Extrapleural pneumonectomy for primary pleural mullerian tumor in a young woman

Our plain-English summary of Extrapleural pneumonectomy for primary pleural mullerian tumor in a young woman, by A.S. Farivar, B.E. Louie, R.W. Aye, et al (The Annals of Thoracic Surgery, 2012).

The study

• Authors: A.S. Farivar, B.E. Louie, R.W. Aye, M.P. Horton, E. Vallières
• Journal: The Annals of Thoracic Surgery
• Published: 2012;93(1):e1-2
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We present a case of a low-grade mullerian tumor of right pleural origin in a 23-year-old woman treated with an aggressive multimodal treatment paradigm. This tumor is heretofore undescribed in the medical literature. She received induction therapy of carboplatin and paclitaxel with minimal response, then had a maximally cytoreductive right extrapleural pneumonectomy. She subsequently underwent intensity-modulated radiotherapy to the right hemithorax. We propose a treatment paradigm for this previously undescribed primary pleural mullerian tumor.

Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This article was a case report from the Swedish Cancer Institute in Seattle about one 23-year-old woman. She was short of breath and had a large pleural effusion (fluid in the chest); draining it revealed a mass on the right mediastinal pleura (the chest lining). Tissue stains did not support mesothelial differentiation. The pathologists concluded the tumor was of mullerian origin, a low-grade serous carcinoma, a type that usually starts in the ovaries or peritoneum. The authors stated this was the first such tumor described as starting in the pleura. The article did not mention asbestos or any other exposure. She received carboplatin and paclitaxel chemotherapy, which did not dramatically shrink the tumor. A staging laparoscopy found no disease in the abdomen, and surgeons then performed a right extrapleural pneumonectomy. Two lymph nodes contained microscopic cancer. Her recovery after surgery was uncomplicated, and 2 months later she received radiation to the right chest. The article did not report longer follow-up. The authors suggested that similar low-grade tumors might be treated with surgery first, then radiation, keeping chemotherapy for last or for recurrence.

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 23-year-old woman with shortness of breath, treated at the Swedish Cancer Institute, Center for Pleural Diseases, Seattle, Washington; dates not given
• Exposure: Not reported. The article does not mention asbestos or any other exposure.
• Main results:
  • The patient had a large pleural effusion. When it was drained, a right mediastinal pleural mass was revealed. The fluid was cytology negative and was 88% lymphocytes.
  • In the patient's pleural biopsies, the staining pattern was judged not to support a mesothelial (mesothelioma-type) origin.
  • The patient's tumor was diagnosed as a low-grade serous carcinoma of mullerian origin, and the diagnosis was confirmed again after surgery.
  • In this patient, induction chemotherapy with carboplatin and paclitaxel did not produce a dramatic reduction in tumor size.
  • In this patient, staging laparoscopy found no disease in the abdomen or pelvis before the extrapleural pneumonectomy.
  • After surgery, one retrocaval lymph node and one subcarinal lymph node in this patient contained microscopic metastases. There was no invasion of the diaphragm or pericardium.
  • The patient's postoperative course was uncomplicated, and 2 months later she received intensity-modulated radiation to the right chest.
• The authors' conclusion: The authors concluded that if a similar low-grade tumor is seen in the future, it may be reasonable to consider surgery first, followed by IMRT, keeping chemotherapy for last or for later recurrence. They believed an aggressive surgical approach with extrapleural pneumonectomy is appropriate when tumor is confined to one side of the chest. They suggested that high-grade tumors may best be treated with induction chemotherapy, then extrapleural pneumonectomy and IMRT.

Topics

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

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Carboplatin, Cytoreductive Surgery, Intensity-Modulated Radiation Therapy (IMRT), Hemithorax.

Related studies

• Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma — M. Egan, B.E. Louie, et al. (2012)
• Epithelial malignant pleural mesothelioma after extrapleural pneumonectomy: stratification of survival with CT-derived tumor volume — R.R. Gill, W.G. Richards, et al. (2012)
• Spinal cord ischemia resulting in paraplegia following extrapleural pneumonectomy — K. Ural, K. Jakob, et al. (2014)
• Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors — T.D. Yan, M. Boyer, et al. (2009)
• Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma — M. de Perrot, R. Feld, et al. (2016)
• Induction chemotherapy, extrapleural pneumonectomy, and adjuvant radiotherapy for malignant pleural mesothelioma: experience of Guy's and St Thomas' hospitals — A. Bille, E. Belcher, et al. (2012)

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