Good vibrations and the power of positron thinking: positron emission tomography and endoscopic ultrasound in staging of mesothelioma-two case reports

Our plain-English summary of Good vibrations and the power of positron thinking: positron emission tomography and endoscopic ultrasound in staging of mesothelioma-two case reports, by C.P. Carden, J.S. Myerson, S. Popat, et al (Journal of Thoracic Oncology, 2008).

The study

• Authors: C.P. Carden, J.S. Myerson, S. Popat, A. Montes, J.M. Larkin, M.J. Benson, M.E. O'Brien
• Journal: Journal of Thoracic Oncology
• Published: 2008;3(5):539-41
• Type of article: Case report
• Read it: PubMed · Publisher

In plain English

This article reported two patients with pleural mesothelioma that had spread to unusual places. The first patient, a 55-year-old electrician who smoked, had epithelioid mesothelioma and trouble swallowing. While surgery (extrapleural pneumonectomy) was being considered, a PET/CT scan showed intense uptake in the left pleura and less intense uptake near the esophagus. Endoscopic ultrasound later found a ring-shaped mass in the esophagus up to 23 mm thick, and biopsies of the esophageal wall itself confirmed mesothelioma there. He later needed an esophageal stent. The article did not describe this patient's asbestos exposure. The second patient, a 60-year-old nonsmoking man with no obvious history of asbestos exposure, had mixed epithelioid and sarcomatoid mesothelioma. After chemotherapy, a PET scan showed an unexpected spot of uptake in the celiac lymph nodes in the abdomen. A needle sample taken through endoscopic ultrasound confirmed spread there, so extrapleural pneumonectomy was judged not feasible. The authors concluded that mesothelioma can spread in unusual and unpredictable ways, and that PET and endoscopic ultrasound are useful staging tools.

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 (two cases)
• Who was studied: Two men with metastatic pleural mesothelioma: a 55-year-old electrician who smoked, and a 60-year-old nonsmoking man. The authors are from the Lung Unit, Royal Marsden Hospital, Sutton, United Kingdom. No dates are given.
• Exposure: No asbestos exposure is described for the first patient beyond his job as an electrician. The second patient had no obvious history of asbestos exposure. No fiber types are named.
• Main results:
  • Case 1: PET/CT showed intense uptake in the left pleura and less intense uptake in the posterior mediastinum near the esophagus.
  • Case 1: mediastinoscopy found malignant mesothelioma in a mediastinal lymph node.
  • Case 1: endoscopic ultrasound showed a circumferential mass of the esophagus between 28 and 40 cm, with a maximal thickness of 23 mm. Biopsies of the esophageal wall confirmed malignant mesothelioma.
  • Case 1: increasing difficulty swallowing led to insertion of an esophageal stent.
  • Case 2: after six cycles of cisplatin and pemetrexed chemotherapy, the best response was stable disease.
  • Case 2: PET showed an unexpected intense focus of uptake (standard uptake value 4) in the celiac nodes, with no uptake in the mediastinum.
  • Case 2: fine-needle aspiration of an enlarged celiac node by endoscopic ultrasound confirmed metastatic mesothelioma, so extrapleural pneumonectomy was not considered feasible.
  • Case 2: a later PET scan, done before palliative decortication was considered, showed significant progression of both the primary disease and the nodes, including the celiac axis nodes.
• The authors' conclusion: The authors concluded that mesothelioma can metastasize in an unusual and unpredictable manner, including to the esophagus or the celiac axis nodes, and that PET and endoscopic ultrasound are useful staging tools for this cancer.

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: Ultrasound, Staging, Mesothelioma.

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• 18-FDG positron emission tomography in the evaluation of malignant pleural diseases - a pilot study — A. Carretta, C. Landoni, et al. (2000)
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