Curēus

About the journal

Publisher: Cureus, Inc
Published: 2009 to the present, United States
Language: English
ISSN: 2168-8184 (electronic)
Continues: Peer e Med
Its record in the NLM Catalog

2020s

A Rare Case of Pleural Deciduoid Mesothelioma With Histological, Immunohistochemical, Fluorescent In Situ Hybridization, and Ultrastructural Findings. H. Sonobe, R. Omote, E. Niman, et al. 2026;18(7):e113332. Case report PubMed · Publisher · Free full text

Abstract

Owing to the rarity of deciduoid mesotheliomas, few studies have reported detailed morphological analyses. Here, we report a case of deciduoid mesothelioma along with cytological, histological, immunohistochemical, fluorescent in situ hybridization (FISH), and electron microscopic findings. The patient was a 75-year-old man with a history of asbestos exposure. Computed tomography revealed multiple nodular shadows in the left pleura, and pleural effusion. Pleural effusion cytology revealed large epithelioid tumor cells with high nuclear atypia, suggesting epithelioid mesothelioma. A biopsy revealed that the tumor tissue consisted of sheets of highly atypical, large epithelioid cells of various sizes. Immunostaining revealed that the tumor cells were positive for mesothelial cell markers, including calretinin, Wilms tumor 1, and podoplanin, and showed loss of expression of BRCA1-associated protein 1, methylthioadenosine phosphorylase, and merlin/neurofibromatosis 2. Furthermore, cyclin-dependent kinase inhibitor 2A-FISH revealed a high frequency of homozygous deletions. Based on these findings, the tumor was diagnosed as a deciduoid mesothelioma. Reflecting the histological features, electron microscopy revealed that the tumor exhibited sheets of large epithelioid cells containing round nuclei with single or multiple distinct nucleoli, and intracytoplasmic intermediate filaments; however, microvillous structures were not evident. After the diagnosis was confirmed, the patient was treated with a combination of immune checkpoint inhibitors and chemotherapy. Long-term follow-up is required, although no disease progression was observed seven months after the initiation of therapy.

Copyright © 2026, Sonobe et al.
Beyond Asbestos: Malignant Pleural Mesothelioma Revealing Lynch Syndrome Through Mismatch Repair Deficiency. S. Vivanco, S. Vega, A. Muguruza, et al. 2026;18(1):e101550. Case report PubMed · Publisher · Free full text

Abstract

Lynch syndrome (LS) is a hereditary cancer predisposition condition. We report a rare case of malignant pleural mesothelioma occurring in a patient with this syndrome. The interplay between genetic susceptibility and environmental exposure remains underrecognized. We describe a case of a patient with multiple primary malignancies, including mesothelioma. A 70-year-old woman, with a history of endometrial, breast, and colorectal cancers, developed malignant pleural mesothelioma following 15 years of residence in a mining area with probable asbestos exposure. Immunohistochemistry revealed a loss of PMS2 expression, supporting a defect in MMR. This report documents an exceptional coexistence of malignant pleural mesothelioma and LS, suggesting that impaired DNA repair may lower the carcinogenic threshold for asbestos exposure. Clinicians should consider LS in patients with multiple or atypical malignancies, including mesothelioma, and recommend comprehensive MMR testing and genetic counseling for at-risk relatives.

Copyright © 2026, Vivanco et al.
Clinical Factors Influencing Spontaneous Pleurodesis Success in Malignant Pleural Effusion in Patients With Indwelling Pleural Catheter. H.G. Kamil, A. AbiMusaAsa'ari, M. Asaduzzaman, et al. 2026;18(1):e100854. PubMed · Publisher · Free full text

Abstract

Background Indwelling pleural catheters (IPCs) provide effective palliation for malignant pleural effusion (MPE) and may induce spontaneous pleurodesis (SP). However, risk factors causing transudative effusion, such as hypoalbuminemia, congestive cardiac failure (CCF), and renal failure (RF), may reduce pleurodesis success. Evidence on the impact of these comorbidities in MPE patients undergoing IPC placement remains limited. Objective To evaluate the impact of hypoalbuminemia, CCF and RF on successful SP in MPE. Methods A retrospective single-centre study was conducted in a tertiary care hospital on all patients with cytologically or radiologically confirmed MPE who underwent IPC placement between January 2020 and December 2024. SP was defined as catheter removal and no fluid recurrence up to 90 days. Demographic data, albumin levels, comorbidities, cancer type, and active anti-cancer therapy were compared between the SP and non-pleurodesis (NP) group. Results Among 110 patients (mean age 70 years; 54/110, 49% male), SP occurred in 30/110 (27%). Mean serum albumin was higher in the SP group (25.2 vs 20.4 g/L, p=0.001). CCF was present in 3/30 (10%) SP group compared with 15/80 (19%) NP group (p=0.005), while RF occurred only in the NP group, 4/80 (5%). Systemic anti-cancer therapy was associated with higher SP rates (26/30, 87% vs 32/80, 40%; p<0.001). SP varied by cancer type, highest in mesothelioma (6/12, 50%) and absent in small cell lung cancer (0/3, 0%). Conclusions Higher albumin, active anti-cancer therapy, and absence of multiple comorbidities causing transudative effusion predict successful SP. Identifying these factors may improve patient selection and procedural outcomes.

Copyright © 2026, Kamil et al.
Diffuse Pleural Mesothelioma Initially Presenting as Cervical Lymphadenopathy: A Report of a Rare Case. K. Saha, S. Ghosh, S. Poddar. 2026;18(8):e114875. Case report PubMed · Publisher · Free full text

Abstract

Diffuse mesothelioma is a rare malignant tumor arising from mesothelial cells, showing diffuse involvement of the pleura and having a strong association with asbestos exposure. Cervical lymphadenopathy as the initial presentation of pleural mesothelioma is very unusual to date. We report here such a rare case of diffuse pleural mesothelioma in a 42-year-old male patient who primarily presented with left-sided lower cervical lymphadenopathy. Fine-needle aspiration cytology (FNAC) from the lymph nodes demonstrated hypercellular smears with polygonal epithelioid cells arranged mostly as singly scattered cells, loosely cohesive clusters, monolayered pavement-like sheets, and spheroid groups. Many cells displayed binucleation, multilobed nuclei, cytoplasmic vacuoles, fuzzy cell borders, and mitotic figures. Guided tru-cut biopsy from the lymph node revealed diffuse sheets of atypical epithelioid cells with abundant eosinophilic cytoplasm, with large nuclei and prominent nucleoli in places. The tumor cells were immunopositive for pancytokeratin, CK5/6, EMA, Calretinin, D2-40, and WT1 while negative for all other relevant markers. Diffuse, irregular thickening and nodularity of left-sided pleura and mediastinal lymphadenopathy were identified on contrast-enhanced computed tomography (CECT). It is very important to consider metastatic pleural mesothelioma in the differential diagnosis of lymph node mass on FNAC, especially in the cervical region, to avoid misdiagnosis or delay in the correct diagnosis of this strikingly unusual presentation.

Copyright © 2026, Saha et al.
Epigenetic Drivers of Pulmonary Hypertension: Environment Meets Genome. W.N. Whitley, R.M. Millis. 2026;18(2):e104241. Review PubMed · Publisher · Free full text

Abstract

Pulmonary hypertension (PH) is a progressive disease in which the pulmonary arteries thicken and narrow, raising pulmonary vascular resistance (PVR) and eventually straining the right ventricle. Known gene mutations explain only a minority of cases and often do not account for why the disease starts, worsens, or varies so widely between patients. Growing evidence suggests that epigenetic changes, chemical marks on DNA and its packaging that alter how genes are used without changing the DNA sequence, help explain this gap. These changes, including DNA methylation, histone modification, and non-coding RNAs, can be triggered by common exposures and disease states, and they can produce lasting shifts in vascular, immune, and metabolic pathways. This narrative review synthesizes current data showing how intrinsic stresses (mitochondrial dysfunction, oxidative stress, and cancer-like metabolic reprogramming) interact with extrinsic and often modifiable factors. Obesity, cigarette smoke, asbestos exposure, chronic hypoxia, and systemic inflammation drive PH through epigenetic reprogramming. We highlight major molecular hubs implicated across studies, including bone morphogenetic factor receptor 2 (BMPR2), NOTCH3, endothelin-1 (ET-1), transforming growth factor‑β (TGF-β), interleukin‑6 (IL-6), and CCL5, and we summarize emerging therapeutic approaches aimed at epigenetic regulators and microRNA networks. This narrative review was not conducted under Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and does not constitute a formal systematic review. The information in this review provides a practical framework for clinicians and researchers to improve risk assessments, to employ biomarkers, and to develop therapies that go beyond vasodilation to address upstream drivers of pulmonary arterial remodeling. This framework may also serve as a model for other difficult-to-treat diseases in which incomplete genetic explanations and limited attention to environmental exposures have slowed progress in prevention, early detection, and personalized treatment.

