Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report

Our plain-English summary of Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report, by N.A. Ansari, N.W. Derias (Acta Cytologica, 2000).

The study

• Authors: N.A. Ansari, N.W. Derias
• Journal: Acta Cytologica
• Published: 2000;44(1):70-4
• Type of article: Case report
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Clinically documented distant metastases are rare in mesothelioma and tend to occur late in the course of the disease, well after the diagnosis has been made. In this instance, diagnosis was not made until a metastatic deposit was identified microscopically in the enlarged lymph node.

Case: A 65-year-old male with no definite history of occupational asbestos exposure presented with chest pain, pleural effusion and supraclavicular lymphadenopathy. Cytologic examination of material obtained by fine needle aspiration from his cervical lymph node revealed malignant mesothelioma. This was confirmed on histology.

Conclusion: This was a particularly rare presentation and, as far as we are aware, was the first case in which mesothelioma was diagnosed by fine needle aspiration of a cervical lymph node. It serves to remind the pathologist that when confronted with a lymph node involved by tumor, the possibility of mesothelioma should be included in the differential diagnosis. The case also demonstrates the usefulness of fine needle aspiration in the diagnosis of metastatic tumor.

In plain English

This article is a case report describing one 65-year-old man. He had chest discomfort, and an X-ray showed fluid around the right lung (a pleural effusion). Fluid drawn from his chest showed a few atypical lining (mesothelial) cells that were thought to be reactive, and no clearly cancerous cells. He later developed a firm 3-cm lymph node above his right collarbone (the right supraclavicular area). Cells taken from this node with a thin needle (fine needle aspiration) were tested with a panel of stains, and a diagnosis of metastatic malignant mesothelioma was made. A surgical biopsy of the node confirmed it. He died within 10 weeks. At autopsy, tumor filled the right pleural cavity. There was no definite history of occupational asbestos exposure, and no asbestos bodies were seen in either lung. He had been a heavy smoker. The authors concluded that, as far as they knew, this was the first report of mesothelioma diagnosed by fine needle aspiration of a cervical (neck) lymph node.

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 65-year-old man, with chest discomfort and a right-sided pleural effusion
• Exposure: No definite history of occupational asbestos exposure; the patient had been a heavy smoker. No fiber type is reported.
• Main results:
  • Initial pleural fluid cytology showed a few atypical mesothelial cells thought to be reactive; no unequivocally malignant cells were seen
  • A solitary, firm, 3-cm lymph node was later found in the right supraclavicular fossa
  • On the fine needle aspirate, tumor cells showed focal positivity for HBME1 and negative reactivity for BerEP4, AUA1 and CEA; metastatic malignant mesothelioma was diagnosed
  • Incisional biopsy of the node confirmed metastatic malignant mesothelioma
  • The patient died within 10 weeks
  • At autopsy, tumor obliterated the right pleural cavity
  • No asbestos bodies were seen in either lung at autopsy
• The authors' conclusion: The authors stated that, as far as they were aware, this was the first report of malignant mesothelioma diagnosed by fine needle aspiration of a cervical lymph node

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Pleural Effusion, Lymphadenopathy, Histology, Differential Diagnosis.

Related studies

• Fine-needle aspiration biopsy of axillary lymph nodes — S. Jaffer, M. Zakowski (2002)
• Malignant pleural mesothelioma initially diagnosed on cervical lymph node biopsy — S. Ogata, S. Hiroi, et al. (2009)
• Electron microscopy in the diagnosis of percutaneous fine needle aspiration specimens — E.J. Wills, S. Carr, et al. (1987)
• Percutaneous image-guided fine-needle aspiration of peritoneal lesions — L.J. Layfield, E.V. Gopez (2003)
• Diagnosis of malignant pleural mesothelioma by axillary lymph node biopsy — S.B. Kim, B. Varkey, et al. (1987)
• Clinical and pathological characteristic of metastatic malignant mesothelioma initially diagnosed by lymph node biopsy — X.L. Zhu, L.M. Gao, et al. (2017)

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