A Rare Case of Malignant Pleural Mesothelioma in a Young Healthy Male Without Asbestos Exposure

Our plain-English summary of A Rare Case of Malignant Pleural Mesothelioma in a Young Healthy Male Without Asbestos Exposure, by S. Khatib, O. Asad, H. Asad, et al (Curēus, 2021).

The study

• Authors: S. Khatib, O. Asad, H. Asad, T. Sabobeh
• Journal: Curēus
• Published: 2021;13(8):e17199
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a highly aggressive malignant tumor that arises from mesothelial cells of pleural cavity. The main risk factor for MPM is asbestos exposure with most cases discovered in elderly males after a long latency period. However, here we report a rare case of MPM diagnosed in a healthy young male patient without significant asbestos exposure. We report the case of an otherwise healthy 47-year-old male who presented with one week of exertional dyspnea and chest pain. Chest X-ray showed unilateral large pleural effusion. Chest CT scan revealed confluent right hilar mass and pleural thickening. Pleural fluid analysis showed exudative features. Cytology was negative for malignant cells. Core tissue biopsy showed features of epithelioid mesothelioma. Although most cases of MPM have been reported in elderly male patients with significant asbestos exposure, more research is needed to explain the pathogenesis of MPM in young patients without asbestos exposure.

Copyright © 2021, Khatib et al.

In plain English

This article was a case report about a single patient: a 47-year-old African-American man with a history of alcohol and tobacco use. He came to the hospital after one week of right-sided chest pain and shortness of breath on exertion. The patient had worked as a maintenance man throughout his life and reported past exposure to black mold. He denied any exposure to asbestos, concrete or heavy metals. A chest X-ray showed a large fluid collection around the right lung (pleural effusion). A CT scan showed a large right hilar mass and thickening of the lining of the lung (pleura). Doctors drained 3000 cc of fluid, but no cancer cells were found in it. Scans of the abdomen, pelvis and brain showed no spread. A core biopsy confirmed epithelioid mesothelioma. The authors acknowledged that the patient may have been exposed to asbestos through maintenance work. They stated that any such exposure would have been too short to cause the disease. The authors concluded that more studies are needed on pleural mesothelioma in young patients without asbestos exposure.

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 47-year-old African-American male with a past medical history of alcohol and tobacco use, who presented to the hospital with chest pain and shortness of breath
• Exposure: No reported asbestos exposure. The patient worked as a maintenance man his entire life, reported past black mold exposure, and denied exposure to asbestos, concrete or heavy metals. He also had 10 pack-years of cigarette smoking, drank 4-6 beers daily, and used marijuana occasionally.
• Main results:
  • The chest X-ray showed a large unilateral right pleural effusion.
  • The chest CT showed a large confluent right hilar mass and mass-like and nodular pleural thickening throughout the right side of the chest.
  • Thoracentesis removed 3000 cc of serosanguineous fluid. The fluid had exudative features, but cytology was negative for malignant cells.
  • Staging CT of the abdomen and pelvis and MRI of the brain were negative for metastatic disease.
  • A core biopsy with immunostains led to a confirmed diagnosis of epithelioid mesothelioma. Tumor cells were positive for WT1 and D2-40 and negative for BAP1.
• The authors' conclusion: The authors concluded that the case was extremely unusual: a healthy young man diagnosed with malignant pleural mesothelioma without previous asbestos exposure. They stated that more studies are needed on the pathogenesis and risk factors of the disease in young patients without asbestos exposure.
• Limitations the authors state:
  • Although the patient denied asbestos exposure, the authors stated it is still possible he was exposed through maintenance work. They argued that any such exposure would have been too short to cause malignant pleural mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Mesothelial Cells, Pleural Cavity, Latency, Dyspnea, Chest X-Ray, Pleural Effusion.

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• Pleural mesothelioma in a young male patient — A. Voulgaridis, V. Apollonatou, et al. (2013)
• Deciduoid pleural mesothelioma affecting a young female without prior asbestos exposure — K. Gloeckner-Hofmann, X.Z. Zhu, et al. (2000)
• A rare case of benign multicystic peritoneal mesothelioma misdiagnosed as hydatid cyst found in the liver parenchyma and abdomen cavity of a male with asbestos exposure — A.B. Kelarji, M.S. Alshutaihi, et al. (2021)
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• Manganese superoxide dismutase in healthy human pleural mesothelium and in malignant pleural mesothelioma — K. Kahlos, S. Anttila, et al. (1998)

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