Copyright © 2026, Whitley et al.
Extensive Bilateral Pleural Plaques: A Cadaveric Case Study. M. Rajaram-Gilkes, R. Frank. 2026;18(4):e107079. Case report PubMed · Publisher · Free full text

Abstract

Pleural plaques are the most common manifestation of asbestos-related pleural disease and function primarily as markers of prior exposure rather than as direct causes of clinically significant symptoms, often appearing several decades after initial contact. They are typically asymptomatic and discovered incidentally on imaging studies or at autopsy, and they initially present as small, well-circumscribed lesions along the parietal pleura, most commonly over the rib surfaces while sparing the intercostal spaces. They may progressively enlarge, coalesce, and undergo calcification over time. Although asbestos exposure is the primary etiology, pleural plaques and pleural calcifications may also arise from prior infections such as tuberculosis or empyema, trauma, hemothorax, end-stage renal disease, or chronic inflammatory and autoimmune conditions such as systemic lupus erythematosus and rheumatoid arthritis, and in some instances they may be idiopathic. Additionally, pleural plaques can be associated with mesothelioma. When extensive, pleural plaques may restrict lung expansion, leading to exertional dyspnea that can progress to dyspnea at rest and, in advanced cases, respiratory insufficiency. During routine cadaveric dissections conducted as part of the preclinical medical curriculum at the Geisinger Commonwealth School of Medicine (GCSOM), Scranton, Pennsylvania, extensive bilateral pleural thickening, predominantly involving the diaphragmatic pleura, was observed in an 89-year-old male cadaver. After the opening of the thoracic cage and removal of the lungs and heart, pleural plaques were identified, examined, and measured. The pleural cavities were relatively free, with minimal adhesions involving the bases of both lungs in the diaphragmatic regions, and any evidence of pleural effusion was likely lost during the dissection process. Small, isolated pleural plaques were also noted along the anterior aspect of the right parietal costal pleura. A small, firm mass was palpated within the anterior border of the right upper lobe. Tissue specimens were obtained from the pleural plaques of the anterior chest wall and diaphragmatic pleura, as well as from the pulmonary mass, for histopathological evaluation. Microscopic examination demonstrated abundant fibrocollagenous thickening of the parietal pleura with adjacent fibro-adipose connective tissue and associated inflammation, without evidence of asbestos fibers. Histological analysis of the pulmonary mass was consistent with acute pneumonia. Pleural plaques are frequently encountered as incidental findings on chest radiographs and computed tomography scans in elderly individuals, particularly those with prior asbestos exposure, yet many such findings remain clinically uninvestigated during life. Establishing an etiology in cadaveric cases poses a significant challenge due to the absence of reliable occupational, environmental, and medical histories. While the histopathologic features observed in this case are consistent with previously published descriptions, the gross anatomical documentation of extensive pleural plaques predominantly confined to the diaphragmatic pleura, including detailed measurements, texture, and imaging, has not been previously reported. Dissemination of these findings aims to enrich anatomical and pathological educational resources, support future research, and deepen the understanding of pleural pathology encountered during cadaveric dissection and medical education.

Copyright © 2026, Rajaram-Gilkes et al.
First-Line Nivolumab Plus Ipilimumab in Inoperable Epithelioid Malignant Pleural Mesothelioma: Real-World Experience From an Indian Tertiary Care Center. A. Shah, A. Agarwal, V. Rajpuria, et al. 2026;18(7):e113313. PubMed · Publisher · Free full text

Abstract

Background Malignant pleural mesothelioma (MPM) is a highly aggressive, rare malignancy with poor prognosis. Standard frontline treatments have traditionally relied on platinum-based chemotherapy doublets, which offer limited long-term survival benefit. This study evaluates the efficacy, clinical-demographic profile, and safety of first-line dual checkpoint inhibition using nivolumab and ipilimumab in patients with inoperable MPM within an Indian tertiary care setting. Materials and methods A retrospective study was conducted from January 2021 to August 2023 at a single tertiary care center in India. Fifteen patients aged ≥ 18 years with histologically confirmed, previously untreated, metastatic/inoperable epithelioid MPM and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0-2 were included. Patients received nivolumab (240 mg intravenously every two weeks) combined with ipilimumab (1 mg/kg intravenously every six weeks) until disease progression or unacceptable toxicity. Response assessments were performed using positron emission tomography (PET) scans at three months using modified RECIST criteria. The primary objective of this study was to evaluate the real-world overall survival (OS), including median OS and one-year OS and safety profile. Secondary objectives included the assessment of objective response rate (ORR) at first reassessment using modified RECIST criteria and the characterization of the clinical-demographic landscape of this population and toxicity profile. Results The cohort consisted of 15 patients (median age: 65 years, range: 40-76), comprising eight males (54%) and seven females (46%). The median number of administered treatment cycles was seven for nivolumab (range: 2-26) and three for ipilimumab (range: 1-10). At the three-month evaluation, nine patients (60%) achieved a partial response, maintaining a stable response through the 12-month follow-up. Six patients (40%) experienced disease progression after the initial assessment, experiencing an OS of less than nine months. At the 12-month endpoint, the one-year OS rate was 60%, with nine patients alive and continuing immunotherapy. Treatment-related adverse events (TRAEs) occurred in 12 patients (80%), with Grade 3 or 4 TRAEs reported in four patients (26%). The most common all-grade TRAEs were diarrhea (26%), hypothyroidism/thyroiditis (20%), and rash (13%). Grade 3/4 toxicities included hepatitis (6%) and severe diarrhea (13%). Conclusion First-line treatment with combined nivolumab and ipilimumab demonstrates promising clinical efficacy, durable responses, and a manageable safety profile in Indian patients presenting with inoperable epithelioid MPM. These real-world outcomes align closely with global clinical trial benchmarks, supporting a chemotherapy-free dual-immunotherapy strategy. Larger prospective randomized trials are needed to validate these findings within the regional population.

Copyright © 2026, Shah et al.
Giant Omental Lymphangioma Presenting With Abdominal Pain and Intra-Cystic Hemorrhage in an Adult: A Case Report. R. Hashizume, H. Imai, A. Hayashi, et al. 2026;18(7):e113140. Case report PubMed · Publisher · Free full text

Abstract

Lymphangiomas are benign tumors of lymphatic origin that usually arise in the neck and axilla during childhood; intra-abdominal involvement is rare, and an omental origin in an adult is exceptional. Because imaging features are non-specific, preoperative diagnosis is difficult, and intra-cystic hemorrhage can transform an otherwise indolent lesion into a surgical emergency. We report the case of a 46-year-old man who presented with sudden right lower-quadrant abdominal pain and a soft, mobile, tender right-abdominal mass. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed a giant (approximately 25 cm), thin-walled, multilocular cystic mass containing a hematoma, with enhancement of the cyst walls but not the internal component, and feeding vessels arising from the greater omentum. Tumor markers were normal apart from mildly elevated carbohydrate antigen (CA) 125. Because malignancy could not be excluded, open resection was performed; the tumor arose from the greater omentum without invading adjacent organs and was completely excised. Histopathology confirmed an omental lymphangioma. The acute presentation was attributable to intra-cystic hemorrhage with a focal, self-sealed rupture superimposed on an indolent lesion. Because cross-sectional imaging cannot reliably distinguish lymphangioma from other cystic lesions, an immunohistochemical panel combining lymphatic and vascular endothelial markers (D2-40, CD31) with mesothelial markers (calretinin, WT-1) was decisive in excluding a mesothelial-lined cyst and mesothelioma. Omental lymphangioma should be considered in the differential diagnosis of a giant intra-abdominal multilocular cystic mass in adults, including those presenting acutely, and complete excision is both diagnostic and curative.

Copyright © 2026, Hashizume et al.
Haemophagocytic Lymphohistiocytosis Following Ipilimumab and Nivolumab in Malignant Pleural Mesothelioma: A Case Report. C.M. Than, M. Moe, Y. Win, et al. 2026;18(7):e112768. Case report PubMed · Publisher · Free full text

Abstract

Haemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal hyperinflammatory syndrome caused by dysregulated immune activation. With the increasing use of immune checkpoint inhibitors (ICIs), HLH has emerged as an uncommon but serious immune-related adverse event. An 84-year-old woman with malignant pleural mesothelioma developed fever, rigours, collapse, confusion, worsening cytopenias, cholestatic liver dysfunction, marked hyperferritinaemia, hypertriglyceridaemia, and hypofibrinogenaemia after treatment with ipilimumab and nivolumab. Extensive microbiological investigations were negative. She fulfilled five HLH-2004 diagnostic criteria, supporting a diagnosis of probable ICI-associated HLH. Dexamethasone was started, with rapid clinical and biochemical improvement. This case highlights the importance of recognising HLH as a rare but life-threatening complication of checkpoint inhibitor therapy and supports early corticosteroid treatment, once infection has been reasonably excluded.

