Foreign body granuloma mimicking recurrence of malignant pleural mesothelioma

Our plain-English summary of Foreign body granuloma mimicking recurrence of malignant pleural mesothelioma, by T. Nakasuka, N. Fujimoto, N. Hara, et al (Respiratory Medicine Case Reports, 2015).

The study

• Authors: T. Nakasuka, N. Fujimoto, N. Hara, Y. Miyamoto, T. Yamagishi, M. Asano, H. Nishi, T. Kishimoto
• Journal: Respiratory Medicine Case Reports
• Published: 2015;16:95-6
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 72-year-old man visited our hospital due to right pleural effusion. He had worked as a welder at a shipbuilding company and had been exposed to asbestos. Cytological examination and thoracoscopic pleural biopsy yielded a diagnosis of epithelial malignant pleural mesothelioma (MPM); extrapleural pneumonectomy (EPP) was performed. Two years later, he became aware of right-back swelling that became a fist-sized mass over 2 months. Microscopy of a tissue specimen revealed no malignant cells, but did indicate foreign body granuloma. Subcutaneous lesions that develop after EPP do not necessarily result from the recurrence of MPM, but could have benign etiologies.

In plain English

This case report described a 72-year-old man who had worked as a welder at a shipbuilding company and had been exposed to asbestos for 43 years. The article did not state the fiber type. Fluid around his right lung led to a diagnosis of the epithelial type of malignant pleural mesothelioma. He underwent extrapleural pneumonectomy, and his diaphragm and pericardium were rebuilt with Gore-Tex mesh. Two years later, a swelling on his right back grew into a fist-sized mass over 2 months. Scans showed a mass extending from the right chest cavity into the tissue under the skin, and the doctors suspected the cancer had returned. A needle biopsy found no cancer cells but did find granulomas. The mass, which involved the mesh, was then removed by surgery. It was confirmed as a foreign body granuloma, with no sign that the mesothelioma had come back. The authors suspected that the mesh caused it. They concluded that lesions under the skin after this surgery do not necessarily mean recurrence and could be benign, and that diagnostic procedures should be considered.

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 of a single patient
• Who was studied: One 72-year-old man seen at Okayama Rosai Hospital, Japan, for a right pleural effusion
• Exposure: Occupational asbestos exposure for 43 years while working as a welder at a shipbuilding company. The fiber type was not stated.
• Main results:
  • The patient was diagnosed with the epithelial subtype of malignant pleural mesothelioma, and thoracoscopic pleural biopsy confirmed the diagnosis.
  • Extrapleural pneumonectomy was performed, with removal of the pericardium and diaphragm.
  • Talc was not used to treat the effusion.
  • Two years later, a swelling on the right back became a fist-sized mass over 2 months.
  • On PET-CT the mass took up the tracer, and it lay near the chest tube site from the surgery.
  • Needle biopsy showed granulomas with giant cells, histiocytes and inflammatory cells, rather than malignant cells.
  • The removed tumor involved the Gore-Tex mesh. Microscopy after the tumor was removed confirmed foreign body granuloma without evidence of mesothelioma recurrence.
  • The authors suspected that the Gore-Tex mesh used to reconstruct the diaphragm was the foreign material that caused the granuloma.
• The authors' conclusion: The authors concluded that lesions under the skin that develop after extrapleural pneumonectomy do not necessarily result from recurrence of malignant pleural mesothelioma but could have benign causes, and that diagnostic procedures should be considered in such cases.

Topics

Medical terms in this study, explained in our Lexicon: Granuloma, Pleural Mesothelioma, Pleural Effusion, Pleural Biopsy, Extrapleural Pneumonectomy (EPP).

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