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Malignant mesothelioma can be differentiated in several ways, including by cell type. The most common cell type, epithelial or epithelioid mesothelioma, can be further divided into several different subtypes. The most common of these is tubulopapillary mesothelioma, which is characterized by tubules and papillary cell architecture.
There is some evidence that patients with the tubulopapillary subtype of pleural or peritoneal mesothelioma have a greater life expectancy, but this is not always the case. Investigating the cell type of mesothelioma is important for making an accurate diagnosis and for planning and developing the best treatments.
There are three main types of mesothelioma as categorized by cell type: epithelial, sarcomatoid, and biphasic, which is a mixture of the other two. Epithelial cells are most commonly involved in mesothelioma, accounting for nearly three-quarters of diagnoses.
Tissue containing epithelial cells lines many parts of the body, from the throat and skin to most organs. The role they play is in protecting other tissues, by providing a barrier. They are healthy, normal cells that come in a variety of sizes and shapes, but they can become cancerous, as in the case of epithelial mesothelioma.
Epithelial mesothelioma is less aggressive than sarcomatoid. The cancerous epithelial cells spread and grow more slowly than those involved in sarcomatoid mesothelioma. It is still a very serious type of cancer, and one that will spread and metastasize, but patients with this cell type are likely to have a better prognosis.
Tubulopapillary Epithelial Cells
There are many subtypes of epithelial cells that can be involved in epithelial mesothelioma. Each one is characterized by different shapes and growth patterns. One of the most common epithelial subtypes is tubulopapillary. This type of mesothelioma exhibits cancer cells that grow papillary structures and smaller tubules. There may also be psammoma bodies—round gatherings or bodies of calcium—seen in biopsies of this type of mesothelioma. The cell structure and growth pattern of tubulopapillary mesothelioma can be mistaken for adenocarcinoma.
Diagnosing Tubulopapillary Mesothelioma
Diagnosing any kind of mesothelioma can be difficult for several reasons. Mesothelioma is rare, so it can often be mistaken for another type of cancer, like lung cancer. As with other types of mesothelioma, asbestos exposure is the most likely cause, so knowing that a patient has been exposed in the past can help make the diagnosis more accurate.
To diagnose mesothelioma in general, doctors need to perform a complete physical and then use imaging scans, like X-rays, MRIs, and CT scans to look for causes of symptoms, to rule out other conditions, and to detect any unusual growths that may be tumors.
If a growth is found, the next step in making a diagnosis is to remove a small sample, or perform a biopsy. A small piece of tissue can be examined under the microscope to determine the cells involved and, the type of cancer, and whether it is a benign growth or a malignant one. Diagnosing mesothelioma as tubulopapillary involves looking at the cells to identify the characteristic tubules and papillary structures and also to determine that the cells involved are epithelial rather than sarcomatoid.
Treating Tubulopapillary Mesothelioma
How tubulopapillary mesothelioma is treated depends a lot on the stage of the cancer and the individual patient. Most cases of mesothelioma are treated with a multimodal approach, using surgery if possible to remove as much of the cancerous tissue as possible and supplementing surgery with chemotherapy or radiation to kill any cells that couldn’t be removed.
The outlook for anyone with mesothelioma is generally poor. This is difficult cancer to treat because most people are diagnosed and begin treatment after it has already spread or even metastasized. On the other hand, Tubulopapillary mesothelioma has some of the longest life expectancies of all types of mesothelioma. This may be a result of the slower, less aggressive growth of the tumors.
If you were exposed to asbestos in the past, and if you have symptoms of mesothelioma, like coughing, chest pains, and shortness of breath, it is important to be screened as soon as possible. Diagnostic techniques are getting better all the time and new treatments are helping patients live longer and with a better quality of life. The best thing you can do is to get an accurate diagnosis now.
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.