Copyright © 2026, Than et al.
Localized Epithelioid Peritoneal Mesothelioma: A Rare Mimicker of Gynecological Malignancy. F. Carvalho, D. Pereira, T.M. Cunha. 2026;18(7):e112299. Case report PubMed · Publisher · Free full text

Abstract

Localized epithelioid peritoneal mesothelioma (LEPM) is a rare variant of peritoneal mesothelioma that presents as a solitary, circumscribed mass rather than with the diffuse serosal spread that characterizes the far more common diffuse form. Because it may arise in the pelvis and be accompanied by ascites and a mildly elevated carbohydrate antigen (CA)-125 level, it is readily mistaken for a gynecological or primary peritoneal malignancy. Although it is generally regarded as less aggressive than the diffuse form, its clinical behavior can be unpredictable. We report the case of a 76-year-old woman in whom a 5 cm pelvic mass was detected incidentally on transvaginal ultrasound and was initially suspected to be a gynecological malignancy. Preoperative MRI demonstrated clear cleavage planes between the mass and the uterus and left ovary, indicating a non-gynecological origin, and surgery confirmed the presence of a tumor on the antimesenteric border of the small bowel. Histopathology, supported by a targeted immunohistochemical panel (showing calretinin, WT1, D2-40, and CK7 positivity and loss of BAP1), established the diagnosis of LEPM. Despite an apparently localized presentation and complete resection, early peritoneal recurrence developed on follow-up imaging, prompting adjuvant systemic therapy and cytoreductive surgery (CRS). This report underscores that LEPM should be considered in the differential diagnosis of a solitary pelvic mass, highlights the importance of cross-sectional imaging combined with a specific immunohistochemical panel for distinguishing it from gynecological tumors and gastrointestinal stromal tumor (GIST), and emphasizes the need for close follow-up even when the disease appears localized.

Copyright © 2026, Carvalho et al.
Long-Term Disease Control With Second-Line Nivolumab Monotherapy in Malignant Pleural Mesothelioma: A Case Report. S. Otsuka, K. Hiraoka, N. Iwashiro. 2026;18(6):e110026. Case report PubMed · Publisher · Free full text

Abstract

Nivolumab is recommended as second-line therapy for malignant pleural mesothelioma (MPM); however, durable responses remain uncommon. In addition, combination immune checkpoint inhibitors are frequently limited by immune-related adverse events. A 72-year-old man with epithelioid MPM underwent extrapleural pneumonectomy followed by adjuvant chemotherapy with cisplatin and pemetrexed. After recurrence, additional platinum-based chemotherapy was administered, followed by disease progression. Nivolumab monotherapy was then initiated as second-line therapy, resulting in a sustained radiological response. The patient has maintained progression-free survival for 24 months without severe immune-related adverse events, allowing long-term treatment continuation. This case highlights that nivolumab monotherapy may achieve durable disease control with a favorable safety profile in selected patients with MPM.

Copyright © 2026, Otsuka et al.
Malignant Mesothelioma Diagnosed From a Spermatic Cord Lesion After Inconclusive Thoracoscopy: A Case With Concomitant Pleural and Peritoneal Involvement. N. Hamazaki, S. Fujimoto, H. Jinno, et al. 2026;18(5):e109236. Case report PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma typically arises in the pleura or peritoneum; however, involvement of the spermatic cord is extremely rare. Here, we report a case in which a definitive diagnosis was achieved through evaluation of a spermatic cord lesion after an inconclusive thoracoscopic biopsy. A 69-year-old man presented with dyspnea and right inguinal swelling. Imaging revealed a right pleural effusion, peritoneal nodules, and increased fluorodeoxyglucose uptake in the diaphragm and bilateral inguinal canals. Thoracoscopy under local anesthesia revealed a diaphragmatic mass; however, the biopsy specimen was insufficient for a definitive diagnosis. Subsequent right orchiectomy and laparoscopic examination revealed disseminated peritoneal nodules and a spermatic cord tumor. Histopathological examination of spermatic cord specimens showed invasive epithelioid malignant mesothelioma. This case highlights the limitations of small thoracoscopic biopsy specimens and underscores the importance of selecting the appropriate biopsy sites and techniques when mesothelioma is suspected.

Copyright © 2026, Hamazaki et al.
Metastatic Malignant Mesothelioma of the Tunica Vaginalis Testis Treated With Sequential Immunotherapy, Chemotherapy, and Radiotherapy With Prolonged Disease Stabilisation: A Case Report. N. Mathiyalagan, S. Khan, A. Pascoe, et al. 2026;18(8):e114824. Case report PubMed · Publisher · Free full text

Abstract

We report the case of a 77-year-old man with no known history of asbestos exposure who presented with a right-sided hydrocele. Histopathological analysis following hydrocele repair identified epithelioid-type malignant mesothelioma of the tunica vaginalis testis. Staging investigations confirmed disease confined to the hemiscrotum, and definitive management included right inguinal orchidectomy, excision of the spermatic cord to the deep inguinal ring, and wide local excision of the involved scrotal tissue. Initial surveillance imaging showed no recurrence, but nodal metastatic disease subsequently developed. The patient received first-line immunotherapy with ipilimumab and nivolumab but experienced progressive nodal disease. Second-line carboplatin-pemetrexed chemotherapy resulted in a mixed radiological response after three cycles, with para-aortic nodal oligoprogression managed using palliative radiotherapy. Following palliative radiotherapy and three further cycles of carboplatin-pemetrexed chemotherapy, imaging demonstrated a partial radiological response. Further surveillance revealed thoracic and intra-abdominal nodal progression, which was managed with a second course of palliative radiotherapy and was followed by renewed disease stabilisation. Subsequent progression involved pulmonary and intra-abdominal nodal disease, prompting initiation of third-line oral vinorelbine. Imaging demonstrated predominantly stable disease with isolated para-aortic oligoprogression, which was treated with a third course of palliative radiotherapy, after which vinorelbine was resumed. Approximately four years after diagnosis, the patient remained clinically stable, with an Eastern Cooperative Oncology Group (ECOG) performance status of 1, and was awaiting interval imaging to assess radiological disease status. This case illustrates that an individualised sequential treatment strategy incorporating immunotherapy, chemotherapy, and palliative radiotherapy to sites of oligoprogression may be associated with periods of disease control in metastatic malignant mesothelioma of the tunica vaginalis testis.

Copyright © 2026, Mathiyalagan et al.
Nephrotic Syndrome During Ipilimumab Plus Nivolumab Therapy for Sarcomatoid Malignant Pleural Mesothelioma: A Case Report of Nivolumab Rechallenge Without Recurrence of Nephrotic Syndrome. K. Shimaya, J. Ota, T. Yasuda, et al. 2026;18(9):e115962. Case report PubMed · Publisher · Free full text

Abstract

Immune checkpoint inhibitor (ICI)-associated nephrotic syndrome is a rare immune-related adverse event. When it occurs during combination ICI therapy, identifying the causative agent and determining an appropriate strategy for subsequent ICI rechallenge can be clinically challenging. A 67-year-old man with unresectable sarcomatoid malignant pleural mesothelioma received combination therapy with ipilimumab and nivolumab, resulting in tumor shrinkage. Approximately four months after treatment initiation, he developed nephrotic syndrome characterized by severe proteinuria, hypoalbuminemia, and bilateral pleural effusions. Both ICIs were discontinued, and prednisolone therapy resulted in improvement of nephrotic syndrome. However, tumor regrowth was observed during corticosteroid tapering, and nivolumab monotherapy was selected for rechallenge. Nephrotic syndrome did not recur after nivolumab rechallenge, which was administered with concurrent prednisolone at a tapering dose. This pattern raises the possibility that ipilimumab alone or the combination of ipilimumab and nivolumab contributed to the development of nephrotic syndrome. This case provides clinical insight into the potential contribution of individual ICIs to ICI-associated nephrotic syndrome and into selective ICI rechallenge as a subsequent treatment strategy.

Copyright © 2026, Shimaya et al.
Pseudomesotheliomatous Adenocarcinoma Presenting as Hemothorax and Mimicking Mesothelioma: A Case Study. M. Ijim, S. Keddabi, C. Rachid, et al. 2026;18(4):e106699. Case report PubMed · Publisher · Free full text

Abstract

Pseudomesotheliomatous carcinoma of the lung (PCL) is a rare and aggressive subtype of peripheral lung adenocarcinoma characterized by diffuse pleural involvement, clinically and radiologically mimicking malignant pleural mesothelioma. We report the case of a 53-year-old Moroccan man presenting with hemothorax, a rare initial manifestation of PCL. Radiological imaging revealed nodular pleural thickening with loculated pleural effusion, while histopathological and immunohistochemical analyses confirmed pseudomesotheliomatous lung adenocarcinoma, distinguished by positive epithelial markers (TTF-1, Napsin A) and negative mesothelial markers. Despite initial management with chest drainage and systemic chemotherapy, the prognosis remained poor, consistent with the aggressive nature of this disease. This case highlights the diagnostic challenge posed by PCL due to its clinical and radiological resemblance to mesothelioma and underscores the essential role of immunohistochemistry in establishing an accurate diagnosis. Increased awareness of this entity is critical for appropriate patient management and guiding future therapeutic strategies.

