is found in less than 6 percent of mesothelioma cases. It is usually diagnosed in biphasic tumors which contain both sarcomatoid and epithelial cells.

Diagnosis and Symptoms of Epitheliod Mesothelial Cells

Epithelioid cells closely resemble other cell types that makeup adenocarcinoma, breast cancer, and other forms of cancer in the lining of the internal organs. Epithelial cells types make up to 70 percent of diagnosis in patients.  The doctor uses the process of immunohistochemistry to confirm the diagnosis in patients. It detects the proteins that used as a cancer cell marker in the sample that is taken from the patient.

Some of the immunohistochemical markers used to diagnose the epithelioid mesothelioma. There is four marker used to distinguish from other cancer types.

  • Wilms’ tumor-I antigen
  • D2-40
  • Calretinin
  • CK5/6

Common Symptoms of epithelioid Mesothelioma are:-

  • Abdominal or chest pain
  • Fluid buildup near the lungs or abdomen
  • Coughing and hoarseness
  • Nausea and vomiting
  • Difficulty breathing
  • Unexplained weight loss
  • Constipation
  • Fever and fatigue

Treatment of Epitheliod Mesothelioma

Treatment of epithelioid mesothelioma is almost the same as other types of mesothelioma. The treatment in epitheloid is more effective than any other types because epitheloid mesothelioma responds better than sarcomatoid and biphasic mesothelioma.

It is less aggressive and slower metastasizes than other cell types that may improve patients prognosis. Surgery is the more effective method in patients because their cancer cells don’t spread fastly.

Some patients with epithelial mesothelioma may be eligible for extrapleural pneumonectomy (EPP) which is most aggressive surgery available for the patient of epithelioid type pleural mesothelioma. In this method removal of entire diseased lungs and pleural lining of the patients. If cancer spread far from the pleural parts like pericardium, diaphragm, or nearby lymph nodes it may also be removed by surgery.

Pleurectomy with Decortication (P/D)

The P/D involves removal of the pleura part called pleurectomy and the surface layer of the lung affected by cancer called decortications. About 90 percent of pleural mesothelioma patients who have this surgery experience get a reduction of symptoms of epithelioid mesothelioma.

The survival rate for patients after a P/D is about 20 months or a year longer than the rate for mesothelioma patients.

Cytoreductive surgery

Those with epitheloid peritoneal mesothelioma may take advantage of this method, but there is no excepted staging system for peritoneal mesothelioma, so its to get the second opinion is more important than ever.

However, the standard treatment method for mesothelioma is Chemotherapy and radiotherapy and some alternative treatment like gene therapy, photodynamic therapy etc., which are currently being researched in the hope of developing a mesothelioma cure.

Prognosis 

Based upon the research, as with the treatment and diagnosis plan, the prognosis varies from patient to patient depending on a many factors like age, type of disease, overall health impact etc. those patients that undergoing multimodal care are better prognosis and longer life expectancy compared to palliative treatments.

One of the studies shows that around 60 percent if patients who were treated epitheloid mesothelioma survived at least 24 months to one year after the treatment started.  Which is a longer survival rate than any other biophasic is up to 12 months of survival rate and sarcomatoid is up to six months of survival rate.

It shows better respond in treatment than any different types, and epithelioid type is less aggressive than sarcomatoid cells and a good candidate for surgeries.

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