Asymptomatic localized pleural amyloidosis mimicking malignant pleural mesothelioma: report of a case

Our plain-English summary of Asymptomatic localized pleural amyloidosis mimicking malignant pleural mesothelioma: report of a case, by T. Nakano, S. Endo, K. Tetsuka, et al (Journal of Thoracic Disease, 2016).

The study

• Authors: T. Nakano, S. Endo, K. Tetsuka, N. Fukushima
• Journal: Journal of Thoracic Disease
• Published: 2016;8(1):E157-60
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We herein report an asymptomatic 65-year-old male with localized pleural amyloidosis mimicking malignant pleural mesothelioma. He had a history of exposure to asbestos and was admitted for investigation of an abnormal pleural thickness detected by chest radiography. Positron emission tomography showed elevation of standardized uptake value corresponding to the pleural thickness. Partial pleurectomy including the tumor was performed for the purpose of diagnosis and local disease control. The pathological examination showed that the tumor was pleural amyloidosis. The tumor was diagnosed as localized primary amyloidosis, because serum monoclonal protein concentration did not increase. Pleural amyloidosis should be considered as a differential diagnosis from pleural mesothelioma.

In plain English

This case report described one man whose pleural disease looked like malignant pleural mesothelioma but turned out not to be cancer. The 65-year-old had no symptoms. Pleural thickening was found on a routine chest X-ray. He had worked in oil stove repair and had a history of asbestos exposure; the article did not name a fiber type. CT showed a pleural tumor on the left side, with pleural thickening and plaque on both sides of the chest. On PET scanning the left-sided pleural tumor had a maximum standardized uptake value of 4.84, so malignancy was suspected. Surgeons removed the masses in an operation on the left side of the chest. Tissue examination found no malignancy. The lesion was amyloidosis, a deposit of a substance called amyloid, and the authors suggested it was a primary light-chain (AL) type confined to the pleura. One year after surgery no symptoms of amyloidosis in other organs had appeared. The authors concluded that localized pleural amyloidosis should be considered when diagnosing a pleural lesion. The article did not discuss whether the asbestos exposure played a role.

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 (one patient)
• Who was studied: one asymptomatic 65-year-old man treated at Jichi Medical University, Japan, who also had an 80 pack-year smoking habit
• Exposure: occupational asbestos exposure from work in oil stove repair; fiber type, duration and dose not reported
• Main results:
  • Chest CT showed a pleural tumor in the left chest cavity, with pleural thickening and plaque spread across both sides of the chest cavity
  • On FDG-PET the left-sided pleural tumor had a maximum standardized uptake value (SUVmax) of 4.84, other lesions had lower uptake, and malignancy was suspected
  • Blood tests, including C-reactive protein, were within normal limits
  • Frozen-section analysis of the tissue taken during surgery showed no malignancy
  • Pathology confirmed amyloidosis and excluded the amyloid protein A (AA) type
  • No serum monoclonal protein was found, so the authors suggested primary immunoglobulin light chain (AL) type amyloidosis of the pleura
  • No symptoms of amyloidosis in other organs had occurred 1 year after surgery
• The authors' conclusion: The authors concluded that localized pleural amyloidosis should be considered as one of the possible diagnoses for a pleural lesion, because it can mimic pleural mesothelioma clinically and on imaging

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Thickness, Monoclonal, Differential Diagnosis.

Related studies

• Pleural amyloidosis mimicking mesothelioma: a clinicopathologic study of two cases — A.L. Adams, C.Y. Castro, et al. (2001)
• Expiratory and inspiratory forced vital capacity and one-second forced volume in asymptomatic never-smokers in Norway — A. Gulsvik, T. Tosteson, et al. (2001)
• Pleural effusion in an asymptomatic patient. Spectrum and frequency of causes and management considerations — N.A. Smyrnios, P.J. Jederlinic, et al. (1990)
• Nodular pulmonary amyloidosis associated with asbestos exposure — K. Hiroshima, H. Ohwada, et al. (1996)
• Amyloidosis presenting as bilateral transudative pleural effusions with normal cardiac investigations: a case report — J.H. Briggs, W.G. Singleton, et al. (2009)
• Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases — R. Shibata, T. Ozaki, et al. (2020)

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