Copyright © 2026, IJIM et al.
Rapid, Recurrent Unilateral Pleural Effusion Presenting as Cryptococcus Infection in a Non-immunocompromised Host. M. Gacutan, K. Bhatti, A. Jordan, et al. 2026;18(9):e115732. Case report PubMed · Publisher · Free full text

Abstract

Cryptococcus neoformans infection presenting as a rapidly reaccumulating unilateral pleural effusion in a non-immunocompromised host is a rare presentation of pulmonary cryptococcal disease. We present a rare case of recurrent unilateral pleural effusion as the initial presentation of cryptococcal disease in an immunocompetent patient. An 85-year-old male with a past medical history of hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease stage IIIb, and coronary artery disease s/p stent placement in the second obtuse marginal branch of the circumflex artery presented to the emergency department with dyspnea on exertion and an unintentional 30-pound weight loss over two to three months. His prior occupation included work in a tire factory; he denied exposure to asbestos. He chewed tobacco and had a dog. A chest radiograph showed a large right-sided pleural effusion. He had undergone repeated thoracentesis and pigtail chest tube placements over four hospital admissions. Review of the initial cytology, extensive serology, pleural fluid analysis, Gram stain, culture, HIV testing, and adenosine deaminase testing was negative. Given the recurrent hospitalizations and reaccumulation of the right pleural effusion, the decision was made to proceed with endobronchial ultrasound, which demonstrated lymphocytosis without evidence of malignancy. Bronchoalveolar lavage grew 100 colonies of Cryptococcus neoformans. The patient underwent lumbar puncture with an opening pressure of 37 and a negative cryptococcal antigen. He was started on fluconazole 400 mg daily upon discharge, with a suspected treatment course of 12 months and close outpatient pulmonology follow-up. This report highlights a rare initial presentation of Cryptococcus neoformans manifesting as recurrent unilateral pleural effusion.

Copyright © 2026, Gacutan et al.
Recurrent Hydropneumothorax as an Initial Presentation of Malignant Pleural Mesothelioma: Diagnostic Challenges and the Evolving Role of Pleural Fluid Cytology. A. Goedseels, E. De Droogh, P. Hollering, et al. 2026;18(8):e114913. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive pleural malignancy typically associated with asbestos exposure and characterized by a prolonged latency period, often resulting in delayed diagnosis. Although pleural effusion and pleural thickening are common presentations, recurrent hydropneumothorax is an uncommon initial manifestation. Given the broad differential diagnosis of hydropneumothorax, recurrent cases require a thorough clinical and occupational history and appropriate diagnostic evaluation to avoid overlooking an underlying MPM. This case report describes an uncommon initial presentation of MPM and discusses when it is necessary to obtain a tissue sample to confirm the diagnosis.

Copyright © 2026, Goedseels et al.
A Case of Primary Malignant Peritoneal Mesothelioma. L. Betancourt, J. Wallace, E. Sugarman, et al. 2025;17(10):e93864. Case report PubMed · Publisher · Free full text

Abstract

Primary malignant mesothelioma (MPM) is a rare malignancy that arises from the epithelial cells that line visceral cavities. The primary pleural presentation is known as the most commonly seen presentation and is best recognized clinically. Less commonly, mesothelioma can arise from epithelial cells lining other visceral cavities, including the peritoneum and pericardium. Primary peritoneal presentations are often difficult to diagnose due to vague symptoms such as abdominal distention, anorexia, and diffuse pain. These symptoms overlap with those of many more common gastrointestinal conditions, often leading to delayed diagnosis. We report a male in his 40s with a past medical history of hypertension and diabetes mellitus type 2 who presented to the emergency room with non-specific abdominal complaints. He had a history of longstanding work on demolition sites. Treatment was initiated following studies that tested positive for H. pylori infection. A CT scan of the abdomen revealed nodular fat stranding of the omentum, with several confluent peritoneal nodules and small-volume ascites. An omental biopsy showed tumor cells positive for markers indicative of epithelioid-type malignant mesothelioma, with the peritoneum identified as the primary site. A key piece of this patient's case was long-standing exposure to demolition sites and asbestos. Asbestos exposure is a well-documented risk factor for the development of mesothelioma. This history was obtained but did not aid in guiding diagnostic practices due to overlapping symptomatology. The discovery of an H. pylori infection may have delayed the diagnosis of primary malignant peritoneal mesothelioma (PMPM) and its appropriate treatment, as H. pylori is a much more common condition.

Copyright © 2025, Betancourt et al.
A Descriptive Summary of Tumor-Associated MUC1 (TA-MUC1) Expression in Epithelial Malignancies: A Systematic Review of Case Reports and Case Series. R. Ohta, K. Nishikawa, K. Tanaka, et al. 2025;17(10):e95636. Review PubMed · Publisher · Free full text

Abstract

Tumor-associated MUC1 (TA-MUC1) is a hypoglycosylated variant of MUC1 that is aberrantly expressed in many epithelial malignancies. Its limited presence in normal tissues and immunogenic properties suggest potential as a target for antibody-drug conjugates and cancer immunotherapy. However, the clinicopathological spectrum and therapeutic context of TA-MUC1-positive tumors remain insufficiently characterized. We conducted a systematic review of case reports and case series describing immunohistochemically confirmed TA-MUC1 expression in malignant tumors. A total of 73 individual cases from 61 publications were included. Data extraction covered demographics, tumor features, TA-MUC1 expression, treatments, outcomes, and associated biomarkers. TA-MUC1 expression was identified across a wide range of tumor types, most frequently in gastrointestinal, breast, and gynecologic cancers, but also in less common malignancies such as sarcomatoid carcinoma and pleural mesothelioma. Expression was frequently retained in metastatic sites. Immunohistochemical staining varied in intensity and methodology, with strong expression often associated with recurrence or aggressive clinical behavior. Multimodal therapy was commonly reported. Across cases, progression-free survival (PFS) was available in 56 of 73 (76.7%) cases. Among these, 47 of 56 (83.9%) had a documented progression event, whereas nine of 56 (16.1%) were censored (progression-free at last follow-up). The median PFS was 12.0 months (IQR 6.0-19.5; range 0.0-118.0 months). Overall survival (OS) was available in 56 of 73 (76.7%) cases. Among these, 14 of 56 (25.0%) deaths were reported, and 42 of 56 (75.0%) observations were censored (alive at last follow-up). The median OS was 12.0 months (IQR 8.0-26.0; range 0.5-118.0 months). Co-expression with biomarkers such as programmed death-ligand 1 (PD-L1) and human epidermal growth factor receptor 2 (HER2) was occasionally observed. These findings demonstrate that TA-MUC1 has been documented in diverse malignancies, including rare and metastatic presentations. The descriptive evidence supports its potential relevance as a therapeutic target and highlights the need for standardized evaluation and prospective studies.

Copyright © 2025, Ohta et al.
A Rare Case of Sarcomatoid-Type Localized Pleural Mesothelioma Derived From Visceral Pleura. T. Kosaka, S. Nakazawa, R. Ushikubo, et al. 2025;17(3):e81473. Case report PubMed · Publisher · Free full text

Abstract

A man in his 80s presented with shortness of breath. Chest CT scan showed pleural effusion and a mass in the right lower lobe. He had high inflammatory reaction and was diagnosed as having pulmonary suppuration with empyema. After three weeks of antibiotic treatment, the lesion grew and he was referred to our department for surgical intervention. A complete resection of the right lower lobe was planned to control infection. Intraoperative findings showed that the lower lobe became a large mass and was judged unresectable. The procedure was converted to drainage of the abscess cavity. Pathological examination, combined with clinical and radiological findings, led to the diagnosis of localized sarcoma-type malignant pleural mesothelioma. Localized malignant pleural mesothelioma is a rare disease and most cases have been reported as epithelial type, deriving from the parietal pleura. Our case is quite rare because it was a sarcoma-type, deriving from the visceral pleura.

Copyright © 2025, Kosaka et al.
A Rare Clinical Presentation of Malignant Pleural Mesothelioma With Central Nervous System Metastases: A Case Report. M.A. Miernik-Skrzypczak, E. Misztela-Lisiecka, P. Nowakowski, et al. 2025;17(9):e92297. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer arising from the pleural mesothelial cells, most often associated with long-term asbestos exposure. Symptoms are typically nonspecific, including shortness of breath, chest pain, and pleural effusion, which may delay diagnosis. We report a case of a 63-year-old woman with bilateral MPM and subsequent central nervous system (CNS) metastases. She received systemic chemotherapy with cisplatin and pemetrexed, achieving a partial radiological response. Several months after completing treatment, she developed neurological symptoms. Imaging revealed multiple CNS metastases. Palliative radiotherapy provided temporary control; however, her condition progressively deteriorated. This case illustrates an unusual presentation and metastatic pattern of MPM in a female patient, highlighting diagnostic and therapeutic challenges, as well as the aggressive nature of the disease despite palliative care.

Copyright © 2025, Miernik-Skrzypczak et al.
A Retrospective Epidemiological Study of Mesothelioma in the United States (1999-2020) Based on Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Data. Y. Guntupalli, B. Vejandla, T. Evans, et al. 2025;17(10):e95811. PubMed · Publisher · Free full text

Abstract

Introduction: Mesothelioma is a rare malignancy of the serous membranes, most commonly the pleura. Variations and demographic trends in mesothelioma incidence form the basis of this study.

Methodology: A retrospective study was conducted on August 30, 2024, using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. The study analyzed age, gender, and race of mortality among mesothelioma patients in the United States from 1999 to 2020.

Results: There was a significant increase in the incidence of mesothelioma from 1999, peaking in 2011, followed by a gradual decline. Incidence was higher among individuals aged ≥75 years, men, and the White population.

Conclusions: This study highlights the higher incidence of mesothelioma in individuals aged ≥75 years compared to younger age groups, in men compared to women, and in White populations compared to other races. Overall, the incidence increased from 1999 to 2010, peaked in 2011, and declined thereafter through 2020.

