Diffuse epithelial pleural mesothelioma presenting as a solitary lung mass

Our plain-English summary of Diffuse epithelial pleural mesothelioma presenting as a solitary lung mass, by M.H. Gotfried, S.F. Quan, R.E. Sobonya (Chest, 1983).

The study

• Authors: M.H. Gotfried, S.F. Quan, R.E. Sobonya
• Journal: Chest
• Published: 1983;84(1):99-101
• Type of article: Case report
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report the occurrence of a malignant pleural epithelial mesothelioma which presented radiographically and at surgery as a localized solitary mass, but was found microscopically to involve grossly normal pleura. Clinically diffuse mesothelioma recurred 19 months later. Localized malignant mesothelioma has been associated with the same poor prognosis as the diffuse form and, as suggested by this case, may represent an early phase of diffuse disease.

In plain English

This article was a case report about one patient, a 61-year-old woman referred to the Arizona Health Sciences Center with fluid around her left lung. Nineteen months earlier, at another hospital, surgeons had removed a 6.5 x 5 x 2.5-cm mass in the area of the major fissure on her left side, which had shown on X-ray as a mass in the left lower lung field. It was first diagnosed as a well-differentiated adenocarcinoma of the lung. She had a 50-pack-year smoking history and no history of exposure to asbestos. At a second operation, tumor had spread across the pleura (the lining around the lung), and she died three months later. When the authors reviewed the first operation's material, lung tissue removed incidentally, away from the mass, already had its pleural surface covered by the same tumor cells. The authors said electron-microscope studies strongly suggested epithelial mesothelioma. The authors concluded that the case supports the idea that apparently localized epithelial malignant mesotheliomas are already diffuse when first diagnosed. They suggested that biopsies of normal-looking pleura away from the visible tumor may help stage the disease.

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 61-year-old white woman referred to the Arizona Health Sciences Center (University of Arizona, Tucson) for a left pleural effusion, 19 months after a mass in the area of the left major fissure was removed at another hospital
• Exposure: The patient had a 50-pack-year smoking history and no history of exposure to asbestos; no fiber type is discussed
• Main results:
  • Nineteen months before referral, a mass appeared on X-ray in the left lower lung field that had not been present one year before
  • At the first operation a 6.5 x 5 x 2.5-cm mass in the area of the major fissure was removed; it was initially diagnosed as a well-differentiated adenocarcinoma of the lung, and the patient received no postoperative treatment
  • On review, lingular tissue removed incidentally at the first operation, away from the mass, had its pleural surface covered in nearly all areas by the same tumor cells as the solitary mass
  • Tissue from the second operation 19 months later showed an identical tumor
  • After the second operation the patient's condition worsened and she died three months later
  • The tumor's microvillous length/diameter ratio was 19.8, within a range the authors cite from another study for epithelial mesotheliomas (4.8 to 21.3)
  • The authors stated that the ultrastructural (electron-microscope) findings strongly suggested an epithelial mesothelioma
• The authors' conclusion: The authors concluded that this case supports the hypothesis that apparently localized epithelial malignant mesotheliomas are diffuse at the time of first diagnosis, and that biopsies of apparently uninvolved pleura away from the visible tumor may help stage the disease

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, Mesothelioma, Pleura, Localized Malignant Mesothelioma, Prognosis.

Related studies

• Malignant mesothelioma presenting as a solitary perifissural nodule — L. Mo, B. Adler, et al. (2020)
• Rosai-Dorfman disease presenting as a solitary mediastinal mass — A.I. Hida, S. Yagi, et al. (2009)
• Solitary pulmonary nodule in a patient without asbestos exposure — J.F. Turner, C. Gronbeck, et al. (1992)
• Solitary pulmonary nodule malignancy predictive models applicable to routine clinical practice: a systematic review — M. Senent-Valero, J. Librero, et al. (2021)
• Peritoneal mesothelioma presenting as an adnexal mass — R.A. Komorowski, D.H. Bobert (1975)
• A diagnosable coin lesion — L. Goodman (1976)

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