Review Question - QID 109917

This patient’s clinical history and tissue biopsy demonstrating a psammoma body is consistent with pleural mesothelioma.

Malignant mesothelioma typically occurs in older age, several decades after exposure to asbestos, and is especially notable in patients involved with construction or renovation work but is not associated with smoking. The presenting signs and symptoms are nonspecific, but a pleural effusion is often present. While a pleural mesothelioma is visible on CXR or CT, a tissue diagnosis is required. One feature of mesothelioma histology is the presence of psammoma bodies, which are basophilic structures on H&E staining that represent whirls with calcification.

Figure A shows an example of a psammoma body. While psammoma bodies generally appear as whirls, they can also appear as the basophilic condensation in the center of this image.

Incorrect Answers:
Answer 1: A Pancoast tumor is a malignancy defined by its location at the apex of either lung and is typically a non-small cell lung cancer such as squamous cell carcinoma. These are not associated with psammoma bodies.

Answer 3: Small cell carcinoma is an aggressive lung cancer composed of neuroendocrine cells that can be biologically active and associated with various paraneoplastic syndromes.

Answer 4: Spinal meningiomas are uncommon meningiomas; although meningiomas are classically associated with psammoma bodies, spinal psammomatous meningiomas are exceedingly rare. This patient has nonspecific pulmonary symptoms that are less likely due to nervous system pathology.

Answer 5: Squamous cell carcinoma is a bronchogenic carcinoma that is the most common lung cancer. While asbestosis is associated with a greater incidence of bronchogenic carcinoma than mesothelioma, mesothelioma is associated with psammoma bodies.

Bullet Summary:
Mesothelioma can result from asbestos exposure and can have histological findings of psammoma bodies.