Copyright © 2025, Guntupalli et al.
Adenomatoid Tumor of the Pericardium: A Case Report and Literature Review. M.H. Abdelhammed, N.S. Ramani. 2025;17(4):e81734. Case report PubMed · Publisher · Free full text

Abstract

Adenomatoid tumors (ATs) are rare benign neoplasms of mesothelial origin, commonly found in the genital tracts but occasionally reported in extragenital locations, including the thoracic cavity. We describe the second case of a pericardial AT in a 65-year-old male with multiple comorbidities, including end-stage renal disease, diabetes mellitus, and heart failure. A small pericardial nodule was incidentally discovered during coronary artery bypass graft surgery without any clinical evidence of pericardial thickening. Histopathologic evaluation showed a well-circumscribed nodule with solid nests of epithelioid to spindled cells with bland cytology within a fibrous stroma. Immunohistochemical analysis demonstrated strong and diffuse positivity for calretinin, D2-40, WT-1, and pan-cytokeratin, confirming mesothelial differentiation. Markers of epithelial origin like MOC-31 and BerEp4 were negative, excluding the possibility of carcinomas of unknown origin. BAP1 nuclear expression was retained, and fluorescence in situ hybridization (FISH) for p16 (CDKN2A) was negative for homozygous deletion, distinguishing the lesion from mesothelioma. Besides contributing to the limited body of knowledge on extragenital and thoracic ATs, this case adds to the limited number of reports on pericardial ATs, providing an understanding of the rare occurrence of these tumors arising from the pericardium.

Copyright © 2025, Abdelhammed et al.
Apical Malignant Pleural Mesothelioma Presenting as Horner's Syndrome: A Case Report. S. Mankal, C. Jacobs. 2025;17(10):e94484. Case report PubMed · Publisher · Free full text

Abstract

Horner's syndrome is a well-recognized presentation of apical lung tumors, though rarely associated with malignant pleural mesothelioma (MPM), with only a few cases documented. We report the case of an 82-year-old man with persistent right-sided chest pain who developed unilateral right-sided ptosis, miosis and a sunken appearance to the eye, in the context of known asbestos exposure. Initial chest radiograph was reported as normal; however, subsequent computed tomography revealed an irregular right apical pleural mass measuring 7.0×4.3×7.5 cm. Biopsy with immunohistochemistry confirmed sarcomatoid MPM. This case report illustrates apical MPM mimicking Pancoast syndrome through compression of the upper thoracic sympathetic chain, resulting in preganglionic Horner's syndrome characterized by unilateral ptosis, miosis and anhidrosis ipsilateral to the lesion. In patients with known asbestos exposure, persistent respiratory symptoms should prompt a thorough investigation for MPM. The presence of preganglionic Horner's syndrome alone, or in combination with brachial plexopathy (arm pain, paresthesia or weakness, shoulder pain, or chest pain) - termed Pancoast syndrome, should heighten clinical suspicion of apical MPM. Cross-sectional imaging should be considered in all cases with a high index of suspicion, even if initial radiographs appear normal. Early recognition may facilitate timely diagnosis. This report contributes valuable insight to the limited literature documenting the association between apical MPM and pre-ganglionic Horner's syndrome.

Copyright © 2025, Mankal et al.
Asbestos-Related Pulmonary Spindle Cell Carcinoma Presenting With Ileus: An Autopsy Case Report. K. Yamane, S. Moriyama, S. Ishikawa, et al. 2025;17(5):e83634. Case report PubMed · Publisher · Free full text

Abstract

We present the case of an 84-year-old male with a history of occupational asbestos exposure who initially developed ileus, which was later found to be related to an aggressive pulmonary malignancy. Imaging revealed extensive pleural thickening, peritoneal dissemination, and ileus. Postmortem examination confirmed a diagnosis of pulmonary spindle cell carcinoma (PSCC), supported by immunohistochemical analysis and the presence of numerous asbestos bodies in lung tissue. This case highlights the diagnostic complexity of rare thoracic malignancies, particularly when presenting with atypical features such as ileus. Further investigation is warranted to better understand asbestos-related carcinogenesis and to improve diagnostic and treatment approaches.

Copyright © 2025, Yamane et al.
Chronic Inflammatory Tunica Vaginalis Masses With Haemorrhagic Hydrocoele Fluid: A Rare Finding in a Patient With Vaginal Hydrocoele. P.E. Ngwu, I.E. Ihedoro, C.P. Ohiarah. 2025;17(10):e94247. Case report PubMed · Publisher · Free full text

Abstract

Tunica vaginalis masses are a part of the paratesticular masses, which are rare. The combination of the finding of tunica vaginalis masses with haemorrhagic hydrocele fluid will make for a high index of suspicion of a mitotic lesion. Most reported cases of tunica vaginalis masses are mesotheliomas, most of which present as painless scrotal swellings with hydrocele. Our patient is a 58-year-old man who presented with a painless swelling involving the left hemiscrotum, in which the histopathological findings following surgery turned out to be chronic inflammatory tunica vaginalis masses. Chronic Inflammatory tunica vaginalis masses, even though rare, should be borne in mind when thinking of possible differential diagnosis in a patient with painless scrotal swelling.

Copyright © 2025, Ngwu et al.
Disseminated Peritoneal Leiomyomatosis: Two Rare Cases With Diagnostic Mimics and a Novel Central Nervous System Disease Association. P.S. Renavikar, T.J. Auen, S.M. Lele, et al. 2025;17(2):e79158. Case report PubMed · Publisher · Free full text

Abstract

Disseminated peritoneal leiomyomatosis (DPL) is a rare benign smooth muscle tumor that proliferates along the peritoneal surface and is mostly reported in young women. Our cases highlight the wide clinical and radiologic mimics of DPL, including primary peritoneal (mesothelial) entities and malignant processes like metastasis or pseudomyxoma peritonei. Both cases shared common findings of premenopausal age (hormonal influence) and a history of prior abdominal surgery. One case was clinically thought to be benign multicystic mesothelioma, while the other had a history of medulloblastoma as a child, followed by recurrent meningiomas. The presentation of multiple previous tumors in the latter case is an unusual association with DPL that has not been previously described. Here, we discuss the existing literature on the etiology and differential diagnosis of DPL, report our histopathologic findings, and highlight novel central nervous system (CNS) disease associations with DPL.

Copyright © 2025, Renavikar et al.
From Hypersensitivity Pneumonitis to Lung Adenocarcinoma: A Case Report Illustrating Diagnostic Complexity. U.K. Pabani, S. Visvalingam, K. Jones, et al. 2025;17(8):e89584. Case report PubMed · Publisher · Free full text

Abstract

Adenocarcinoma of the lung is the most common type of lung cancer and is classified as one of the non-small cell lung cancers. It typically arises in the peripheral regions of the lungs, affecting the dense glandular tissues. Most patients diagnosed with pulmonary adenocarcinoma are current or former smokers and present with nonspecific respiratory symptoms such as a persistent cough and shortness of breath. Many also go on to develop B symptoms, including weight loss and night sweats. We present a case of an 84-year-old Caucasian woman, a lifelong nonsmoker and teetotaller, who presented with a two-week history of dry cough, shortness of breath, and chest heaviness following receipt of her influenza vaccination. Her past medical history included hypertension (treated with amlodipine and perindopril), glaucoma, and bilateral cataracts. Initial blood tests showed normal infection and inflammatory markers. However, her chest X-ray was suggestive of pulmonary fibrosis, with fibrotic changes predominantly in the bilateral lower lung zones. She was initially treated with a tapering course of prednisolone for suspected hypersensitivity pneumonitis. Lung function tests were arranged, and a computed tomography chest scan revealed tiny centrilobular nodules in both lungs, located in peribronchovascular, perifissural, and subpleural areas. Further history revealed regular exposure to a Western Rosella bird. She denied dampness, mold, or known asbestos exposure at home. Connective tissue disease screening and avian precipitins, however, were negative. She later presented again with worsening symptoms. Arterial blood gas analysis revealed type 1 respiratory failure. The patient was admitted to the intensive care unit and was intubated and ventilated. A repeat chest X-ray showed progressive parenchymal changes without regression. Intravenous 500 mg of methylprednisolone was started; however, she showed no improvement with it. The patient's case was discussed at the lung multidisciplinary team meeting, and a lung biopsy was recommended, which was carried out via bronchoscopy. Histopathology revealed fragmented cores of adenocarcinoma with lepidic and papillary growth patterns, mucinous type, consistent with a primary lung origin (T4N0M1a). The patient's condition continued to deteriorate despite intensive care support, and she sadly passed away two weeks after admission. This case underscores the need to maintain a broad differential diagnosis, particularly in patients who fail to improve with treatment. It also emphasizes the role of biopsy in resolving the diagnostic challenge, as imaging studies did not provide a clear diagnosis.

