Sarcomatoid Mesothelioma - A Descriptive Review

Introduction

Most lung conditions are associated with cigarette smoking, infections of the lungs, cancer metastasis, and asbestos inhalation. A sarcomatoid mesothelioma is an aggressive form of cancer. It is an occupational hazard and is seen among asbestos workers. These tumor cells are resistant to the treatment and are highly competitive. The average longevity of life is six months to one year after diagnosis. Therefore, making the prognosis very poor.

What Are Sarcomatoid Mesothelioma?

Sarcomatoid mesothelioma is the rarest form of lung cancer. It is caused due to asbestos inhalation and is found among factory workers. Sarcomatoid tumors account for ten to twenty percent of all mesothelioma tumors. Some of the distinct features of sarcomatoid cells are:

• The sarcomatoid cells are seen in an oval spindle shape.

• It has a large nucleus.

• It transports the cells to distant parts of the body.

• It shows multiple nuclei in specific cells.

• Change in cell structure with increased fibrous deposition.

• They are more aggressive.

What Is Asbestos?

It is a naturally occurring mineral. It can also be excavated from soils. It comprises hydrogen, oxygen, silicon, and other positively charged metal particles. A charged metal is called an ion. It is one of the most robust materials. It has the property to withstand heat. Hence, it is used in many industrial workplaces like aluminum plants, chemical plants, electricity storehouses, oil refineries, shipyards, field mills, and construction sites. However, asbestos is not limited to big industries but is used in various daily products like hair dryers, car manufacturing, pipes, and windshield products. These asbestos particles, on inhalation, can turn into malignant lung conditions and remain dormant for years. As all these professions are dominant male industries, it affects more of the male population. Asbestos is of two types, namely- serpentine asbestos and amphibole asbestos.

On microscopic examination, it is seen as rod-shaped. These long rod-shaped crystalline structures get trapped inside the lungs forever without a way of escape. With the passing years, the asbestos crystals start creating stress inside the lung lining cells. The cells thus start mutating and proliferating into abnormal mass tissue. Serpentine asbestos has the property of remaining in layers. Such conditions are permanent complications and do not improve if asbestos exposure is completely blocked. Secondary infection can be passed from an asbestos-infected person’s clothes but is rare. It takes fifteen to fifty years for any medical emergency to develop. The tissues are scarred from these crystals and obstruct the blood flow.

What Are Sarcomatoid Tumors Made Up Of?

The sarcomatoid tumor cells are made up of any of the following cells:

• Sarcomatoid: These types of cells occur rarely and are very aggressive forms of cells. They are formed in cylindrical shapes. These cells can transport around the tumor, leading to its spread in distal parts of the organ. Tumors of sarcomatoid origin are hard to treat.

• Epithelial Cells: They are the most common type of cell occurring in the sarcomatoid tumor. They are treatable.

• Biphasic Cells: It is a combination of sarcomatoid and epithelial cells.

What Are the Symptoms of Sarcomatoid Mesothelioma?

The symptoms develop during late stages and are usually asymptomatic initially. Presenting signs are:

• This type of cancer shows a high dormancy period and remains silent for decades.

• It appears in the fifth and sixth decades of life.

• It is highly metastatic and can spread to the stomach.

• Chest pain.

• Fluid deposition in chest and abdomen.

• Cough.

• Shortness of breath.

• Blood in feces or vomit.

• Bloody sputum.

• Thick saliva.

• Coughing up blood.

• Loss of appetite.

• Fatigue.

• Nausea.

• Rib pain, pain within the shoulders.

• Weight loss.

• Constant cough.

• Upper back pain.

Can Sarcomatoid Mesothelioma Be Treated?

Sarcomatoid tumors are hard to treat due to their aggressive progression, high rate of metastasis, and late detection. Plum-spindle-shaped cells make it difficult to diagnose. Most of the cure for this disease is not obtained. Some of the available treatment options are:

• Chemotherapy: It is the first line of treatment response to tumor invasion. The drugs used are Cisplatin and Carboplatin. However, research also suggests that some tumor cells can also be resistant to chemotherapy.

• Surgery: Surgical resection of the tumor will not be a good option for many patients.

• Immunotherapy: Clinical trials have shown positive results for immunotherapy in sarcomatoid mesothelioma. A patient who received chemotherapy before immunotherapy has shown a high chance of improvement.

• Radiotherapy: Some cases are also advised for radiotherapy to relieve the pain and increase the quality of life. It is a kind of palliative care.

How Can Sarcomatoid Mesothelioma Be Diagnosed?

It is difficult to diagnose sarcomatoid mesothelioma due to its common presenting symptoms. Some of the tests performed are:

• X-ray: It helps to detect the fluid filled in the lungs.

• Blood Tests: These tests help to identify the biomarkers to differentiate mesothelioma from other conditions.

• Biopsy: A tissue sample is collected and studied under a microscope to check for cancer cells. Biopsy is the most crucial test in confirming the diagnosis.

• Immunohistochemistry (IHC): It isolates specific antigens, antibodies, and proteins from tissue samples. The tumor is categorized as benign or malignant by a pathologist. Then, several cells are stained to determine the stage and prognosis.

• Tumor Markers: The test is confirmed by the presence of positive proteins and D2-40 cells, indicative of sarcomatoid mesothelioma.

• Computed Tomography (CT): It helps to identify the tumor lesion.

• Magnetic Resonance Imaging (MRI): This is a more magnified and higher resolution version where the tumor can be appreciated much better.

Conclusion

Sarcomatoid mesothelioma occurs in very less percentage in less than one percent of all diagnoses. The lesion affects the pleural membrane of the lungs. This condition's average life expectancy rate lies from three to eight months. These tumor cells comprise pleural, epithelial, lymphatic, and plasma cells. Treatment becomes difficult due to the lack of positive response from tumor cells, making the prognosis poor. The asbestos product should be stopped or banned to reduce the risk of sarcomatoid mesothelioma. In addition, the consumer court should act voluntarily against using and exploiting workers in asbestos factories.