A 26-year-old male with mesothelioma due to asbestos exposure

Our plain-English summary of A 26-year-old male with mesothelioma due to asbestos exposure, by P. Zarogoulidis, M. Orfanidis, T.C. Constadinidis, et al (Case Reports in Medicine, 2011).

The study

• Authors: P. Zarogoulidis, M. Orfanidis, T.C. Constadinidis, E. Eleutheriadou, T. Kontakiotis, T. Kerenidi, L. Sakkas, N. Courcoutsakis, K. Zarogoulidis
• Journal: Case Reports in Medicine
• Published: 2011;2011:951732
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelioma is a malignancy with poor prognosis, with an average 5-year survival rate being less than 9%. This type of cancer is almost exclusively caused by exposure to asbestos. A long exposure can cause mesothelioma and so can short ones, as each exposure is cumulative. We report a case of a 26-year-old male who was exposed to asbestos during his primary school years from the age of 6 to 12. Although the tumor mainly affects older men who in their youth were occupationally exposed to asbestos, malignant mesothelioma can also occur in young adults. A medical history was carefully taken and asbestos exposure was immediately mentioned by the patient. We conducted biopsy on the right supraclavicular lymph node. The patient was not a candidate for surgery, and chemotherapy treatment was initiated. While patient's chemotherapy is still ongoing, no other similar cases of students or teachers have been traced up to date from his school. The school building was demolished in January 2009.

In plain English

This was a case report of one 26-year-old man treated in Thessaloniki, Greece, who came to the emergency department with a painful lump above his right collarbone. He told doctors that his primary school building, attended from age 6 to 12, was built with asbestos-containing materials, and that this was his only asbestos exposure. The article did not identify the fiber type. Scans showed enlarged chest lymph nodes, a small pleural effusion and fluid in the abdomen (ascites). Two biopsies of the neck lymph node, checked by two pathology departments, were positive for metastatic malignant mesothelioma, stage IV. Its subtype could not be determined. After six cycles of chemotherapy the nodes shrank, but two months later he had extensive ascites, and doctors decided to start a new chemotherapy regimen. No similar cases among students or teachers from his school had been traced. The authors concluded that malignant mesothelioma can also occur in young adults. They did not compare fibers in his tissue with the school materials and had no data on others exposed in the building.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 26-year-old man seen at the emergency department and treated at the Oncology Unit, Pulmonary Department, G. Papanikolaou General Hospital, Thessaloniki, Greece. He was a non-smoker with no previous medical problems. The article gives no exact date of diagnosis.
• Exposure: The patient reported that his primary school building, which he attended from age 6 to 12, was constructed with asbestos-containing materials. He said it was his only lifetime asbestos exposure. The fiber type was not identified, and the building was demolished in January 2009.
• Main results:
  • A biopsy of the right supraclavicular lymph node was positive for malignant metastatic mesothelioma.
  • A second biopsy, sent to another pathology department, was also positive for metastatic malignant mesothelioma.
  • Immunohistochemistry was positive for AE1/AE3, WT-1, calretinin and D2-40, and negative for CEAp and TTF-1.
  • The patient was stage IV under the International Mesothelioma Group (IMIG) system.
  • Examination found ascites, and abdominal ultrasound confirmed peritoneal effusion (exudate). CT showed a small pleural effusion and an epiphrenic node on the right.
  • The chest X-ray showed no pathology.
  • The patient was treated with carboplatin, gemcitabine and pemetrexed. After six cycles there was an initial response, with a decrease in mediastinal and supraclavicular lymph nodes.
  • Two months after the last chemotherapy session, the patient had extensive ascites despite stable disease in the thorax.
  • After the extensive ascites was found, doctors decided to start chemotherapy with carboplatin AUC 5.5 and docetaxel 100 mg/m2. The article reports the decision, not the outcome of this regimen.
  • No other similar cases among students or teachers from his school had been traced up to the time of the report.
• The authors' conclusion: The authors concluded that, although the tumor mainly affects older men exposed at work, malignant mesothelioma can also occur in young adults. They stated that in this case the patient's exposure to asbestos fibres was certain.
• Limitations the authors state:
  • Neither pathology laboratory could determine the mesothelioma subtype (epithelial, sarcomatoid or mixed).
  • The authors did not compare fibers in the patient's biopsy tissue with fibers in the school materials, because they had no access to the school debris.
  • The authors had no data on mesothelioma among other people exposed in the building, because the patient had lost contact with his teachers and classmates.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Prognosis, Malignant Mesothelioma, Biopsy, Chemotherapy.

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