Biphasic Mesothelioma
Page Medically Reviewed and Edited by Pinar Kanlikilicer, PhDThis page has been fact checked by a PhD who specializes in cancer research. Sources of information are listed at the bottom of the article.
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Biphasic mesothelioma is the second most common type of mesothelioma as described by the cells in the tumors. Approximately 20% of diagnosed mesothelioma cases are biphasic. It includes a mix of two major cell types: epithelioid and sarcomatoid.[1]
How is Mesothelioma Classified by Cell Type?
Histology is the study of microscopic cell structures. When a tumor is discovered through imaging scans, cells are removed for examination by a pathologist to determine whether they are benign or malignant and to determine the origin of the cells. Mesothelioma cells may develop in the peritoneum, pleura, or pericardium.[2]
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A pathologist will also look at biopsied cells to determine their histological classification, or cell type:[3]
- Epithelioid
- Sarcomatoid
- Biphasic
To be classified as biphasic, the biopsied sample must contain more than 10% of either epithelioid or sarcomatoid cells. The remaining cells can consist of the other type.
Biphasic Mesothelioma Cells (by WebPathology)
What Are Sarcomatoid and Epithelioid Cells?
Biphasic mesotheliomas are tumors that include a mix of these two cell types. Epithelial cells make up tissue in the body that line surfaces of organs, blood vessels, and the interiors of cavities. When these cells become cancerous, it is called a carcinoma.[4]
On the other hand, sarcoma develops from cells that make up bone, fat, muscle, vascular, and connective tissue. Sarcomas are rarer than carcinomas. [4]
The distinction between the cell types is important in diagnosis and treatment of mesothelioma:
- Epithelioid mesothelioma cells are easier to treat.
- They are also less aggressive because they tend to stick together rather than spread.
- Sarcomatoid cells are more likely to spread to other organs as they adhere less to one another.
- Epithelioid cells appear as rounded, cube-like shapes.
- Sarcomatoid cells are spindle shaped and arrange themselves in a disorganized manner.
- Biphasic tumors may have up to 90% of either cell type.
How is Biphasic Mesothelioma Diagnosed?
All types of mesothelioma are difficult to diagnose and may lead to misdiagnoses. Pleural mesothelioma is often misdiagnosed as lung cancer for instance. Peritoneal biphasic mesothelioma can be misdiagnosed as liver cancer, carcinosarcomas, synovial sarcoma, and other cancers.[5][6]
- Diagnosis of biphasic mesothelioma begins with a visit to the doctor and a physical examination.
- This is usually followed by an X-ray, CT scan, MRI, or PET scan (or combination of these) to determine if there are tumors or other abnormal tissues.
- Any abnormal tissues are then biopsied. In most cases this requires the insertion of a needle to draw fluid or tissue. If the tumor is particularly difficult to reach, surgery may be required.
- A pathologist then examines the biopsied cells to determine if they are malignant or benign.
- The pathologist will also determine if the cells are in the mesothelium or some other tissue. This histological diagnosis is not always accurate. It is often difficult to distinguish mesothelioma cells from other cancer types.[7]
- If the pathologist makes a confident mesothelioma diagnosis, they will then examine the cells to determine what type they are. If there is a mix of epithelioid and sarcomatoid cells in the sample, the diagnosis will be biphasic mesothelioma.[7]
How Is Biphasic Mesothelioma Treated?
Treatment for biphasic mesothelioma depends on many factors. One factor is the ratio of epithelial to sarcomatoid cells:
- If more epithelial cells are present, the cancer is likely to spread slowly to areas near the original tumor.
- If sarcomatoid cells dominate, the cancer is more likely to be fast-growing and aggressive. This heterogeneity is the major factor that limits treatment options for biphasic mesothelioma.
There are also individual factors to consider. These factors include the patient’s health, tumor location, and how extensive the metastasis.
Surgery is usually only performed for epithelioid mesothelioma; however, if the biphasic tumor is mostly epithelioid, surgical removal of all or part of the tumor may be part of the treatment. Surgery is typically followed by radiation and chemotherapy.
For mostly sarcomatoid biphasic tumors, chemotherapy and radiation are more likely choices for treatment.
What Is the Outlook for Biphasic Mesothelioma?
As with treatment, the prognosis for patients with biphasic mesothelioma varies by individual. Unfortunately, most patients have a poor prognosis, regardless of cell type.
Even with mostly epithelial cells, this cancer type is aggressive and is often not diagnosed until the latter stages of development. Survival rates for biphasic mesothelioma are low; however, patients with biphasic mesothelioma are expected to live longer than those with sarcomatoid tumors. The greater the ratio of epithelial cells present in a biphasic tumor, the longer the life expectancy.[8]
If you were exposed to asbestos and then received a diagnosis of biphasic mesothelioma, you may feel someone else is to blame. Either your employer or the maker of asbestos-containing materials could be at fault. File with an asbestos trust fund or start a lawsuit if you feel you have a strong case to make for compensation. This process can be complicated, but a lawyer with experience in asbestos and mesothelioma cases can help you navigate the process.
Page Medically Reviewed and Edited by Pinar Kanlikilicer, PhD
Dr. Pinar Kanlikilicer has a PhD in Biomedical Engineering. She completed her 5-years of postdoctoral training in the Department of Experimental Therapeutics at MD Anderson Cancer Center. She is currently working in the field of cancer as a research scientist.