An autopsy case of malignant pleural mesothelioma associated with nephrotic syndrome

Our plain-English summary of An autopsy case of malignant pleural mesothelioma associated with nephrotic syndrome, by S. Suzuki, M. Toyoshima, F. Nihashi, et al (Internal Medicine, 2014).

The study

• Authors: S. Suzuki, M. Toyoshima, F. Nihashi, H. Tsukui, S. Baba, H. Sugimura, T. Suda
• Journal: Internal Medicine
• Published: 2014;53(3):243-6
• Type of article: Case report, Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 64-year-old man who had been exposed to asbestos was referred to our hospital for a detailed examination of left pleural effusion. A laboratory examination of the urine and blood revealed nephrotic syndrome. A thoracoscopic examination did not yield a definitive diagnosis. Twenty months later, a left pleural tumor became apparent, and the patient died of respiratory failure and cachexia. An autopsy revealed epithelioid malignant pleural mesothelioma. The glomeruli appeared normal under light microscopy. A review of the English literature revealed only three reports of malignant mesothelioma associated with minimal-change nephrotic syndrome. The natural course of malignant mesothelioma with nephrotic syndrome has not been previously reported.

In plain English

This was a case report from Japan about one man who had an autopsy, plus a review of earlier published cases. A 64-year-old man who had worked at an asbestos products manufacturer for 10 years during his thirties was referred to hospital for fluid around the left lung (left pleural effusion). Tests showed heavy protein loss in the urine (9.7 g/day), consistent with nephrotic syndrome, a kidney disorder. The pleural fluid contained no malignant cells, and a thoracoscopic examination with biopsy gave no definite diagnosis. Twenty months after he first came to the hospital, a left pleural tumor was found, with spread to the left adrenal gland. He died of respiratory failure and cachexia on hospital day 11. The autopsy confirmed epithelioid pleural mesothelioma. His kidney filtering units (glomeruli) looked normal under a light microscope. The authors considered minimal-change nephrotic syndrome, but no electron microscopy was done. Seven earlier reported cases of mesothelioma with nephrotic syndrome were reviewed, and three of them showed minimal changes. The authors concluded that the literature suggested a possible correlation, while noting it remained unclear whether mesothelioma caused this patient's kidney disorder.

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 (autopsy case) with a review of the English-language literature
• Who was studied: one 64-year-old man with a 40-pack-year smoking history, referred to a hospital in Hamamatsu, Japan, after a left pleural effusion was seen on screening chest radiography
• Exposure: occupational asbestos exposure: 10 years working at an asbestos products manufacturer during his thirties; fiber type not stated
• Main results:
  • At first presentation, urine protein was 9.7 g/day, with low serum albumin and high cholesterol, suggesting nephrotic syndrome
  • The pleural fluid had an elevated hyaluronic acid level (171,000 ng/mL) and no malignant cells; thoracoscopy and pleural biopsy did not yield a definitive diagnosis
  • Malignant pleural mesothelioma became apparent and was diagnosed 20 months after the initial presentation, with a left pleural tumor and left adrenal metastasis on imaging
  • Computed tomography of the abdomen showed left adrenal metastasis and peritoneal dissemination
  • The patient died of respiratory failure and cachexia on hospital day 11
  • At autopsy, immunohistochemical staining confirmed epithelioid pleural mesothelioma, which had spread to the lung, hilar lymph nodes, liver, left adrenal gland, multiple bones and peritoneum
  • The glomeruli were normal on light microscopy, and a diagnosis of minimal-change nephrotic syndrome was considered
  • The literature review found seven reported cases of malignant mesothelioma with nephrotic syndrome; the glomeruli showed minimal changes in three of the seven
• The authors' conclusion: The authors concluded that their review of the English literature suggested a possible correlation between malignant mesothelioma and minimal-change nephrotic syndrome. They speculated that cytokines made by mesothelioma cells might play a role and said larger studies are needed.
• Limitations the authors state:
  • No electron microscopic studies of the kidney were performed, so minimal-change disease was only considered, not confirmed
  • Whether the mesothelioma was involved in causing this patient's nephrotic syndrome remains unclear
  • The authors' hypothesis needs further investigation in a large number of patients

Topics

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

Medical terms in this study, explained in our Lexicon: Autopsy, Pleural Mesothelioma, Pleural Effusion, Cachexia, Epithelioid, Malignant Mesothelioma.

Related studies

• Nephrotic syndrome and mesenteric infarction secondary to metastatic mesothelioma — C.K. Farmer, D.J. Goldsmith (2001)
• Epithelioid pleural mesothelioma concurrently associated with miliary pulmonary metastases and minimal change nephrotic syndrome - A hitherto undescribed case — Y. Tsukamoto, T. Otsuki, et al. (2015)
• Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases — R. Shibata, T. Ozaki, et al. (2020)
• Asbestos bodies in human lungs at autopsy — D. Cauna, R.S. Totten, et al. (1965)
• Asbestos fibers and pleural plaques in a general autopsy population — A. Churg (1982)
• Iron signature in asbestos-induced malignant pleural mesothelioma: A population-based autopsy study — S. Crovella, A.M. Bianco, et al. (2016)

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