Floor of mouth and tongue metastasis from malignant pleural mesothelioma

Our plain-English summary of Floor of mouth and tongue metastasis from malignant pleural mesothelioma, by D. Kirke, K. Horwood, B. Wallwork (ANZ Journal of Surgery, 2010).

The study

• Authors: D. Kirke, K. Horwood, B. Wallwork
• Journal: ANZ Journal of Surgery
• Published: 2010;80(7-8):556-8
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

The authors, from an ear, nose and throat surgery department in Brisbane, Australia, described a 71-year-old man whose malignant pleural mesothelioma had spread to the floor of the mouth and tongue. He had had significant asbestos exposure in his working life, and mesothelioma had been diagnosed one year earlier. He presented with a right floor of mouth lesion that had been present for 3 weeks and was rapidly enlarging, together with a growing mass in the right neck. MRI showed a tongue mass measuring 5.4 × 4.3 × 3.6 cm that crossed the lingual septum, with lymph node enlargement on both sides of the neck. Chest CT showed no progression of the mesothelioma in the left hemithorax, and abdominal CT was normal. The initial biopsy was thought most likely to show poorly differentiated squamous cell carcinoma. The immunohistochemical profile was consistent with either that cancer or mesothelioma. A multidisciplinary clinic recommended surgery for palliation. The patient had a right hemiglossectomy, a modified radical neck dissection and a tracheostomy. The surgical specimen confirmed metastatic mesothelioma in the tongue, the floor of the mouth and 6 of 21 lymph nodes. Around day 13 after surgery, lesions were found in the liver and pancreas and a new neck mass appeared. He developed aspiration pneumonia and died 6 days later. The authors identified seven earlier reports of this kind. They concluded that accurate histological diagnosis can be difficult. They advised that a new cancer in a patient with known mesothelioma should be presumed to be mesothelioma unless proven otherwise.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This case report, by authors from an ear, nose and throat surgery department in Brisbane, Australia, described a 71-year-old man with malignant pleural mesothelioma of the left chest, diagnosed 1 year earlier. He had had significant asbestos exposure in his working life; the article does not name fiber types or jobs. He developed a rapidly growing lump in the right floor of the mouth, involving the tongue, and an enlarged neck lymph node. A biopsy was first thought most likely to be a poorly differentiated squamous cell carcinoma. After surgery intended to relieve symptoms, the removed tissue showed metastatic malignant mesothelioma in the tongue, floor of mouth and 6 of 21 neck lymph nodes. About 13 days after surgery, lesions were seen in the liver and pancreas, a new neck mass appeared, and he developed aspiration pneumonia and died. The authors concluded that accurate diagnosis can be difficult and that a new cancer in a patient with mesothelioma should be thought of as the same disease unless proven otherwise.

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 71-year-old male patient with malignant mesothelioma of the left hemithorax, diagnosed 1 year before he presented with a right floor of mouth lesion; the authors were from the Department of Ear Nose and Throat Surgery, Greenslopes Hospital, Brisbane, Queensland, Australia
• Exposure: Significant asbestos exposure during his working life; no fiber type, job or dose was given. He had smoked very briefly in his youth.
• Main results:
  • Mesothelioma had been diagnosed 1 year earlier; a chest CT at presentation showed no progression of the mesothelioma of the left hemithorax
  • Examination found a 3-cm hard right floor of mouth lesion tethered to the underside of the tongue
  • The initial biopsy showed a poorly differentiated malignant infiltrate, thought most likely to be poorly differentiated squamous cell carcinoma because of squamoid-like cells
  • After right hemiglossectomy, neck dissection and tracheostomy, histology showed metastatic malignant mesothelioma in the tongue, floor of mouth and 6/21 lymph nodes from the neck dissection
  • The diagnosis was clear on the surgical specimen because the tumour was based in skeletal muscle rather than the epithelium
  • Around day 13 after surgery, ultrasound showed a lesion in the left lobe of the liver and a solid lesion in the pancreatic head, despite an earlier normal abdominal CT
  • The patient developed a new neck mass and aspiration pneumonia, and died 6 days later from aggressive disease and aspiration pneumonia
• The authors' conclusion: The authors concluded that accurate histological diagnosis can be difficult in patients with pre-existing mesothelioma who present with a new malignancy, and that the new malignancy should be thought to be of similar pathology unless proven otherwise.

Topics

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

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Asbestos Exposure, Mesothelioma, Hemithorax, Biopsy, Squamous Cell Carcinoma.

Related studies

• Tongue metastasis from a malignant diffuse mesothelioma of the pleura: report of a case — A. Piattelli, M. Fioroni, et al. (1999)
• Metastatic pleural mesothelioma presenting with solitary involvement of the tongue: report of a new case and review of the literature — F. Zanconati, A. DelConte, et al. (2003)
• Solitary fibrous tumour of the tongue: a case report with immunohistochemical studies — Y. Yamashita, T. Satoh, et al. (2002)
• Solitary fibrous tumour of the tongue — A. Piattelli, M. Fioroni, et al. (1998)
• Pleural mesothelioma with initial presentation as cervical lymphadenopathy — E.J. Wills (1995)
• Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report — N.A. Ansari, N.W. Derias (2000)

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