Small cell mesothelioma is a rare subtype of epithelioma mesothelioma. The tumor cells are smaller than cells in the tumors of other mesothelioma types. Small cell lung cancer is a common misdiagnosis for small cell mesothelioma.
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What Is Small Cell Mesothelioma?
Small cell mesothelioma is a rare epithelial cell subtype of malignant mesothelioma. It is less common than other cell subtypes. Less than 6% of all mesothelioma tumors contain small cells.
Small cell mesothelioma tumors usually contain a mixture of cell types, with at least 50% small cells. The small cells are round, uniform, and small but with a large nucleus.
The few cases of small cell mesothelioma reported in the literature included both pleural and peritoneal mesothelioma. Many, but not all, of the patients studied had past asbestos exposure.
Characteristics of Small Cell Mesothelioma
Small cell mesothelioma cells are round, all similar in appearance, and contain a distinguishable single, large nucleus in each cell.
Small cell mesothelioma looks like small cell carcinoma, yet without the ribbon patterns that are prevalent throughout carcinoma. According to one case study, mesothelioma small cell tumors have specific features:
- Large nuclei
- Minimal cytoplasm around the nuclei
- Infrequent mitosis (cell division)
- Powdery chromatin
Pathologists use characteristics like these to identify small cells during a mesothelioma diagnosis.
Symptoms of Small Cell Mesothelioma
When small cell mesothelioma forms in the pleural tissue, it causes these typical symptoms:
- Coughing
- Shortness of breath
- Difficulty breathing
- Chest pains
Symptoms of small cell peritoneal mesothelioma include:
- Abdominal pain
- Abdominal swelling
- A feeling of fullness
- Unintentional weight loss or gain
- Diarrhea or constipation
Diagnosing Small Cell Mesothelioma Diagnosis
It’s difficult for physicians to correctly diagnose small cell mesothelioma because it looks similar to other cell types and to small cell lung cancer.
After diagnosing mesothelioma, pathologists examine biopsy samples carefully for characteristics of cell types. They also use immunohistochemical tests, which identify markers specific to certain cancers and cell types.
According to the National Institutes of Health (NIH), an accurate diagnosis of small cell mesothelioma is possible with the following:
“We conclude that the accurate diagnosis of small cell mesothelioma is possible, provided that the clinical presentation is known, the tumour is adequately sampled and the microscopy carefully assessed.”
Physicians usually need to conduct and collect numerous samples before accurately diagnosing small cell mesothelioma. After the samples are collected and tested, they must test negative for other types of cells before an accurate diagnosis is made.
Small Cell Mesothelioma and Small Cell Lung Cancer
Small cell mesothelioma is often mistaken for small cell lung cancer. The similarity in cell type and the location of the tumors in the chest cavity make it difficult to distinguish this rare mesothelioma from a much more common lung cancer.
Making the correct diagnosis is essential for a patient to get the most appropriate and effective treatment. Small cell lung cancer is an aggressive type of lung cancer, but treatments are not exactly the same as for aggressive mesothelioma.
One study of 13 cases of small cell mesothelioma helped outline important differences between the two cancers. The researchers found that small cell lung cancer tumors have specific growth patterns lacking in mesothelioma. These include what they described as ribbons, rosettes, and streams.
Treating Small Cell Mesothelioma
Although there are not enough cases of small cell mesothelioma to have a detailed standard of treatment, most doctors approach it the way they would approach other types of epithelioid mesothelioma.
The usual treatments include surgery, chemotherapy, radiation therapy, immunotherapy, or a combination. The specific treatment plan depends significantly on individual patient factors.
Patients may qualify for surgery if small cell mesothelioma is diagnosed before it is too widespread. Surgery is usually combined with chemotherapy and sometimes radiation therapy.
Patients who do not qualify for surgery can benefit from chemotherapy and immunotherapy. They also benefit from palliative treatments to relieve symptoms and improve quality of life.
Small Cell Mesothelioma Prognosis
Small cell mesothelioma is an epithelial mesothelioma, the least aggressive type of mesothelioma. Even so, the prognosis is often poor for small cell mesothelioma.
According to a study of seven patients, the average survival time of small cell mesothelioma patients is a little over eight months.
Keep in mind that, as with forms of mesothelioma, the long-term outlook can vary according to each patient. While some may live only eight months, others may go on to beat the standard prognosis and live for another year, another five years, and even longer.
Overall health, physical activity, stress levels, age, and how quickly treatment starts all factor in the long-term outlook.
In addition, more studies are needed on small cell mesothelioma, including favorable treatment options, which may change the median survival rate.
Small cell mesothelioma is a rare, uncommon diagnosis. Talk to your medical team to get more information and discuss treatment options.
Additional Resources and Helpful Information for Mesothelioma Patients
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