Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor

Our plain-English summary of Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor, by J.B. Gleason, B. Tashtoush, M.J. Diacovo (Case Reports in Pulmonology, 2016).

The study

• Authors: J.B. Gleason, B. Tashtoush, M.J. Diacovo
• Journal: Case Reports in Pulmonology
• Published: 2016;2016:7560929
• Read it: PubMed · Publisher · Free full text

Abstract

Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT) scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma), with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid), supporting the diagnosis of biphasic malignant mesothelioma.

In plain English

This was a case report of one patient seen at Cleveland Clinic Florida. A 41-year-old man had pain in the left side of his chest for about a year. He did not smoke and had no occupational or environmental exposures, and the authors described him as having no history of asbestos exposure. A CT scan showed an 8.5 × 8.2 × 3.0 cm destructive tumor of the left seventh, eighth and ninth ribs. A primary bone cancer such as chondrosarcoma or osteosarcoma was highly suspected. A needle biopsy instead pointed to sarcomatoid mesothelioma, and an expert second opinion agreed. After four cycles of pemetrexed-cisplatin chemotherapy, the mass was stable at 8 cm. Surgeons then removed the tumor and rebuilt the chest wall. Lung samples taken during surgery showed mesothelioma with epithelioid features, so the final diagnosis was biphasic malignant pleural mesothelioma, staged as stage IV. He then had radiation because tumor reached the edges of the removed tissue. Follow-up CT showed no recurrence after ten months. The authors concluded that this cancer must be considered for chest wall lesions, even in relatively young people with no history of asbestos exposure.

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 41-year-old Caucasian man with left lateral chest pain for about one year, seen at Cleveland Clinic Florida (Weston, FL, USA). He also reported a five-pound unintentional weight loss over three months.
• Exposure: No asbestos exposure was identified. The patient had no history of cigarette smoking or tobacco use and no occupational or environmental exposures.
• Main results:
  • In this patient, repeat CT showed an 8.5 × 8.2 × 3.0 cm destructive tumor involving the left seventh, eighth and ninth ribs, with a soft tissue component bulging into the pleural space.
  • Based on imaging, a primary bone cancer of the ribcage (chondrosarcoma or osteosarcoma) was highly suspected at first.
  • A CT-guided core needle biopsy led to a suspected diagnosis of sarcomatoid mesothelioma, and an expert second opinion agreed.
  • PET-CT showed uptake in the chest wall lesion with an SUV of 17, and an additional area of uptake on the left side of the T12 vertebra with an SUV of 4.
  • After 4 cycles of pemetrexed-cisplatin chemotherapy, the rib-pleural mass was stable at 8 cm.
  • After surgical resection, the lung specimens showed mesothelioma with epithelioid features in addition to the sarcomatoid component. This led to a final diagnosis of biphasic malignant pleural mesothelioma, staged T4N0M1 (stage IV).
  • The patient received chest wall radiation for positive resection margins. Follow-up CT showed no recurrence after ten months.
• The authors' conclusion: The authors concluded that variants of malignant pleural mesothelioma must always be considered when evaluating a chest wall lesion that looks like a skeletal tumor, even in relatively young people with no history of asbestos exposure. They added that core or fine needle biopsies may not capture all of the tumor's histologic components.

Topics

Medical terms in this study, explained in our Lexicon: Biphasic Mesothelioma, Pleural Mesothelioma, Asbestos Exposure, Sarcomatoid, Mesothelioma, Surgical Resection, Epithelioid, Malignant Mesothelioma.

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