Biphasic Mesothelioma

The biphasic mesothelioma cell type contains a mix of epithelial and sarcomatoid cells. The ratio of epithelial to sarcomatoid cells will influence how aggressively the cancer grows. Treatment will depend upon the cancer's stage, how quickly it is growing and your overall health.

Malignant biphasic mesothelioma is the second most common cell type of the disease. Patients with this form of cancer will have varying life expectancy rates because prognosis will depend on the ratio of epithelial and sarcomatoid cells. Learning about biphasic and understanding its characteristics, how it is diagnosed, and how this type affects treatment can help you make informed decisions with your doctor.

20-35 % chart

Approximately 20 to 35 percent of all malignant mesothelioma cases are classified as biphasic. This cell type is more common among pleural patients. It is important to determine which cells are present because this information may have an impact on your prognosis.

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Characteristics

In biphasic cases, epithelioid cells and sarcomatoid cells can exist in close proximity or, more frequently, within distinctly separate areas of a tumor. These cell types are important to detect because some clinical trials and treatments can be targeted at specific cell types. The characteristics of your cell type do not affect your symptoms and they may only affect your prognosis by a few months.

Most common mesothelioma cell types

Epithelioid

Epithelioid mesothelioma is comprised of round, cube-like cells that have long and slender microvilli, which are small hair-like protrusions in the cell membrane.

Biphasic

Biphasic mesothelioma is often called the "mixed" cell type because it is made up of cells from both of the other mesothelioma cell types.

Sarcomatoid

Sarcomatoid mesothelioma is made up of spindle-shaped cells arranged in a disorganized fashion.

The diagnostic process can be harder for biphasic patients since epithelioid and sarcomatoid cells must both be detected.

Diagnosis

Patient Advocate Karen Selby explains biphasic mesothelioma.

This type can be difficult to detect and diagnose because during a key diagnostic test called biopsy, doctors may collect only a small sample of tissue to study in the lab. Taking samples from just one location offers a limited view of the type and amount of mesothelioma cells involved.

Doctors can make a more accurate diagnosis by taking tissue samples from several parts of the tumor. Determining the specific cell type is important to the diagnostic process because it can affect your treatment options and prognosis.

Preventing a Misdiagnosis

To distinguish biphasic mesothelioma from other diseases easily confused with this cancer, doctors use advanced tests like immunohistochemistry. This technique can detect certain proteins in cells, revealing the specific type of abnormal cells found with this diagnosis.

With this information, doctors can rule out common misdiagnoses, including cancers like synovial sarcoma and carcinosarcoma.

A recent study published in the Journal of Thoracic Oncology found the biphasic type can be misdiagnosed after a biopsy. A total of 83 patients in the study were confirmed to have this type of pleural cancer after undergoing an extensive surgical procedure called an extrapleural pneumonectomy.

However, only 26 percent of those patients had been originally diagnosed with this subtype. The authors explained biphasic mesothelioma can be more accurately diagnosed following surgery. The initial diagnostic methods included thoracoscopy, thoracotomy, computerized tomography and other biopsy methods.

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Treatment and Prognosis

Treatment generally depends more on the stage and location of the tumor than the cell type involved. Because biphasic carries a slightly poorer prognosis than epithelioid, patients with the biphasic cell type may not be considered for an aggressive treatment plan as would epithelioid patients. However, treatment is not completely based on cell type, and most patients undergo one or more of the three most common therapies, including:

The prognosis for patients with this cell type will vary depending on the mix and ratio of epithelial and sarcomatoid cells that are present in each case.

In one study involving 85 pleural mesothelioma patients with a variety of cellular subtypes, people with the biphasic subtype had an average survival of about 15 months. Those with the epithelial subtype displayed the highest average survival — more than 22 months.

The researchers observed slightly better survival among biphasic patients whose tumors had mostly epithelial cells, compared to those with mostly sarcomatoid cells. While the survival advantage was only 16 days, sarcomatoid cells are less responsive to treatment than epithelial cells. As a result, biphasic patients with a lower number of sarcomatoid cells tend to see better results from treatment.

The more epithelial cells you have in a biphasic mix, the better your prognosis may be. How much better may amount to only a few months depending on the case.

Additional Resources

  1. Dodson, R. and Hammar, S. Asbestos: Risk Assessment, Epidemiology, and Health Effects. Taylor & Francis: Boca Raton. 2006.
  2. Galateau-Salle, Francoise. Pathology of Malignant Mesothelioma. Springer-Verlag London Limited: London. 2006.
  3. Pass, I., Vogelzang, N., Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. Springer: New York. 2005.
  4. Bruce, W., Robinson, A., & Philippe Chahinian. "Mesothelioma". Informa Health Care, 2002. (ISBN 9058231801).
  5. "Accuracy of Diagnostic Biopsy for the Histological Subtype of Malignant Pleural Mesothelioma." Journal of Thoracic Oncology. 6.3 (2011): 602-5.
  6. "Diffuse Malignant Mesothelioma of the Peritoneum and Pleura, analysis of markers." Modern Pathology. 17 (2004): 476-81.
  7. Tannapfel, A. (2011). Malignant Mesothelioma. Hiedelberg: Springer. Print.
  8. Johansson, L, Linden, CJ. (1996). Aspects of histopathologic subtype as a prognostic factor in 85 pleural mesotheliomas. Chest. 109(1): 109-114. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8549169

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