Copyright © 2025, Pabani et al.
Hypertrophic Pulmonary Osteoarthropathy as an Initial Manifestation of Lung Cancer. S.K. Mohamed Ahmed, Y.K. Mohamedahmed, L. Fadl, et al. 2025;17(12):e98619. Case report PubMed · Publisher · Free full text

Abstract

Hypertrophic pulmonary osteoarthropathy (HPOA) is a paraneoplastic syndrome characterised by digital clubbing, periostitis, and arthralgia, most commonly secondary to lung malignancy. This case report presents a man in his 60s with a long history of smoking and asbestos exposure who developed progressive wrist and ankle pain, limb swelling, and enlargement of the hands and feet over eight months. He was initially investigated for rheumatoid arthritis due to positive rheumatoid factor (RF) and anti-citrullinated peptide (anti-CCP) antibodies, but repeated chest X-rays were normal. A CT scan later revealed a left lower lobe lesion, and biopsy confirmed squamous cell carcinoma of the lung. This case underscores the importance of maintaining a high index of suspicion for paraneoplastic syndromes such as HPOA when unexplained arthropathy and digital clubbing occur, even in the absence of respiratory symptoms.

Copyright © 2025, Mohamed Ahmed et al.
Impact of Multimodal Surgical Resection and Personalized Targeted Therapy on Survival Outcomes in Early-Stage Malignant Pleural Mesothelioma: A Meta-Analysis. A.Q. Vega Morales, J.L. Rivera Gastelum, A.J. Massé Ponce, et al. 2025;17(5):e84640. Review PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive malignancy with limited evaluates the efficacy and safety of these treatments. A systematic review and meta-analysis were conducted, including 14 studies that compared multimodal therapies for early-stage MPM. Continuous variables were analyzed using random-effects modeling, with heterogeneity assessed using I² statistics. The primary outcomes included physical function, social function, and lethargy. The meta-analysis found no statistically significant differences between experimental and control groups in terms of physical function (standardized mean difference [SMD]: -0.34, 95% confidence interval [CI]: -1.14 to 0.45), social function (SMD: 0.01, 95% CI: -0.52 to 0.53), or lethargy (SMD: -0.34, 95% CI: -0.96 to 0.27). Heterogeneity across studies was moderate to high (I²: 47%-76%). These findings suggest limited improvements in quality-of-life domains with experimental approaches compared to controls. This systematic review and meta-analysis highlights the need for individualized, multimodal treatment strategies in MPM management. While extrapleural pneumonectomy and extended pleurectomy/decortication offer specific benefits, their impact on quality of life varies and may not consistently provide significant improvements. Future research should focus on large-scale, randomized trials with standardized protocols to optimize treatment outcomes.

Copyright © 2025, Vega Morales et al.
Long Road to Identifying Peritoneal Mesothelioma: An Elusive Diagnosis. T.S. Konduru, G. Gourisaria, G. Ozen, et al. 2025;17(6):e85973. Case report PubMed · Publisher · Free full text

Abstract

Peritoneal mesothelioma is a rare and aggressive malignancy that often presents with non-specific abdominal symptoms such as ascites, leading to delayed diagnosis and treatment. It poses significant diagnostic challenges, especially in the absence of classical risk factors like asbestos exposure. We report the case of a 60-year-old woman with a background of coeliac disease and no known asbestos exposure, who presented with progressive abdominal distension and ascites. Initial investigations, including imaging, paracentesis, cytology and liver biopsy, failed to reveal a definitive cause. Despite multiple evaluations and treating a presumptive diagnosis of sarcoidosis, her symptoms persisted. One year after the initial presentation, imaging revealed peritoneal nodularity and enhancement. Following biopsy and immunohistochemistry, a multidisciplinary team discussion led to the diagnosis of peritoneal mesothelioma. The patient was commenced on chemotherapy which showed clinical improvement. This case underscores the importance of maintaining a high index of suspicion for rare malignancies such as peritoneal mesothelioma in patients with recurrent unexplained ascites, even in the absence of classical risk factors. Early multidisciplinary involvement and persistence in diagnostic evaluation are essential for timely diagnosis and management, which may improve patient outcomes in complex presentations.

Copyright © 2025, Konduru et al.
Medical Thoracoscopy in Malignant Pleural Effusion. A.K. Rath, S. Pothal, P. Bharadwaj. 2025;17(6):e85707. PubMed · Publisher · Free full text

Abstract

Introduction: Malignant pleural effusion (MPE) is a common complication of advanced malignancies, often resulting in significant morbidity and impaired quality of life. In most cases, pleural fluid cytology remains negative. In the era of targeted cancer therapy, pathologists expect larger tissue samples. Therefore, medical thoracoscopy (MT) has gained popularity for adequate tissue sampling under supervision. During MT, various morphological pleural lesions were identified, yet their histopathological associations remain unknown. This study aimed to assess the diagnostic yield of medical thoracoscopy and the complications associated with the procedure. We also observed various morphological lesions in MPE and their histopathological associations.

Methods: This was a single-center, hospital-based, prospective cross-sectional study conducted in the Department of Pulmonary Medicine, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, India. Patients with undiagnosed pleural effusion underwent MT. During the procedure, the lesions were morphologically characterized, and samples were collected for histopathological examination (HPE).

Results: A total of 87 patients underwent medical thoracoscopy using a rigid thoracoscope (Optymed®, Delhi, India), out of which 72 patients had malignant effusion and seven patients had tuberculous effusion. Eight patients had nonspecific inflammation. The diagnostic yield of medical thoracoscopy in this study was at least 90.8% (95% CI: 84.8%-96.8%). Seventy-two patients were evaluated for histopathologic and morphologic association. The most common procedure-related complication was pain at the incision site (87, 100%, median Visual Analogue Scale (VAS): 5), followed by desaturation. The mean fall in saturation was 5.13% (±33.78%). We did not observe any serious adverse effects related to rigid MT. The mean age of the patients was 54.17 (±15.17) years. Among MPE, pleural-based nodules (46, 63.9%), followed by adhesions (27, 37.5%), were the most common findings during MT. Other noted lesions included masses (26, 36.12%), plaques (22, 30.56%), and strands (19, 26.39%). Nodules were significantly associated with metastatic adenocarcinoma (p<0.01). Adhesions and plaques were commonly linked with pleural abnormalities in malignant mesothelioma (p<0.01). Masses were most frequently associated with lymphomas (p<0.01) and undifferentiated carcinoma (p<0.01). Small cell carcinoma comprised only five patients among MPE and was associated with strands (p<0.01).

Conclusion: Medical thoracoscopy is a valuable tool in evaluating and managing malignant pleural effusion. Its high diagnostic accuracy, therapeutic capabilities, and favorable safety profile make it the procedure of choice in appropriate clinical settings. Specific morphological patterns may be observed in different pleural malignancies.

Copyright © 2025, Rath et al.
Non-Asbestos-Related Malignant Peritoneal Mesothelioma: A Diagnostic Challenge in a Case of Unexplained Ascites. M.A.F. Dar, N. Nasir, G. Mujtaba, et al. 2025;17(10):e95421. Case report PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare and aggressive malignancy arising from mesothelial cells of the peritoneum. It is most frequently linked to asbestos exposure, although up to half of cases occur without such history. Because of its vague and non-specific presentation, diagnosis is often delayed; cytology is frequently non-diagnostic, and histological confirmation with immunohistochemistry is required. Prognosis remains poor, although advances in cytoreductive surgery and intraperitoneal chemotherapy have improved outcomes in selected patients. We describe a man in his late 60s with no history of asbestos exposure who presented with progressive abdominal distension over 18 months. He underwent repeated paracenteses with negative cytology and multiple imaging studies, initially attributed to an intraductal papillary mucinous neoplasm (IPMN) under surveillance. Subsequent computed tomography (CT) demonstrated extensive peritoneal disease with omental caking and splenic lesions. Omental biopsy confirmed epithelioid-type MPM with BRCA1-associated protein 1 (BAP1) loss on immunohistochemistry. Given advanced disease and poor performance status, the patient was deemed unsuitable for surgery or chemotherapy and was managed with best supportive palliative care. This case highlights the diagnostic challenges of MPM, particularly in the absence of asbestos exposure and in the presence of coexistent pathology, and underscores the importance of early histological evaluation in patients with unexplained recurrent ascites.

Copyright © 2025, Dar et al.
Peritoneal Mesothelioma Diagnosed on Frozen Section During Diagnostic Laparoscopy: A Case Report. M. Visconti, J.M. Watts, W. Weston, et al. 2025;17(10):e94474. Case report PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a rare neoplasm arising from the proliferation of mesothelial cells. When this proliferation involves the lining of the abdomen, the peritoneum, it is referred to as malignant peritoneal mesothelioma (MPM). We present a case of MPM identified during diagnostic laparoscopy, detailing the patient's symptoms and prior workup that prompted the procedure. This report describes a rare, rapidly progressive case in an elderly female patient, diagnosed via frozen section and immunohistochemistry, who experienced clinical deterioration over 24 days from initial presentation, highlighting both the diagnostic challenges and the aggressive nature of this disease.

