A 70-year-old woman with dyspnea and chest pain

Our plain-English summary of A 70-year-old woman with dyspnea and chest pain, by A. Ganesh, M. Flores, I. Oliva, et al (Chest, 2014).

The study

• Authors: A. Ganesh, M. Flores, I. Oliva, G.E. Carr
• Journal: Chest
• Published: 2014;146(1):e14-e18
• Type of article: Case report
• Read it: PubMed · Publisher

In plain English

This was a case report about a 70-year-old white woman with 10 months of worsening shortness of breath, recent right-sided chest pain and weight loss. The authors stated that she had a significant smoking history but no exposure to asbestos. Imaging showed a large right-sided pleural effusion (fluid around the lung) with thickening of the pleura. After drainage and surgery, her right lung still failed to re-expand. A pleural biopsy at first appeared to favor mesothelioma. Special stains were positive for thyroid transcription factor-1, cytokeratin-7 and carcinoembryonic antigen. They were negative for CK 5/6, calretinin and D2-40. The diagnosis was pseudomesotheliomatous adenocarcinoma, a cancer that resembles mesothelioma. In discussing earlier reports, the authors wrote that an association between this tumor and asbestos has not been clearly determined. The authors concluded that definitive diagnosis requires tissue examination with immunohistochemistry. They also said that distinguishing this tumor from mesothelioma matters for treatment and medicolegal reasons. The patient opted for hospice care.

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 (single patient), presented as a clinical, imaging and pathology teaching case
• Who was studied: one 70-year-old white woman evaluated at a hospital (authors from the University of Arizona, Tucson)
• Exposure: No asbestos exposure, according to the authors. The patient had a significant smoking history.
• Main results:
  • CT showed a large right-sided pleural effusion with the mediastinum shifted to the left
  • After surgery (VATS), the right lung failed to re-expand
  • The preliminary reading of the pleural biopsy favored mesothelioma
  • On immunohistochemical staining, the specimen was positive for thyroid transcription factor-1, cytokeratin-7 and carcinoembryonic antigen
  • The specimen was negative for the mesothelial markers CK 5/6, calretinin and antipodoplanin (D2-40)
  • Final diagnosis: pseudomesotheliomatous adenocarcinoma
  • In their discussion of other reports (not a finding of this case), the authors wrote that the association of this tumor with asbestos has not been clearly determined
  • The patient opted for hospice care
• The authors' conclusion: The authors concluded that PMA is a specific variant of adenocarcinoma with a presentation similar to mesothelioma. They said definitive diagnosis requires histopathology with immunohistochemistry, and that it is important to distinguish the two tumors because of treatment and medicolegal implications.

Topics

Medical terms in this study, explained in our Lexicon: Dyspnea.

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• Chest pain in asbestos and silica-exposed workers — E.K. Park, P.S. Thomas, et al. (2011)
• A retrospective study of chest pain in benign asbestos pleural disease — R.K. Allen, T. Cramond, et al. (2011)
• Dyspnea with slow-growing mass of the left hemithorax — N. Patel, A. Bishay, et al. (2007)
• Persistent Dyspnea in a 74-Year-Old Man With Normal Spirometry and Lung Volumes — W.H. Chong, B. Saha, et al. (2021)

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