Diagnosis of malignant pleural mesothelioma by axillary lymph node biopsy

Our plain-English summary of Diagnosis of malignant pleural mesothelioma by axillary lymph node biopsy, by S.B. Kim, B. Varkey, H. Choi (Chest, 1987).

The study

• Authors: S.B. Kim, B. Varkey, H. Choi
• Journal: Chest
• Published: 1987;91(2):279-81
• Type of article: Case report
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Diffuse malignant mesothelioma was diagnosed by axillary lymph node biopsy in a patient with brief asbestos exposure and extensive pleural masses. The clinical, radiographic and pathologic findings of this case are reported and lymph node involvement in DMM is briefly discussed.

In plain English

This was a case report, with a short review of earlier published cases. A 52-year-old white man, an ex-smoker (45 pack-years), had worsening breathlessness on exertion, fatigue and a 10-pound weight loss over three months. He had been exposed to asbestos in childhood when his grandfather was installing pipe insulation. The fiber type was not reported. He had a 2 cm lymph node in the right armpit (axilla), and CT showed his right lung encased by a pleural mass about 2 cm thick. Biopsy of the armpit node showed metastatic tumor, and a diagnosis of diffuse malignant mesothelioma was made, supported by special stains and electron microscopy. He died on the 11th hospital day. In 401 published cases, at least 183 of them with autopsies, the authors found 81 autopsied cases (44 percent) with hilar or mediastinal node involvement but only two with axillary node involvement. The authors concluded that their case suggested biopsy of an enlarged node as a method of diagnosing this cancer.

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, with a brief review of published case series in the discussion
• Who was studied: one patient, a 52-year-old white man, seen at the Zablocki Veterans Administration Medical Center, Milwaukee (date not given); ex-smoker with a 45 pack-year history
• Exposure: brief childhood asbestos exposure while his grandfather was installing pipe insulation; fiber type not stated
• Main results:
  • The patient had a hard, movable, non-tender 2 cm lymph node in the right axilla
  • CT showed the right lung encased by a pleural mass about 2 cm thick, with multiple enlarged mediastinal lymph nodes
  • Biopsy of the enlarged right axillary node showed extensive metastatic tumor; diffuse malignant mesothelioma was diagnosed
  • Immunocytochemical studies of the node were negative for carcinoembryonic antigen and positive for keratin; electron microscopy showed long, slender microvilli
  • The patient died on the 11th hospital day; autopsy was refused, but a small piece of pleural tumor removed with family consent showed the same features as the axillary node
  • The authors' review of published articles covered 401 cases of diffuse malignant mesothelioma, at least 183 of them autopsied
  • Of the autopsied cases, 81 (44 percent) had tumor in hilar or mediastinal nodes
  • Only two reviewed cases had axillary lymph node involvement; in one more case axillary node enlargement was found on examination without tissue diagnosis
• The authors' conclusion: The authors concluded that their case points to axillary node enlargement in diffuse malignant mesothelioma and suggests biopsy of an enlarged node as a method of diagnosis
• Limitations the authors state:
  • For the literature review, the authors suggested the reviewed autopsies may not have included axillary node dissections, especially when no enlarged node was felt. They said a prospective multicenter study would be needed to establish the true frequency.

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 Mesothelioma, Biopsy, Malignant Mesothelioma, Asbestos Exposure.

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)
• Clinical and pathological characteristic of metastatic malignant mesothelioma initially diagnosed by lymph node biopsy — X.L. Zhu, L.M. Gao, et al. (2017)
• Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report — N.A. Ansari, N.W. Derias (2000)
• Lymph node metastases in diffuse malignant peritoneal mesothelioma — D. Baratti, S. Kusamura, et al. (2010)
• Monitoring of fluoro-edenite fibre pollution through the study of sheep lymph nodes as a model of a biological indicator — V. Rapisarda, G. Rapisarda, et al. (2005)

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