Bilateral diffuse pulmonary infiltrates secondary to malignant peritoneal mesothelioma - A rare clinical presentation

Our plain-English summary of Bilateral diffuse pulmonary infiltrates secondary to malignant peritoneal mesothelioma - A rare clinical presentation, by M. Haygarth, K.K. Zaw, V. Yachmenikova, et al (Respiratory Medicine Case Reports, 2019).

The study

• Authors: M. Haygarth, K.K. Zaw, V. Yachmenikova, A.M.J. Pokorny, K.K. Kwong, S.S. Heraganahally
• Journal: Respiratory Medicine Case Reports
• Published: 2019;26:326-327
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Diffuse pulmonary metastasis secondary to primary peritoneal malignant mesothelioma is rarely reported in the literature. In this report we describe a 59-year-old Caucasian women with no known previous asbestos exposure presenting with bilateral diffuse pulmonary opacities in association with primary malignant peritoneal mesothelioma. The diagnosis was confirmed by ultrasound guided abdominal and bronchoscopy, trans-bronchial lung biopsy. The biopsy demonstrated positive staining with AE1/3, CK7, CK5/6, WT1, calretinin and D2 40. The cells were negative for BerEP4, PAX8, CA125, ER, CD34, ERG, P63, P40, Melan A, Gata3 and mammaglobin. The morphology and immunohistochemical profile supported a diagnosis of epithelioid malignant mesothelioma.

In plain English

This case report from Royal Darwin Hospital, Australia, described one 59-year-old Caucasian woman with malignant peritoneal mesothelioma (a cancer of the abdominal lining) that had spread to both lungs. The article states she had no known occupational or environmental exposure to asbestos. She was a current smoker with a 30-pack year history. She first had abdominal discomfort and a mass in the abdomen. A biopsy of the abdominal mass was diagnosed as epithelioid malignant mesothelioma. She later became breathless on exertion. A chest scan showed fluid around the right lung, enlarged lymph nodes, and widespread shadowing in both lungs that suggested spread through the lymph vessels. A lung biopsy taken during bronchoscopy confirmed metastatic epithelioid mesothelioma in the lung. The biopsy samples were small, and the biopsy did not show invasion of lymph vessels. She died within three months of first presenting, before any systemic treatment began. The authors called this a rare presentation. They concluded that mesothelioma should be considered when patients present with diffuse lung infiltrates in a relevant clinical context.

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 59-year-old Caucasian woman, reported by authors from Royal Darwin Hospital, Darwin, Australia
• Exposure: no known previous asbestos exposure, either occupational or environmental; the patient was a current smoker with a 30-pack year history
• Main results:
  • An ultrasound-guided biopsy of the abdominal mass was diagnosed as epithelioid malignant mesothelioma, based on cell appearance and staining
  • A chest CT showed a moderate right-sided pleural effusion, lymph node enlargement in the chest, and extensive opacities in both lungs suggestive of lymphangitic spread
  • A bone scan and a brain CT showed no distant spread
  • A trans-bronchial lung biopsy confirmed metastatic malignant epithelioid mesothelioma in the lung
  • The patient died within three months of initial presentation, before any systemic treatment was started
• The authors' conclusion: The authors concluded that this was a rare presentation and that mesothelioma should be considered in the differential diagnosis of patients presenting with diffuse pulmonary infiltrates in a relevant clinical context
• Limitations the authors state:
  • The lung biopsy samples were small and did not contain muscle or fat tissue, so invasion into muscle or fat could not be shown
  • The lung biopsy did not show lymphovascular or lymphangitic invasion; lymphangitic spread was suggested only by the CT findings
  • ALK testing, which the authors note may be useful in peritoneal mesothelioma, was not routinely performed at their centre

Topics

Medical terms in this study, explained in our Lexicon: Bilateral, Peritoneal Mesothelioma, Metastasis, Malignant Mesothelioma, Asbestos Exposure, Ultrasound, Bronchoscopy, Biopsy.

Related studies

• Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma — H.E. Fayed, V.K. Woodcock, et al. (2013)
• Bilateral Malignant Mesothelioma of Tunica Vaginalis A Case Report on Rare Presentation — A.A. Shaikh, K.V. Naik, et al. (2017)
• Diffuse pulmonary mesothelioma presenting as bilateral lymphangitis — A.P. Chahinian (1986)
• Malignant peritoneal mesothelioma in a 16-year-old girl: presentation of a rare disease — I.B. Brecht, A. Agaimy, et al. (2012)
• A Case Report of Peritoneal Mesothelioma as an Acute Abdomen Mimic: A Rare Presentation and Diagnostic Challenges — L. Fadl, M. Fadl, et al. (2024)
• Massive bilateral upper lobe fibrosis secondary to asbestos exposure — R.A. Green, D.G. Dimcheff (1974)

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