Epithelioid pleural mesothelioma concurrently associated with miliary pulmonary metastases and minimal change nephrotic syndrome - A hitherto undescribed case

Our plain-English summary of Epithelioid pleural mesothelioma concurrently associated with miliary pulmonary metastases and minimal change nephrotic syndrome - A hitherto undescribed case, by Y. Tsukamoto, T. Otsuki, H. Hao, et al (Pathology, Research and Practice, 2015).

The study

• Authors: Y. Tsukamoto, T. Otsuki, H. Hao, K. Kuribayashi, T. Nakano, A. Kida, T. Nakanishi, E. Funatsu, C. Noguchi, S. Yoshihara, K. Kaku, S. Hirota
• Journal: Pathology, Research and Practice
• Published: 2015;211(12):1014-9
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is the aggressive disease typically spreading along the pleural surface and encasing the lung, leading to respiratory failure or cachexia. Rare cases with atypical clinical manifestation or presentation have been reported in MPM. We experienced a unique case of MPM concurrently associated with miliary pulmonary metastases and nephrotic syndrome. A 73-year-old Japanese man with past history of asbestos exposure was referred to our hospital for the investigation of the left pleural effusion. Chest computed tomography showed thickening of the left parietal pleura. Biopsy specimen of the pleura showed proliferating epithelioid tumor cells, leading to the pathological diagnosis of epithelioid MPM with the aid of immunohistochemistry. After the diagnosis of MPM, chemotherapy was performed without effect. Soon after the clinical diagnosis of progressive disease with skull metastasis, edema and weight gain appeared. Laboratory data met the criteria of nephrotic syndrome, and renal biopsy with electron microscopic examination revealed the minimal change disease. Steroid therapy was started but showed no effect. Around the same time of onset of nephrotic syndrome, multiple miliary lung nodules appeared on chest CT. Transbronchial biopsy specimen of the nodules showed the metastatic MPM in the lung. The patient died because of the worsening of the general condition. To our knowledge, this is the first case of MPM concurrently associated with multiple miliary pulmonary metastases and nephrotic syndrome.

Copyright © 2015 Elsevier GmbH. All rights reserved.

In plain English

This article is a case report about one patient: a 73-year-old Japanese man who had never smoked and who had worked at an asbestos factory for about 2 months at age 20. He was referred to Hyogo College of Medicine because of fluid around his left lung. A biopsy of the pleura, with special staining, led to a diagnosis of epithelioid malignant pleural mesothelioma. Eight cycles of cisplatin and pemetrexed chemotherapy were stopped because the disease progressed. A trial drug was then stopped after the cancer spread to his skull. About 4 months before his death he developed nephrotic syndrome, a kidney disorder that causes heavy protein loss in the urine. A kidney biopsy showed minimal change disease, and steroid treatment did not work. Around the same time, many tiny nodules appeared in both lungs, and a lung biopsy showed these were spread of the mesothelioma. He died 17 months after diagnosis, and no autopsy was done. The authors also listed earlier published cases. To their knowledge, this was the first reported mesothelioma case with both conditions together.

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 (published as a teaching case), with tables of previously published cases from the English literature
• Who was studied: one 73-year-old Japanese man with no smoking history, referred to Hyogo College of Medicine, Japan, 17 months before his death
• Exposure: work at an asbestos factory for about 2 months at age 20; fiber type not stated
• Main results:
  • A pleural biopsy showed epithelioid tumor cells that were positive for pankeratin AE1/AE3, calretinin, D2-40 and WT-1 and negative for TTF-1 and CEA. This led to a diagnosis of epithelioid malignant pleural mesothelioma.
  • Eight cycles of cisplatin and pemetrexed were stopped because of progression of the pleural thickening on both sides. A histone deacetylase inhibitor (MK0683), given for 3 months as a clinical trial, was abandoned after a skull metastasis appeared.
  • About 4 months before death, the patient had generalized edema and weight gain of about 10 kg within a month. Proteinuria of 12.2 g/day, serum albumin of 1.3 g/dl and cholesterol of 388 mg/dl met the criteria of nephrotic syndrome.
  • On kidney biopsy, light microscopy showed no obvious glomerular abnormality, but electron microscopy showed extensive foot process fusion. This gave a diagnosis of minimal change disease.
  • Steroid pulse therapy (methylprednisolone 500 mg/day for 3 days) followed by oral prednisolone was ineffective.
  • Around the onset of nephrotic syndrome, miliary nodules appeared in both lungs. A transbronchial biopsy showed nodules up to 1 mm made of mesothelioma cells, confirming spread of the mesothelioma to the lungs.
  • Kidney function worsened and required ultrafiltration and hemodialysis. Gemcitabine was stopped because of pancytopenia. The patient died 17 months after diagnosis, and no autopsy was done.
• The authors' conclusion: The authors concluded that, to their knowledge, this was the first case of malignant pleural mesothelioma occurring together with miliary lung metastases and nephrotic syndrome. They wrote that an unclarified common cause might be involved, but that different factors might cause the two conditions, given how rarely they occur together. They also suggested the steroid failure might reflect the mesothelioma's poor response to chemotherapy.

Topics

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

Medical terms in this study, explained in our Lexicon: Epithelioid, Pleural Mesothelioma, Cachexia, Asbestos Exposure, Pleural Effusion, Parietal Pleura, Biopsy, Pleura.

Related studies

• Minimal change disease associated with malignant pleural mesothelioma: case report and review of the literature — H. Yildiz, S.I. Andreea, et al. (2016)
• Diffuse pleural mesothelioma with epithelioid and angiosarcomatous components--a hitherto undescribed pattern of differentiation — A. Klabatsa, A.G. Nicholson, et al. (2012)
• Nephrotic syndrome and mesenteric infarction secondary to metastatic mesothelioma — C.K. Farmer, D.J. Goldsmith (2001)
• Malignant pleural mesothelioma with associated minimal change disease and acute renal failure — J.Y. Li, T.Y. Yong, et al. (2010)
• Spontaneous pneumothorax and pulmonary malignant disease--a syndrome sometimes associated with cavitating tumours. Report of nine new cases, four with metastases and five with primary bronchial tumours — F.W. Wright (1976)
• An autopsy case of malignant pleural mesothelioma associated with nephrotic syndrome — S. Suzuki, M. Toyoshima, et al. (2014)

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