Epithelial Mesothelioma

Epithelial pleural mesothelioma is a type of asbestos-related cancer defined by the appearance and location of its cancerous cells. If diagnosed with this type of mesothelioma, you may be given a better prognosis and be more responsive to treatment than patients diagnosed with other types of this aggressive cancer.

There are four types of mesothelioma, including pleural mesothelioma, that affect different parts of the body and that are formed by different cell types, including epithelial, sarcomatoid and biphasic. About 50 to 70 percent of all mesothelioma cancers are epithelial.

Epithelial pleural mesothelioma refers to a specific type of mesothelioma that affects the protective tissue surrounding the lungs, called the pleura, and where epithelial cells are present, which look like small, square cells with a tubular configuration and visible cell nucleus. When these cells become cancerous, they are referred to as epithelioid cells.

How Is Epithelioid Pleural Mesothelioma Diagnosed

Epithelioid pleural mesothelioma can be difficult to diagnose. Patients often first visit their primary care physician with complaints of chest pain or shortness of breath. Referral to a pulmonologist is common before an oncologist (cancer doctor) becomes involved.

Diagnosing pleural mesothelioma quickly can be problematic because symptoms don’t become obvious until the cancer progresses. These symptoms also often mimic less severe respiratory conditions, such as asthma or pneumonia, which may lead to an initial misdiagnosis.

Once the symptoms of pleural mesothelioma are recognized, additional diagnostic tests like imaging scans and testing tumor samples are conducted to confirm the presence of cancer.
Detecting epithelioid cells requires an experienced pathologist, who analyzes tumor samples to determine which cell type is present. There are subtypes of epithelial mesothelioma that an experienced pathologist knows how to test for, and they know how to tell these cells apart from cells of other types of cancer.

Because epithelial pleural mesothelioma can resemble adenocarcinoma cells, it’s important to have an experienced pathologist analyzing the tumor samples. For example, a pathologist should look for certain cell structures like microvilli (which are different sizes for pleural mesothelioma and adenocarcinoma) to differentiate between the two cancers.

Different characteristics help pathologists differentiate between the subtypes of epithelial mesothelioma. For example, tubulopapillary epithelioid mesothelioma cells form a cube-like shape, histiocytoid cells resemble pulmonary macrophages, and poorly differentiated cells are round or irregularly shaped.

Though statistics on all the epithelioid subtypes aren’t available, it is known that deciduoid epithelioid mesothelioma accounts for approximately 2-5 percent of all mesothelioma cases, and small cell accounts for less than 6 percent. Most epithelial cases have a tubulopapillary cell pattern, while rare cases are adenoid cystic or signet ring.

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Subtypes of Epithelial Mesothelioma
Single File Deciduoid
Diffuse - NOS Tubulopapillary
Glomeruloid Glandular
Small Cell Histiocytoid
Poorly Differentiated Adenoid Cystic
Mucin Positive Microcystic
Gaucher Cell-Like Macrocystic
Well Differentiated Papillary Signet Ring

How Epithelioid Cells Affect Pleural Mesothelioma Treatment and Prognosis

Treatment for mesothelioma cancer typically depends on the type and stage of cancer, rather than the cell type. This means that treatment for epithelial pleural mesothelioma is similar to treatment of other mesothelioma cell types. Chemotherapy, radiation therapy and surgery may be viable options for epithelial pleural mesothelioma patients.

Because epithelial cells have proven to respond better to treatment, epithelial pleural mesothelioma patients may be eligible for a more aggressive treatment plan — and may be given a better prognosis than patients with other cell types.

It’s important to find a mesothelioma specialist who can determine the cell type of your cancer and create a specialized treatment plan. The Patient Advocates at the Pleural Mesothelioma Center can help you find a doctor.

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