A Case of Primary Epithelioid Sarcoma of the Pleura

Our plain-English summary of A Case of Primary Epithelioid Sarcoma of the Pleura, by T. Yamashita (The American Journal of Case Reports, 2023).

The study

• Author: T. Yamashita
• Journal: The American Journal of Case Reports
• Published: 2023;24:e938696
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

BACKGROUND Epithelioid sarcoma is a rare tumor and that is extremely rare as a primary pleural neoplasm. On imaging, it may appear similar to malignant pleural mesothelioma; thus, it can be difficult to diagnose. CASE REPORT A 64-year-old Asian woman, who had a treatment history of cervix adenocarcinoma, was admitted with dyspnea and right massive pleural effusion. Chest drainage was performed, and malignant cells were found in the pleural effusion. The malignant cells were thought to be metastasized from previous cervical cancer. We continued pleural drainage; however, the volume of the pleural effusion did not decrease. On the 5th hospital day, the chest tube became occluded. Computed tomography showed structures similar to empyema. Pleural irrigation and fibrinolytic therapy did not improve her condition. Empyema curettage was performed on the 14th hospital day. The resected pleura was submitted for pathological examination and showed tumor lesion but not metastatic adenocarcinoma of the cervix. The intrathoracic tumor grew extremely rapidly, and the patient died of respiratory failure on postoperative day 8 (22nd hospital day) before a diagnosis could be made. The final pathological diagnosis obtained on the 34th hospital day was epithelioid sarcoma. CONCLUSIONS For patients who appear to have empyema complicated by neoplastic lesions, a histopathological examination should also be performed to ensure accurate diagnosis. In addition, if a tumorous lesion is detected and it is neither metastatic nor malignant pleural mesothelioma, pleural epithelioid sarcoma should be added to the differential diagnosis in the presence of a rapidly growing and histologically difficult-to-diagnose pleural tumor.

In plain English

This is a case report of one patient in Japan: a 64-year-old Asian woman previously treated for adenocarcinoma of the cervix. She was admitted with shortness of breath and a massive right pleural effusion (fluid around the lung). Malignant cells were found in the fluid, but cultures showed no bacterial infection, and she was treated for empyema (infected pleural fluid). On the 14th hospital day, surgeons removed thickened pleura. Pathologists found tumor that was not cervical cancer that had spread. The tumor grew very fast. For tumor tissue that had spread outside the chest through the drainage site, the author calculated a volume doubling time of approximately 7 days. She died of a respiratory disorder on the 22nd hospital day, before a diagnosis was reached. On the 34th hospital day, staining results, including a negative stain for INI1, led to a diagnosis of epithelioid sarcoma of the pleura. The author concluded that this tumor should be considered when a rapidly growing, histologically difficult-to-diagnose pleural tumor is neither metastatic nor malignant pleural mesothelioma. The article does not mention asbestos.

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)
• Who was studied: One 64-year-old Asian woman with a history of adenocarcinoma of the cervix, treated at Iwata City Hospital, Shizuoka, Japan
• Exposure: Not reported. The article does not mention asbestos or any occupational exposure.
• Main results:
  • On admission the patient had a massive right pleural effusion, which was first treated as empyema
  • Surgery was performed on the 14th hospital day; the resected pleura was tumor, not metastatic cervical adenocarcinoma
  • Tumor spread into the tissue under the skin at the site of the first chest drain
  • For the tumor that had spread outside the chest through the drainage site, the volume doubling time was calculated as approximately 7 days
  • The patient died on postoperative day 8 (22nd hospital day); no autopsy was performed
  • The tumor stained negative for INI1 and other markers; epithelioid sarcoma of the pleura was diagnosed on postoperative day 20 (34th hospital day)
• The authors' conclusion: The author concluded that apparent empyema with possible tumor should be examined histologically. The author also concluded that pleural epithelioid sarcoma should be considered when a rapidly growing, histologically difficult-to-diagnose pleural tumor is neither metastatic nor malignant pleural mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Epithelioid, Sarcoma, Pleura, Neoplasm, Pleural Mesothelioma, Adenocarcinoma, Dyspnea, Pleural Effusion.

Related studies

• Primary pulmonary epithelioid sarcoma: a case report — E. Mizutani, R. Morita, et al. (2021)
• Metastatic proximal epithelioid sarcoma in pleural effusion: cytopathologic findings and differential diagnosis — H. Guan, F. Haque, et al. (2013)
• Mediastinal undifferentiated pleomorphic sarcoma with pleural effusion cytopathologically misdiagnosed as epithelial malignant pleural mesothelioma: An autopsy case report — K. Matsumoto, Y. Nakamura, et al. (2021)
• Epithelioid sarcoma. A clinical and pathologic study of nine cases — H. Santiago, L.K. Feinerman, et al. (1972)
• A case of pleural epithelioid sarcoma of proximal type presenting as malignant pleural mesothelioma — G.A. Madsen, T.R. Rasmussen, et al. (2013)
• Pulmonary tumor diagnosed as an undifferentiated sarcoma with epithelioid features: a case report — M.R. El Ochi, M.M. El Hammoumi, et al. (2016)

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