Benign asbestos pleural effusion associated with pulmonary aspergilloma

Our plain-English summary of Benign asbestos pleural effusion associated with pulmonary aspergilloma, by J. Hiyama, M. Marukawa, Y. Shiota, et al (Internal Medicine, 1998).

The study

• Authors: J. Hiyama, M. Marukawa, Y. Shiota, T. Ono, K. Yunoki, S. Imai, K. Motohiro, J. Aoki, N. Sasaki, K. Taniyama, H. Mashiba
• Journal: Internal Medicine
• Published: 1998;37(11):965-8
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A rare case of benign asbestos pleural effusion associated with aspergilloma is reported. A chest radiograph of a 75-year-old Japanese man who was admitted with right chest pain showed a right pleural effusion and nodular shadows in the right apex and left middle lung field. Thoracocentesis revealed an exudate with atypical mesothelial cells. An open lung biopsy showed aspergilloma in the right S2 area and no evidence of malignancy. Many reactive mesothelial cells were found in the pleura. A quantitative asbestos digestion study of the lung tissue biopsy showed high-grade asbestos exposure.

In plain English

This case report described one 75-year-old Japanese man admitted to Kure Kyosai Hospital in March 1995 with right-sided chest pain and shortness of breath on exertion. The patient had been exposed to asbestos at work for 30 years in a steel plant. The article does not name the fiber type. A chest X-ray showed fluid around the right lung and nodular shadows in the right and left lungs. The fluid contained mesothelial cells with abnormal-looking nuclei, and it was hard to tell whether malignant cells were present. A surgical biopsy of the right lung and pleura found an aspergilloma (a fungus ball) in a 1.7 by 1.0 cm cavity and no malignancy. It also found many reactive mesothelial cells and a calcified area consistent with a pleural plaque. An asbestos digestion study of 5 g of lung tissue found 10,190 ferruginous bodies, which the authors took to reflect high-grade exposure. The fluid gradually disappeared and had not returned as of January 1998. The authors concluded this was benign asbestos pleural effusion with pulmonary aspergilloma, and they called for continued observation.

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
• Who was studied: one 75-year-old Japanese man admitted to Kure Kyosai Hospital, Japan, on March 13, 1995, with right-sided chest pain and dyspnea on exertion
• Exposure: occupational asbestos exposure for 30 years in a steel plant; fiber type not stated
• Main results:
  • Pleural fluid cytology showed mesothelial cells with nuclear atypia, and it was difficult to determine whether malignant cells were present
  • Tumor markers and ADA in the pleural fluid were within commonly used cut-off levels
  • The resected right upper lobe tumor was a cavitary lesion (1.7x1.0 cm) containing an aspergilloma
  • Whitish thickening of the parietal pleura showed calcification consistent with a pleural plaque
  • Microscopy showed numerous reactive mesothelial cells in the pleura. The authors judged the atypical cells seen in the fluid most likely reactive, due to inflammation
  • A quantitative asbestos digestion study of a 5 g lung tissue biopsy found 10,190 ferruginous bodies
  • Discrete foci of fibrosis with asbestos bodies were seen; the authors stated this confirmed asbestosis, although diffuse pulmonary fibrosis was not seen
  • Pulmonary function tests showed a moderate mixed respiratory impairment
  • The authors reported a latency period of 50 years in this case
  • After the open lung biopsy, the right pleural fluid gradually disappeared and had not reappeared as of January 14, 1998
• The authors' conclusion: The authors diagnosed benign asbestos pleural effusion with pulmonary aspergilloma, because biopsy showed no malignancy and the effusion did not recur. They stated that further periodic observation is needed because of the high level of asbestos exposure
• Limitations the authors state:
  • The 3-year malignancy-free period in the diagnostic criteria the authors cite had not yet passed at the time of diagnosis
  • The left lung shadows were not examined histologically; the authors suggested they might represent old inflammatory changes
  • Normal ranges for tumor markers and ADA in pleural fluid have not been established

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Benign Asbestos Pleural Effusion, Chest X-Ray, Pleural Effusion, Exudate, Mesothelial Cells, Biopsy, Reactive Mesothelial Cells, Pleura.

Related studies

• Two familial mesothelioma cases with high concentrations of soluble cytokeratin 19 fragment in pleural fluid — J. Hiyama, M. Marukawa, et al. (1998)
• Pleurectomy decortication in the treatment of the "trapped lung" in benign and malignant pleural effusions — S. Rathinam, D.A. Waller (2013)
• Diagnostic usefulness of tumour marker levels in pleural effusions of malignant and benign origin — F. Kuralay, Z. Tokgöz, et al. (2000)
• Benign mesothelial proliferation with effusion. Clinicopathologic entity that may mimic malignancy — R.M. Hansen, J.G. Caya, et al. (1984)
• Retrospective investigation on diagnostic process for benign asbestos pleural effusion (BAPE) using checklist — T. Kishimoto, N. Fujimoto, et al. (2020)
• Significance of secretory leukocyte peptidase inhibitor in pleural fluid for the diagnosis of benign asbestos pleural effusion — T. Kishimoto, Y. Kojima, et al. (2021)

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