An unusual presentation of malignant pleural mesothelioma

Our plain-English summary of An unusual presentation of malignant pleural mesothelioma, by M.M. Lacle, M.F. van Oosterhout (Journal of Thoracic Oncology, 2013).

The study

• Authors: M.M. Lacle, M.F. van Oosterhout
• Journal: Journal of Thoracic Oncology
• Published: 2013;8(7):e63-4
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This case report described an unusual presentation of malignant pleural mesothelioma in a 65-year-old man. He was admitted with several months of progressive shortness of breath on exertion and cough. He had a history of hypertension and smoking, no previous cancers, and had never been exposed to asbestos. High-resolution computed tomography showed diffuse nodular opacities in both lungs, ground-glass opacities in the upper left lobe, septal thickening, increased peripheral vascular markings and pleural effusion, but no pleural thickening. These findings were first interpreted as small airways disease with an added component of congestive heart failure. He did not improve after diuretics and stopping smoking, so a lung biopsy was taken by video-assisted thoracoscopic surgery. His condition worsened after the biopsy and he died. No autopsy was performed. Microscopy showed widespread infiltration of the lung tissue and pleura by epithelioid cells, with prominent involvement of the lung lymphatics. The cells were positive for pan-keratin, calretinin, D2-40 and cytokeratin 5/6, and negative for carcinoembryonic antigen, MOC-31, TTF-1 and CD31. This confirmed epithelioid malignant mesothelioma. Epithelioid hemangioendothelioma had initially been considered. The authors stated that, to their knowledge, no epithelioid mesothelioma with this growth pattern had been reported before. They concluded that recognizing unusual growth patterns is important to avoid misdiagnosis, which could adversely affect treatment and prognosis.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was a case report about one patient, written by authors from pathology departments in the Netherlands. A 65-year-old man with a history of high blood pressure and smoking was admitted after several months of worsening breathlessness on exertion and coughing. The report states he was never exposed to asbestos. High-resolution CT scans showed diffuse nodular shadows in both lungs, ground-glass shadows in the upper left lobe, septal thickening and pleural effusion, but no pleural thickening. The scans were first read as small airways disease, with other lung conditions and heart failure considered. Diuretics and stopping smoking did not help, so a lung biopsy was taken by keyhole chest surgery. His condition worsened after the biopsy and he died. No postmortem examination was done. Under the microscope, tumor cells had spread widely through the lung tissue and pleura and into the lung's lymphatic vessels. Staining tests confirmed epithelioid malignant mesothelioma. The authors said they knew of no earlier report of epithelioid pleural mesothelioma with this growth pattern. They concluded that recognizing such unusual patterns is important to avoid misdiagnosis, which could harm treatment and prognosis.

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 65-year-old man with a history of hypertension and smoking, admitted with progressive breathlessness on exertion and cough for several months
• Exposure: The report states the patient was never exposed to asbestos; he had a history of smoking
• Main results:
  • High-resolution CT showed diffuse nodular opacities in both lungs, ground-glass opacities in the upper left lobe, septal thickening, increased peripheral vascular markings and pleural effusion, with no pleural thickening
  • Clinically and radiologically the tumor was first diagnosed as an interstitial lung disease
  • There was no improvement with diuretics and smoking cessation, so a lung biopsy was done by video-assisted thoracoscopic surgery
  • The patient deteriorated after the biopsy and died; no postmortem examination was performed
  • Microscopy and immunostaining (positive for pan-keratin, calretinin, D2-40 and cytokeratin 5/6; negative for CEA, MOC-31, TTF-1 and CD31) confirmed malignant mesothelioma, epithelioid type, with widespread infiltration of lung tissue and pleura
  • The authors stated that, to their knowledge, no previous report describes an epithelioid diffuse malignant pleural mesothelioma with this growth pattern
• The authors' conclusion: The authors concluded that it is important to recognize the unusual growth patterns of diffuse malignant pleural mesothelioma, both clinically and under the microscope, to avoid misdiagnosis that could adversely affect treatment and prognosis

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: Pleural Mesothelioma, Pleural Effusion, Pleural Thickening, Biopsy, Video-Assisted Thoracoscopic Surgery (VATS), Autopsy, Pleura, Epithelioid.

Related studies

• An unusual presentation of malignant mesothelioma: the incidental finding of tumor in the hernia sac during herniorrhaphy — J. Brenner, P.P. Sordillo, et al. (1981)
• Recurrent hydropneumothorax: An unusual presentation for malignant pleural mesothelioma — D. DeLapp, C. Chan, et al. (2016)
• Well-Differentiated Papillary Mesothelial Tumor: An Unusual Radiologic Presentation: A Case Report — M. Abdelghafar, K. Anand, et al. (2023)
• Two malignancies or an unusual presentation of a pleural malignancy? — B.J. Knipscheer, R.C. Kromontono, et al. (2013)
• Spontaneous urinary bladder perforation: An unusual presentation of well-differentiated papillary peritoneum mesothelioma — A. Serao, F. Ambrosini, et al. (2022)
• Recurrent pneumothorax: an unusual presentation of malignant mesothelioma — S.I. Handa, A.G. Wilkinson (1989)

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