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Journal of Clinical Urology 15(1)
Figure 3. Microscopic histologic hematoxylin-eosin-stained sections from patient B: Well-differentiated papillary mesothelioma.
(a) Low-power view of the polypoid well-differentiated papillary tumor (40× magnification). (b) Low-power magnification of the
occasional fibrotic sarcomatoid stromal component (40× magnification). (c) High-power view of the papillary neoplasm with
fibrovascular cores, evenly spaced bland mesothelial-lined cells, and rare to no mitotic figures (400× magnification). (d) High-power
magnification of the fibrotic sarcomatoid stromal portion of the neoplasm with small nucleoli, open chromatin, plump eosinophilic
cytoplasm, low nuclear to cytoplasmic ratio, rare mitotic figures, and interspersed chronic inflammatory cells (400× magnification).
surgical scar or cord or metastasize to the inguinal nodes,
retroperitoneal nodes or distant sites. Protocols for localized
and advanced or recurrent disease have been suggested,8
but there is no widely accepted treatment
consensus. Although adjuvant treatment with surgery,
chemotherapy, and/or radiotherapy has yielded generally
disappointing cancer-specific results, a recent series of
patients treated with aggressive surgical management
alone or in combination with adjuvant chemotherapy demonstrates
better results - median overall survival of this
trial was not reached at 42 months of follow-up.2 Kaplan-
Meier overall survival estimates at 3 and 5 years were 80%
and 50%, respectively.
Although adjuvant therapy has been disappointing, a
series published in 2017 indicates that aggressive adjuvant
surgery may improve outcomes. Surgical treatments
beyond radical orchiectomy were performed in 12 of 15
(80%) patients. Pathologic examination revealed tumor
in six of 12 (50%) hemiscrotectomy specimens, seven of
eight (88%) retroperitoneal lymph node dissection
(RPLND) specimens, one of six (17%) pelvic lymph
node dissection specimens and 10 of 10 (100%) groin
dissection specimens. RPLND was performed in five
clinical stage I patients and MM was found in all of
them. This highlights a predominately lymphatic spread
of metastasis. Five patients received chemotherapy with
pemetrexed plus cisplatin given its proven efficacy in
pleural mesothelioma.9 In addition, two of the patients
who received chemotherapy also received adjuvant radiation
therapy to the groin. Disease progression results
were nevertheless disappointing, with seven of 15 (47%)
exhibiting progression after a median follow-up of 3.5
years and five deaths overall.2
Despite improvements in survival for MM, likely
thanks to more aggressive surgical management, improved
chemotherapy agents and understanding of tumor biology,
long-term surveillance is critical. Although most recurrences
happen within 2 years of diagnosis, late recurrences,

JCU - January 2022

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