A Worsening Cough: An Unusual Presentation of Malignant Mesothelioma

Our plain-English summary of A Worsening Cough: An Unusual Presentation of Malignant Mesothelioma, by Y. Alsalihi, C. Kandaswamy (Curēus, 2023).

The study

• Authors: Y. Alsalihi, C. Kandaswamy
• Journal: Curēus
• Published: 2023;15(8):e43205
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Localized malignant pleural mesothelioma (LMPM) is a rare cancer with poor survival rates. Often affecting males with asbestos exposure, we report a case of a 56-year-old female with no history of occupational exposure presenting with a worsening cough. A radiological examination revealed left pleural effusion and pleural thickening. Cytological and pathological reports of pleural samples were consistent with malignant mesothelioma of epithelioid type, with the histological examination via video-assisted thoracoscopic surgery (VATS) consistent with a clear cell epithelioid mesothelioma. We discuss the rapid presentation of the disease with emphasis on considering the disease in young patients with no prior asbestos exposure.

Copyright © 2023, Alsalihi et al.

In plain English

This article is a case report about one patient. She was a 56-year-old woman who had never smoked and worked as a principal in the education system. She developed a dry cough in March 2022 and the next month went to an emergency room with worsening cough and shortness of breath. The authors described her as having no prior asbestos exposure and no industrial risk factors. The article does not say how her exposure history was taken. A CT scan showed fluid around the left lung and a 5.5 cm lobulated mass on the pleura (the lung's lining) at the top of the left lung. Biopsies taken by video-assisted thoracoscopic surgery were judged compatible with malignant mesothelioma of the epithelioid type. A PET/CT scan found no spread. She received three cycles of cisplatin and pemetrexed. A later scan showed slight improvement. She was still being considered for surgery, with a pleurectomy (surgery to remove the lining) pending once the tumor bulk was reduced. The authors concluded that mesothelioma should be considered in younger patients without occupational risk factors who have a mediastinal mass.

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 56-year-old woman, a never-smoker working as a principal in the education system, whose symptoms began in March 2022; the authors are affiliated with California Health Sciences University, Clovis, USA
• Exposure: No asbestos exposure reported: the authors describe the patient as having no prior asbestos exposure and no industrial risk factors. No fiber type is named.
• Main results:
  • CT scan showed a left pleural effusion and a 5.5 cm lobulated pleural-based mass at the apex of the left lung, with marked pleural thickening
  • Thoracentesis showed an exudative pleural effusion with protein 4.9 (g/dL), LDH 173 (units/L) and 99% lymphocytes
  • Biopsy findings from video-assisted thoracoscopic surgery were reported as compatible with malignant mesothelioma, epithelioid type
  • A full-body PET/CT scan showed no metastatic findings
  • The patient received three cycles of cisplatin and pemetrexed as neoadjuvant therapy
  • A second scan showed slight improvement in the left-sided pleural disease
  • The patient was still under consideration for surgery, with a pleurectomy pending after reduction of the tumor bulk
• The authors' conclusion: The authors concluded that mesothelioma should be considered in young patients without occupational risk factors when a mediastinal mass is being evaluated
• Limitations the authors state:
  • The biopsies captured only epithelioid cells, so an invasive component could not be assessed

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Asbestos Exposure, Occupational Exposure, Pleural Effusion, Pleural Thickening, Epithelioid, Video-Assisted Thoracoscopic Surgery (VATS).

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