Clinicopathologic Characteristics of Malignant Mesotheliomas Arising in Patients with a History of Radiation for Hodgkin Lymphoma
JA Barletta, J Godleski, DJ Sugarbaker, LR Chirieac. Brigham and Women's Hospital, Boston, MA
Background: Recent studies have reported an association between malignant mesothelioma and chest radiation for Hodgkin lymphoma (HL). The clinicopathologic characteristics of malignant mesotheliomas arising in these patients have not been established.
Design: We compared the clinicopathologic characteristics of nine malignant mesotheliomas from patients with a history of radiation for HL and no reported asbestos exposure (case group) with 12 malignant mesotheliomas from patients with a history of asbestos exposure (control group). Clinical features ascertained were sex, age at mesothelioma diagnosis, asbestos exposure, and dates of radiation for HL, diagnosis of malignant mesothelioma, and death. Tumors were classified as epithelioid, sarcomatoid, or mixed types according to WHO criteria. We reviewed an average of 14 H&E slides (range 2-25) from each tumor and recorded the presence of rhabdoid, clear cell, signet-ring cell, and myxoid morphologies, pleomorphism, necrosis, mitoses, and cytogenetic and molecular alterations.
Results: Median time from radiation for HL to mesothelioma was 24.4 years (range 13-36). Eight mesotheliomas after HL were epithelioid and one was mixed. Two cases had pleomorphic histology, one had a myxoid morphology, one had clear cells, and three had signet-ring cells. The cytogenetic and molecular alterations were numerous losses/deletions, including deletion of 22q, and deletion of the p16 gene. Patients with mesothelioma after radiation for HL were younger than the patients in the control group (median age 41 vs. 65, p<0.0001) and had a significantly longer median overall survival (31.5 vs. 11.2 months, p=0.046).
Conclusions: Patients with mesothelioma after HL are significantly younger and had a longer overall survival compared to patients in the control group. Continued studies are needed to further define the clinicopathologic characteristics of patients with malignant mesothelioma with a history of radiation for HL.
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 247, Tuesday Afternoon