Copyright © 2025, Visconti et al.
Primary Malignant Mesothelioma of the Tunica Vaginalis Presenting as a Benign Scrotal Mass: A Case Report. Z.C. Dagdeviren, O. Amac, Y. Dere, et al. 2025;17(8):e90608. Case report PubMed · Publisher · Free full text

Abstract

Primary malignant mesothelioma of the tunica vaginalis is an exceptionally uncommon neoplasm, comprising a very small fraction of all mesothelioma cases. Due to its nonspecific clinical presentation, it is frequently misdiagnosed as benign scrotal conditions, such as a hydrocele. In our case, a 77-year-old male presented with a gradually enlarging swelling in the left hemiscrotum. Scrotal Doppler ultrasonography (USG) and magnetic resonance imaging (MRI) revealed a hydrocele with polypoid masses and nodular soft tissue components of the tunica vaginalis. Tumor markers were normal. Surgical exploration revealed multiple solid masses on the testis and spermatic cord. Histopathologic examination confirmed malignant mesothelioma of epithelioid type, supported by immunohistochemical reactivity for calretinin, cytokeratin 7 (CK7), cytokeratin 5/6 (CK5/6), pan-cytokeratin (PanCK), Wilms tumor 1 (WT1), and loss of BRCA1-associated protein-1 (BAP1). Following the diagnosis of primary tunica vaginalis mesothelioma, the patient underwent radical inguinal orchiectomy and hemiscrotectomy. Adjuvant chemotherapy with pemetrexed and cisplatin was administered. No recurrence was detected after seven cycles, and the patient remains disease-free. This case highlights the diagnostic challenges of tunica vaginalis mesothelioma because of its infrequency and clinical similarity with benign processes. Diagnosis needs to be based on multimodal imaging, histopathology, and immunohistochemistry. Early and total surgical intervention followed by adjuvant therapy may hold the key to successful treatment.

Copyright © 2025, Dagdeviren et al.
Primary Malignant Mesothelioma of the Tunica Vaginalis: A Case Report and Review of the Literature. A. Elmadani, A. Farag, Z. Al-Qassim, et al. 2025;17(10):e94081. Case report PubMed · Publisher · Free full text

Abstract

Primary malignant mesothelioma of the tunica vaginalis is an extremely rare neoplasm, and its diagnosis is often unclear initially due to its nonspecific presentation. We present the case of an 87-year-old gentleman who presented with a left-sided hydrocele that increased in size over seven months, with no associated history of asbestos exposure. On initial ultrasound, he had a benign appearing hydrocele and proceeded to hydrocelectomy, where suspicious lesions were noticed and sent for histopathology. A subsequent radical inguinal orchiectomy was performed. Histopathologic examination revealed malignant mesothelioma, which was positive for calretinin, Wilm's Tumour 1 (WT-1), AE1/AE3, and D2-40 immunohistochemically, from both operations. On postoperative staging, no metastases were seen, and the patient has been disease-free on follow-up after six months. This case illustrates the challenges in reaching the diagnosis of malignant mesothelioma of the tunica vaginalis and emphasizes the importance of timely surgical intervention in the form of radical orchidectomy and histological examination of any uncommon scrotal mass. Ongoing case reporting is needed to guide management, as there are no standard guidelines due to the limited number of reported cases.

Copyright © 2025, Elmadani et al.
Pseudoachalasia Due to Malignant Pleural Mesothelioma Involving the Esophagus. M. Honda, M. Iwamuro, K. Miyamoto, et al. 2025;17(5):e84161. Case report PubMed · Publisher · Free full text

Abstract

We report a rare case of pseudoachalasia secondary to malignant pleural mesothelioma involving the esophagus. A 66-year-old man presented with progressive dysphagia, weight loss, and postprandial hiccups. Endoscopic examination showed esophageal dilation with luminal narrowing at the esophagogastric junction, but no mucosal abnormalities. Computed tomography revealed an irregular-shaped mass extending from the peri-esophagogastric junction to the retroperitoneum, accompanied by pleural effusion, right-sided hydronephrosis, and multiple hepatic lesions. Endoscopic ultrasound-guided fine-needle aspiration from the mass lesion through the esophageal lumen revealed epithelioid malignant mesothelioma. This case highlights the importance of considering malignant mesothelioma in the differential diagnosis of pseudoachalasia, particularly when imaging reveals extrinsic esophageal compression without mucosal lesions.

Copyright © 2025, Honda et al.
Reactivation of Latent Varicella-Zoster Virus Leading to Meningitis in a Patient With Malignant Pleural Mesothelioma Undergoing Immune Checkpoint Inhibitor Therapy: A Case Report. R. Shionoya, S. Ishiyama, H. Ono, et al. 2025;17(7):e88696. Case report PubMed · Publisher · Free full text

Abstract

Immune checkpoint inhibitor (ICI) therapy represents a significant advancement in cancer treatment through immune system activation. However, ICI presents paradoxical immunotherapy infections due to dysregulated immunity (ITI-DI). Here, we report varicella-zoster virus (VZV) meningitis in a patient with malignant pleural mesothelioma undergoing ICI therapy, characterized by disturbed consciousness and cerebrospinal fluid abnormalities. Although antiviral therapy with acyclovir effectively reduced VZV DNA to undetectable levels, persistent cerebrospinal fluid mononuclear pleocytosis was observed, which is akin to immune reconstitution inflammatory syndrome (IRIS). This case highlights the complex immunological interplay during ICI therapy, where immune activation paradoxically creates vulnerability to certain infections through mechanisms distinct from classic immunosuppression. Our findings underscore the importance of recognizing IRIS and ITI-DI as distinct entities requiring specific clinical consideration. We propose that comprehensive monitoring for atypical infections and implementation of pathogen-specific management strategies are essential components of care for patients receiving ICI therapy, particularly given the unique immunological milieu these treatments create.

Copyright © 2025, Shionoya et al.
Slowly Progressive Melanoma Differentiation-Associated Gene 5 (MDA-5) Interstitial Lung Disease Following COVID-19 Infections: A Pulmonary Puzzle. S.A. Armstrong, D. Sese, A. Menon. 2025;17(4):e81584. Case report PubMed · Publisher · Free full text

Abstract

Melanoma differentiation-associated gene 5 (MDA-5) autoimmunity has been increasingly recognized in association with interstitial lung disease (ILD), particularly in the context of viral infections. While MDA-5 ILD is typically rapidly progressive with high mortality, emerging evidence suggests that COVID-19 may induce a distinct, more indolent phenotype. We report two cases of MDA-5 ILD following COVID-19 infection with a slowly progressive course. In Case 1, an 87-year-old woman with a history of breast cancer, chronic obstructive pulmonary disease (COPD), and a prior COVID-19 infection developed progressive dyspnea. Imaging revealed new-onset ILD with subpleural reticulations and traction bronchiectasis. A myositis antibody panel was positive for MDA-5 autoantibodies. She was diagnosed with MDA-5 ILD and initiated on corticosteroids, later transitioned to mycophenolate. She has since remained clinically stable over the past two years. In Case 2, an 84-year-old man with a history of smoking and asbestos exposure developed severe dyspnea and hypoxia after a mild COVID-19 infection. CT imaging revealed diffuse ground-glass opacities and interlobular septal thickening. He was diagnosed with MDA-5 ILD and Group 1 and 3 pulmonary hypertension. He was treated with mycophenolate and pulmonary vasodilators, leading to symptom stabilization. These cases illustrate a possible post-COVID-19 endotype of MDA-5 ILD that follows a slower disease trajectory, distinct from the classical rapidly progressive phenotype. The association between viral infections and MDA-5 autoimmunity is supported by prior studies demonstrating viral-induced interferon signaling and MDA-5 gene activation. Given the indolent nature of disease progression in our patients, a tailored immunosuppressive approach was pursued, resulting in the stabilization of symptoms and pulmonary function. These cases contribute to the growing recognition of post-COVID-19 MDA-5 ILD as a unique clinical entity. Further research is needed to elucidate the precise mechanisms underlying virus-induced autoimmunity and to guide treatment strategies for this emerging ILD subtype.

Copyright © 2025, Armstrong et al.
Synchronous Primary Pleural Mucosa-Associated Lymphoid Tissue Lymphoma and Pulmonary Squamous Cell Carcinoma in a Patient With Asbestos Exposure: A Case Report. R. Irie, T. Kawai, N. Nakamura, et al. 2025;17(9):e93467. Case report PubMed · Publisher · Free full text

Abstract

Primary pleural extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is extremely rare. We report the case of a Japanese man in his 70s who had a history of asbestos exposure and known bilateral pleural plaques and presented with dyspnea. Imaging studies revealed a pulmonary mass in the left lower lobe, and a biopsy confirmed squamous cell carcinoma of the lung. Positron emission tomography-computed tomography (PET-CT) incidentally revealed increased radiotracer uptake in the pleura between the third and fourth left ribs. The pleural mass was diagnosed as primary pleural MALT lymphoma on biopsy. To the best of our knowledge, this is the first reported case of the synchronous occurrence of primary pleural MALT lymphoma and pulmonary squamous cell carcinoma in a patient with a documented history of asbestos exposure.

