Coarse pleural calcification in a mesothelioma patient raises the possibility of a rare tumour subtype: osteoblastic sarcomatoid mesothelioma

Our plain-English summary of Coarse pleural calcification in a mesothelioma patient raises the possibility of a rare tumour subtype: osteoblastic sarcomatoid mesothelioma, by A.M. Mortimer, J. Rowlands, P. Murphy (The British Journal of Radiology, 2011).

The study

• Authors: A.M. Mortimer, J. Rowlands, P. Murphy
• Journal: The British Journal of Radiology
• Published: 2011;84(1001):e106-8
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

It is often suggested that calcification seen in association with pleural thickening implies benign disease. However, we present a case of a patient presenting with coarse pleural calcification associated with a pleural effusion and thickening, which following biopsy was shown to represent osteoblastic sarcomatoid mesothelioma. We describe the imaging features associated with this and differentiate these findings from those seen with benign pleural calcification. Similarities are drawn to other rare cases described in the literature.

In plain English

This case report, written by radiologists at Bristol Royal Infirmary in the UK, described a single patient. He was a 78-year-old man with a history of asbestos exposure. Three months after coronary artery bypass surgery, he had worsening shortness of breath on exertion and anaemia. The article does not say what type of asbestos or what work was involved. A first chest X-ray showed a small collection of fluid (effusion) around the left lung. Later imaging showed thickened lining of the left lung (pleura) containing many dense, clumped calcium deposits. On CT, these clumps were oriented perpendicular to the lung lining. They did not have the flat, linear appearance that the authors described as consistent with a plaque. A biopsy showed sarcomatoid mesothelioma of the pleura. Tumour bone tissue (osteoid) inside it accounted for the calcification seen on imaging. The authors concluded that, in the context of asbestos exposure, pleural calcification usually represents benign disease. However, they said unusual patterns of calcification, together with effusion or thickening, should raise suspicion of this rare mesothelioma subtype.

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 78-year-old man with a history of asbestos exposure. He presented 3 months after coronary artery bypass graft surgery with worsening shortness of breath on exertion and anaemia. He was seen in the Department of Radiology, Bristol Royal Infirmary, UK.
• Exposure: A history of asbestos exposure. No fiber type, job, product or dose is given.
• Main results:
  • The patient's first chest radiograph showed a small left pleural effusion.
  • CT showed circumferential pleural thickening containing multiple dense nodular clumps of calcification. The clumps were oriented perpendicular to the pleural margin rather than having a flat, linear appearance consistent with a plaque.
  • Biopsy of the patient's pleura showed diffuse, infiltrating sarcomatoid tumour. Immunohistochemistry showed no staining for calretinin or cytokeratin 5/6. The authors said these findings were in keeping with sarcomatoid mesothelioma.
  • Tumour osteoid (bone-forming tissue) was found in the biopsy material. It accounted for the calcification seen on imaging.
• The authors' conclusion: The authors concluded that, in the context of asbestos exposure, pleural calcification usually represents benign disease. However, rare atypical appearances should raise suspicion of this rare mesothelioma subtype. These include unusual distribution and shape of calcification, together with pleural effusion or thickening.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Calcification, Mesothelioma, Sarcomatoid, Pleural Thickening, Pleural Effusion, Biopsy.

Related studies

• Malignant pleural mesothelioma with osteoblastic heterologous elements: CT and MR imaging findings — G. Chave, L. Chalabreysse, et al. (2002)
• Pleural calcification associated with exposure to chrysotile asbestos in southeast Turkey — S. Yazicioglu (1976)
• Metsovo lung: pleural calcification and restrictive lung function in northwestern Greece. Environmental exposure to mineral fiber as etiology — S.H. Constantopoulos, J.A. Goudevenos, et al. (1985)
• Lymphocytic alveolitis and pleural calcifications in nonoccupational asbestos exposure. Protection against neoplasia? — S.H. Constantopoulos, Y.A. Dalavanga, et al. (1992)
• Pleural calcification, pleural mesotheliomas, and bronchial cancers caused by tremolite dust — S. Yazicioglu, R. Ilçayto, et al. (1980)
• The occurrence of pleural calcification among asbestos insulation workers — I.J. Selikoff (1965)

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