A rare cause of dysphagia: malignant pleural mesothelioma in the posterior mediastinum

Our plain-English summary of A rare cause of dysphagia: malignant pleural mesothelioma in the posterior mediastinum, by M. Hayama, H. Maeda (The Annals of Thoracic Surgery, 2010).

The study

• Authors: M. Hayama, H. Maeda
• Journal: The Annals of Thoracic Surgery
• Published: 2010;90(4):1358-61
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 69-year-old man presented to the emergency room with dysphagia and vomiting. A computed tomographic scan revealed a posterior mediastinal mass surrounding the lower portion of the esophagus. Endoscopic examination demonstrated narrowing of the lower esophagus without malignant mucosal lesions. Thoracoscopic biopsies of the mediastinal mass failed to yield a pathologic diagnosis. The hyaluronic acid concentration in the left pleural effusion was remarkably high (755 mg/L), which is a finding strongly suggestive of malignant mesothelioma. Four months after the initial admission, a subcutaneous nodule was found in the left chest wall and a biopsy was taken. The histopathologic and immunohistochemical findings of the biopsy were consistent with the diagnosis of pleural malignant mesothelioma.

Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This was a case report from a thoracic surgery department in Kagawa, Japan. It described one 69-year-old man who came to the emergency room with difficulty swallowing (dysphagia) and vomiting. He was a heavy smoker, and the article states he had "no history of occupational asbestosis exposure." A CT scan showed a mass in the lower posterior mediastinum. The mass surrounded and narrowed the lower esophagus, without the pleural thickening seen in diffuse pleural mesothelioma. Surgical biopsies of the mass did not give a diagnosis, and repeated cytology of the fluid around both lungs was negative. However, the hyaluronic acid level in the left pleural fluid was 755 mg/L. A PET-CT scan showed the tumor had invaded the diaphragm and reached the peritoneal cavity. Later, a nodule appeared in the left chest wall where a drainage tube had been placed. Its biopsy was consistent with malignant pleural mesothelioma (epithelioid type). An esophageal stent improved his swallowing. Cisplatin and pemetrexed chemotherapy brought no improvement, and he died 6 months after his first admission. The authors concluded that reaching a confirmed diagnosis early is critical.

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
• Who was studied: One 69-year-old man seen at the authors' hospital (Department of Thoracic Surgery, Mitoyo General Hospital, Kagawa, Japan); dates not given
• Exposure: No asbestos fiber type or exposure was reported. The patient was a current heavy smoker with, in the article's words, no history of occupational asbestosis exposure.
• Main results:
  • In this patient, CT showed a posterior mediastinal mass surrounding the lower esophagus and causing esophageal stenosis.
  • The same CT showed no pleural thickening in either pleural cavity.
  • Surgical biopsies of the mediastinal mass did not yield a pathologic diagnosis.
  • PET-CT showed a standardized uptake value of 5.2 in the mediastinal mass. The tumor had invaded the diaphragm and extended to the peritoneal cavity.
  • Repeated cytology of both pleural effusions was negative. The hyaluronic acid concentration in the left pleural effusion was 755 mg/L.
  • On the second admission, a subcutaneous nodule appeared in the left chest wall at a former pleural drainage tube site.
  • Biopsy of the nodule was immunohistochemically positive for calretinin, vimentin, epithelial membrane antigen and cytokeratin. The findings were consistent with malignant pleural mesothelioma, epithelioid type.
  • An endoscopically placed esophageal metal stent markedly improved the patient's dysphagia.
  • Cisplatin and pemetrexed chemotherapy gave no symptomatic or radiographic improvement. The patient died 6 months after his first admission.
• The authors' conclusion: The authors concluded that this type of mesothelioma is extremely difficult to treat at an advanced stage, so it is critical to reach a confirmed diagnosis early.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Dysphagia, Pleural Mesothelioma, Mediastinum, Hyaluronic Acid, Pleural Effusion, Mesothelioma, Biopsy.

Related studies

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• Peribronchiolar metaplasia: a common histologic lesion in diffuse lung disease and a rare cause of interstitial lung disease: clinicopathologic features of 15 cases — J. Fukuoka, T.J. Franks, et al. (2005)
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• Malignant peritoneal mesothelioma as a rare cause of ascites: a case report — I. Ahmed, A. Koulaouzidis, et al. (2008)

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