Challenging the Norm: Occurrence of Synchronous Pleural and Peritoneal Mesothelioma in a Female Patient

Our plain-English summary of Challenging the Norm: Occurrence of Synchronous Pleural and Peritoneal Mesothelioma in a Female Patient, by S. Reddy, K. M G, R. Gattu, et al (Curēus, 2024).

The study

• Authors: S. Reddy, K. M G, R. Gattu, A. P, M. Kuthadi
• Journal: Curēus
• Published: 2024;16(8):e67118
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Here, we present a unique case involving a female patient in her 40s with synchronous malignant pleural and peritoneal mesothelioma, despite lacking a history of asbestos exposure. The patient's initial symptoms included dyspnoea, chest pain, cough, fever, appetite loss, and weight loss over a month. Clinical evaluation led to the identification of right-sided pleural effusion, prompting consideration of differential diagnoses, such as tubercular or malignant pleural effusion. A thoracoscopy-guided biopsy, followed by histopathological examination and immunohistochemical staining, confirmed the diagnosis of mesothelioma. Chemotherapy was initiated as part of the treatment plan. The prognosis for this condition is generally bad; however, unusual cases of extended survival have been documented. The complexities of our case underscore the critical necessity for a thorough and aggressive evaluation of pleural effusion cases to unveil rare underlying causes, such as mesothelioma.

Copyright © 2024, Reddy et al.

In plain English

This article is a case report from the pulmonology department of ESIC Medical College & Hospital, Hyderabad, India. It describes one woman in her 40s with synchronous (present at the same time) malignant pleural and peritoneal mesothelioma. The authors reported that she had no documented history of asbestos exposure, either occupationally or environmentally. She had a one-month history of breathing difficulties, chest pain, cough, fever, appetite loss and weight loss. Drainage of chest fluid and tuberculosis drugs given elsewhere had not helped. Fluid around her right lung was exudative, with adenosine deaminase of 34.3 IU/L, and showed no atypical cells. A CT scan showed fluid and nodular thickening of the right pleura. A thoracoscopic biopsy of the parietal pleura, with staining positive for WT1 and calretinin, confirmed epithelioid malignant mesothelioma. A PET/CT scan showed metabolically active peritoneal deposits and enlarged lymph nodes, and the disease was classed as stage IV. She received carboplatin and pemetrexed, and two cycles had been completed at the time of writing. The authors concluded that pleural effusions need a systematic, stepwise investigation to uncover rare causes such as mesothelioma.

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 woman in her 40s, living in a rural area, seen at the pulmonology department of ESIC Medical College & Hospital, Hyderabad, India; non-smoker with no existing health conditions
• Exposure: No asbestos exposure was reported: the authors state the patient had no documented history of asbestos exposure, occupationally or environmentally, and no asbestos in her living environment
• Main results:
  • Before referral, the patient had been treated elsewhere with thoracocentesis and antitubercular therapy, and her condition did not improve
  • Pleural fluid was exudative with low adenosine deaminase (34.3 IU/L); the cell block showed no atypical cells
  • Contrast-enhanced CT of the chest showed a moderate right-sided pleural effusion and nodular thickening of the right pleura, up to 6 mm thick
  • Pleural biopsy tissue was positive for WT1 and calretinin and negative for napsin, TTF-1, p40 and PAX8
  • The parietal pleural biopsy confirmed the epithelioid subtype of malignant mesothelioma
  • FDG-PET/CT showed metabolically active peritoneal deposits, nodules in the right lung, and mediastinal, retroperitoneal, axillary and right supraclavicular lymph node enlargement (lymphadenopathy)
  • Synchronous pleural and peritoneal mesothelioma was diagnosed at advanced stage IV
  • Because the tumor was inoperable, the patient was treated with carboplatin 350 mg and pemetrexed 600 mg every three weeks; two cycles had been completed at the time of writing
  • Draining the pleural fluid through a chest tube gave the patient significant symptom relief
• The authors' conclusion: The authors concluded that a systematic, stepwise approach to pleural effusions is needed, and that malignancy, including rare causes such as mesothelioma, should be kept in mind when investigating exudative pleural effusions

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure, Pleural Effusion, Thoracoscopy, Biopsy, Immunohistochemistry, Mesothelioma, Chemotherapy.

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