Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma

Our plain-English summary of Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma, by J. Hamamoto, D. Notsute, K. Tokunaga, et al (Internal Medicine, 2010).

The study

• Authors: J. Hamamoto, D. Notsute, K. Tokunaga, J. Sasaki, K. Kojima, S. Saeki, R. Tanaka, H. Tanaka, H. Kohrogi
• Journal: Internal Medicine
• Published: 2010;49(5):423-6
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 74-year old man was admitted to our hospital with right diffuse pleural thickening and effusion and with subcarinal lymph node swelling. The effusion obtained by thoracentesis showed no malignant cells, although positron emission tomography showed abnormal uptake in the right pleural thickening and subcarinal lymph node. Histopathological examination of the lymph node specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration showed a sheet of epithelioid-like large atypical cells. The tumor cells were immunohistochemically positive for calretinin and cytokeratin 5/6, and negative for CEA and TTF-1. Therefore, malignant pleural mesothelioma of epithelioid type was diagnosed.

In plain English

This case report described one 74-year-old man in Japan. He had a history of asbestos exposure for 5 years, from age 25 to 30 (the fiber type was not stated). He had smoked 7.5 pack years and had been diagnosed with pleural asbestosis 6 years earlier. He was admitted with low-grade fever, cough and fluid around the right lung (right pleural effusion). The fluid showed no malignant cells. A PET/CT scan showed high uptake on the right pleura and in a subcarinal lymph node measuring 3.5 cm. Doctors sampled the node with a needle passed through the airway under ultrasound guidance (EBUS-TBNA). The cells appeared malignant but not likely to be primary lung cancer. They stained positive for calretinin and cytokeratin 5/6 and negative for CEA and TTF-1. He was diagnosed with epithelioid malignant pleural mesothelioma, stage III, and received cisplatin and pemetrexed. The authors concluded that EBUS-TBNA is a promising procedure for diagnosing and staging this disease when it has spread to lymph nodes. They said more cases are needed to confirm the risk of tumor seeding with the procedure.

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 74-year-old man admitted to the authors' hospital (Department of Respiratory Medicine, Kumamoto University Hospital, Japan) with low-grade fever, cough and right pleural effusion
• Exposure: asbestos exposure for 5 years, between ages 25 and 30; fiber type and job not stated. He also had a smoking history of 7.5 pack years and a diagnosis of pleural asbestosis 6 years before admission.
• Main results:
  • The patient's pleural effusion was exudative and no malignant cells were found in it.
  • Hyaluronic acid in the patient's effusion was 67,600 ng/mL, which the authors described as not high against a reference level of 100,000 ng/mL or less.
  • PET/CT showed multiple regions of high uptake on the right pleura and in the subcarinal lymph node.
  • The subcarinal lymph node had a maximal diameter of 3.5 cm. Its ultrasound images could not definitely distinguish benign from malignant disease.
  • Cells obtained by EBUS-TBNA from the node suggested malignancy but not likely primary lung cancer.
  • The atypical cells were positive for calretinin and cytokeratin 5/6 and negative for CEA and TTF-1.
  • The patient was diagnosed with epithelioid malignant pleural mesothelioma, stage III, based on spread to the subcarinal (N2) lymph node.
  • The patient received chemotherapy with cisplatin and pemetrexed.
• The authors' conclusion: The authors concluded that EBUS-TBNA is a promising procedure to establish the diagnosis of malignant pleural mesothelioma with lymph node metastasis, and its lymph node stage, and that it is useful for deciding the treatment plan.
• Limitations the authors state:
  • The authors stated that more cases will be needed to confirm the risk of tumor seeding with EBUS-TBNA.

Topics

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

Medical terms in this study, explained in our Lexicon: Ultrasound, Pleural Mesothelioma, Diffuse Pleural Thickening, Thoracentesis, Pleural Thickening, Epithelioid, Calretinin, Cytokeratin 5/6.

Related studies

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• "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) — F. Lococo, G. Rossi, et al. (2014)
• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma — H. Ashinuma, M. Shingyoji, et al. (2015)
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• Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle — R. Trisolini, F. Natali, et al. (2018)
• Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions — I. Skovgaard Christiansen, J.C. Kuijvenhoven, et al. (2019)

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