Asbestos Exposure and Development of Pulmonary Pleomorphic Carcinoma in a Non-smoker: A Rare Non-small Cell Lung Cancer

Our plain-English summary of Asbestos Exposure and Development of Pulmonary Pleomorphic Carcinoma in a Non-smoker: A Rare Non-small Cell Lung Cancer, by A.L. Alejo, R.A. Patel, K.K. Pandya, et al (Curēus, 2023).

The study

• Authors: A.L. Alejo, R.A. Patel, K.K. Pandya, K. Bodrya, L. Goldstein, L. Hemrock
• Journal: Curēus
• Published: 2023;15(4):e37860
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Pulmonary pleomorphic carcinoma (PPC) is a subtype of non-small cell lung cancer that is extremely rare and carries a poor prognosis due to its inadequate response to treatment. Patients that present with PPC often exhibit similar symptoms of other malignancies of the lung, making it hard for clinicians to distinguish between each type. However, cytology and gene mutation testing are two approaches that can aid physicians in an accurate and definitive diagnosis. We present a case of an 88-year-old male patient with a diagnosis of pulmonary pleomorphic carcinoma after experiencing recurrent sanguineous pleural effusions. The patient had no smoking history but did have a history of asbestos exposure and pulmonary fibrosis. The patient underwent thoracotomy with pleurodesis and analysis of the surgical pleural biopsy specimen stained positive for markers indicative of PPC. The pathology report was also consistent with the associated cell morphology. Lung cancer is the leading cause of mortality due to cancer in the United States, and exposure to certain substances contributes to the development of these poorly treatable lung malignancies. Smoking and asbestos exposure are well known to act synergistically with each other as risk factors in developing these lung malignancies. In addition to clinical suspicion, screening for these risk factors with laboratory values and imaging is important to diagnose these rare cases of lung malignancies.

Copyright © 2023, Alejo et al.

In plain English

This article is a case report about one patient. He was an 88-year-old Caucasian man with pulmonary fibrosis, atrial fibrillation and chronic kidney disease. He came to an emergency department after a week of chest pain. He had never smoked but reported over 10 years of asbestos exposure at work. The article does not name his job or the type of asbestos. Bloody fluid kept collecting around his lung. A test of this fluid found no cancer but showed reactive changes in the lining cells. After open chest surgery, a pleural sample showed pleomorphic carcinoma of the lung, a rare type of non-small cell lung cancer. Mesothelioma markers were reported negative, though the stain table listed calretinin as focally and weakly positive. The cancer was in the right lower lobe, with the fluid in the same region. His breathing failed after surgery. He and his family chose comfort care, and he died. The authors concluded that asbestosis may play a role in the development of this cancer. As a single case, the report cannot show how often asbestos exposure leads to this cancer.

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 88-year-old Caucasian man with a past medical history of pulmonary fibrosis, atrial fibrillation and chronic kidney disease. He came to an emergency department with chest pain. The body text does not state the hospital location or dates.
• Exposure: Occupational asbestos exposure for over 10 years, with no smoking history. The article does not state the job or the fiber type.
• Main results:
  • Thoracentesis removed 1500 cc of serosanguinous fluid. The effusion recurred, and an indwelling catheter drained 1100 cc of grossly bloody fluid.
  • Cytology of the pleural fluid was negative for malignancy but showed reactive atypia of the mesothelium.
  • The surgical pleural specimen showed pleomorphic carcinoma of the lung, and the text describes negative markers for mesothelioma.
  • In the stain table, calretinin was focally and weakly positive. WT1, mesothelin and D2-40 were negative.
  • The tumor was in the same anatomical region where the recurrent pleural effusions occurred, which the authors identify as the right lower lobe.
  • The tumor expressed PDL-1.
  • The patient developed respiratory failure. He and his family chose comfort care, and he died.
• The authors' conclusion: The authors concluded that asbestosis may play a role in the development of pulmonary pleomorphic carcinoma.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Pleomorphic, Carcinoma, Non-Small Cell Lung Cancer, Prognosis, Cytology, Pleural Effusion, Pulmonary Fibrosis.

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