Copyright © 2025, Irie et al.
Trends in the Incidence of Rare Primary Cardiac Neoplasms: A Surveillance, Epidemiology, and End Results (SEER)-Based Analysis. J.K. Alhousani, A. Abdelmageed, H. Khoursheed, et al. 2025;17(9):e92613. PubMed · Publisher · Free full text

Abstract

Background Primary malignant cardiac tumors (PMCTs) are considered extremely rare neoplasms, with limited population-level data on incidence patterns and future trends. This study aims to describe the epidemiology of PMCTs in the United States, focusing on three main histologic subtypes, such as sarcomas, lymphomas, and mesotheliomas, and to forecast incidence over the next decade. Methods We extracted cases of pathologically confirmed PMCTs diagnosed between 2000 and 2022 from the Surveillance, Epidemiology, and End Results (SEER) 17 Registries database. Incidence rates (IRs) were age-adjusted to the 2000 US Standard Population and stratified by histology, sex, age (<60 vs. ≥60 years), and race. Annual percent change and percentage change were calculated. Time series forecasting was performed using linear regression, ETS, ARIMA, and neural network autoregression models, with model selection based on root mean square error, mean absolute error, mean absolute percentage error, and residual diagnostics. Poisson and quasi-Poisson regression analyses evaluated demographic associations with incidence. Results From 2000 to 2022, PMCTs demonstrated distinct subtype-specific trends. Cardiac lymphoma incidence increased steadily, with forecasts predicting a rise from 0.062 per 100,000 in 2023 to 0.080 by 2032. Sarcoma incidence remained stable (~0.008-0.009 per 100,000) but was highly volatile year to year. Mesothelioma incidence was consistently low (<0.001 per 100,000) but projected to increase slightly over time. Age ≥60 years was strongly associated with higher sarcoma and mesothelioma incidence, whereas lymphoma showed no significant age-related difference. Sex and race disparities were evident: males had higher sarcoma and mesothelioma rates, while females had slightly higher lymphoma rates; Asian/Pacific Islander groups exhibited greater volatility in lymphoma incidence, and Black populations had the lowest incidence across subtypes. Conclusions PMCTs remain exceptionally rare, but incidence trends vary by histologic subtype. Cardiac lymphoma incidence is rising and expected to continue increasing, whereas sarcoma rates are stable, and mesotheliomas show a modest upward trajectory. These findings highlight the need for improved detection in high-risk groups, the integration of molecular data into registries, and the development of global cardiac tumor collaborations to refine epidemiologic understanding and improve patient care..

Copyright © 2025, Alhousani et al.
Unraveling Peritoneal Mesothelioma: A Case-Based Discussion on Diagnosis and Management. O. Zouiten, L. Azarou, H. Hadiri, et al. 2025;17(10):e94653. Case report PubMed · Publisher · Free full text

Abstract

Peritoneal mesothelioma is a rare and aggressive tumor, and its management remains poorly standardized in the literature. This case highlights the diagnostic and therapeutic challenges through a 56-year-old woman with no significant medical history or known asbestos exposure, who presented with progressive abdominal distension and postprandial vomiting. Imaging revealed diffuse nodular peritoneal thickening and large-volume ascites. A laparoscopic biopsy confirmed malignant epithelioid mesothelioma, supported by immunohistochemical positivity for cytokeratin 7 (CK7), calretinin, and Wilms tumor 1 (WT1). Treatment was based on systemic chemotherapy with platinum (cisplatin/carboplatin) and pemetrexed, which elicited a rapid initial response. However, the long-term efficacy remains uncertain due to the aggressive nature of the disease. The absence of standardized treatment underscores the necessity for multidisciplinary management.

Copyright © 2025, Zouiten et al.
A Case of Malignant Pleural Mesothelioma With Unknown Asbestos Exposure. A. Paremuzyan, E. Onwubuya, J. Mathews. 2024;16(9):e69966. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare, locally invasive tumor that develops from mesothelial cells lining the lung's pleura. It is mostly associated with prolonged asbestos exposure. The long latency period between asbestos exposure and clinical symptoms makes diagnosing MPM challenging. This report describes a 57-year-old Hispanic female who presented with a persistent nonproductive cough and was ultimately diagnosed with advanced-stage pleural mesothelioma after extensive work-up. It highlights the difficulties in diagnosing MPM in patients without apparent asbestos exposure independent of age or gender.

Copyright © 2024, Paremuzyan et al.
A Case Report of Peritoneal Mesothelioma as an Acute Abdomen Mimic: A Rare Presentation and Diagnostic Challenges. L. Fadl, M. Fadl, O. Fadl, et al. 2024;16(11):e74598. Case report PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare and aggressive cancer often linked to asbestos exposure. This case report presents a 60-year-old man with a history of asbestos exposure who developed MPM, initially presenting with acute abdominal pain, an uncommon mimic of the acute abdomen. Diagnosing MPM is challenging due to its vague symptoms, often leading to delayed diagnosis. Additionally, the patient developed internal jugular vein thrombosis, a rare complication associated with malignancies. This case highlights the rare presentation of peritoneal mesothelioma as an acute abdomen mimic, the diagnostic complexities associated with MPM, and the rare type of thromboembolic event in this case.

Copyright © 2024, Fadl et al.
A Complete Response to Pembrolizumab in Malignant Peritoneal Mesothelioma: A Case Report. M. Bairos Menezes, R. Pedroso de Lima, I. Dunões, et al. 2024;16(1):e52716. Case report PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPeM) is a rare cancer of the peritoneum with a poor prognosis and nonspecific clinical course. We discuss a case of MPeM in a 59-year-old male who presented with abdominal pain and distension, without any known previous asbestos exposure. The diagnosis was made after a second biopsy finally confirmed epithelioid MPeM in an advanced stage with pleural effusion. The patient underwent six cycles of chemotherapy with cisplatin and pemetrexed, experienced disease progression, and was then started on pembrolizumab as a second-line treatment. The patient achieved a complete response after two years of treatment with pembrolizumab and has been disease-free for almost four years with an Eastern Cooperative Oncology Group (ECOG) performance status of 0. Despite the lack of evidence to support the treatment with immunotherapy for MPeM, our case report encourages its use, highlighting its ability to enable a complete response with pembrolizumab with an excellent quality of life.

Copyright © 2024, Bairos Menezes et al.
A Comprehensive Pan-Cancer Analysis Reveals Cyclin-Dependent Kinase Inhibitor 2A Gene as a Potential Diagnostic and Prognostic Biomarker in Colon Adenocarcinoma. A. Salem, S. Ahmed, M. Khalfallah, et al. 2024;16(5):e60586. PubMed · Publisher · Free full text

Abstract

Introduction Cyclin-dependent kinase inhibitor 2A (CDKN2A) is a suppressor carcinogenic gene that is upregulated across various types of cancer including breast, liver, thyroid, and bile duct cancer due to its crucial role in cell cycle regulation and cell division. Nevertheless, it is mostly investigated at the genetic level, but it is still poorly studied on pan-cancer analysis as a biomarker and this study shows its significant potential diagnostic and prognostic characteristics. However, this study aims to investigate the role of CDKN2A as a diagnostic and prognostic biomarker across various types of cancer focusing primarily on colon adenocarcinoma (COAD). Methods We investigated CDKN2A gene expression in a pan-cancer analysis across different types of cancer to show its diagnostic potential characteristics by using various bioinformatic tools, including Tumor Immune Estimation Resource (TIMER) 2.0, Gene Expression Profiling Interactive Analysis (GEPIA), and University of Alabama at Birmingham Cancer Data Analysis Portal (UALCAN) database. TIMER was used to profile gene expression across 32 types of cancer composed of 10,000 RNA-seq samples obtained from the Cancer Genome Atlas (TCGA) and to analyze the tumor-infiltrating immune cells. In addition, GEPIA and UALCAN were further used to analyze gene expression, in terms of gene regulation, pathological stages, and clinical parameters, including gender, age, and race. Therefore, we used GEPIA, UALCAN, and Kaplan-Meier plotter particularly across adenocarcinoma to investigate CDKN2A prognosis by studying its high expression association with the patient's overall survival rate to show the tumor progression. Then, we looked into the genetic alteration of CDKN2A by using the cBio Cancer Genomics Portal (cBioPortal), including 10 pan-cancer studies. We concluded the analysis with gene validation by using a public cohort in Gene Expression Omnibus (GEO). Results CDKN2A showed a trend of upregulation in most cancers and it was significantly upregulated in five cancers, which were commonly identifiable in three databases, including breast invasive carcinoma (p < 0.001), kidney chromophobe (p < 0.001), kidney renal clear cell carcinoma (p < 0.001), kidney renal papillary cell carcinoma (p < 0.001), and COAD (p < 0.001). The upregulation was significantly different in association with pathogenic stages II and III (pr(>F) = 0.00234) which was identifiable significantly in COAD more than in other cancers. The gene showed a high upregulation in association with poor prognosis of patient survival in three cancers, including COAD (log-rank p = 0.011), mesothelioma (log-rank p = 5.9e-07), and liver hepatocellular carcinoma (log-rank p = 0.0045). Therefore, COAD was the only comprehensively analyzed tumor to show a diagnostic and prognostic potential characteristic during high upregulation of CDKN2A. Furthermore, CDKN2A displayed a rare mutation in the form of deep deletion (9%) and revealed an upregulation associated with CD4+ T cells (p = 0.0108), macrophage (p = 0.0073), and neutrophils (p = 0.0272) as immune cells infiltrating COAD. Conclusion Our study demonstrates the pan-cancer relevance of CDKN2A and revealed a novelty in showing CDKN2A underscores its potential as a diagnostic prognostic biomarker in COAD since CDKN2A is mostly studied at a genetic level across COAD.

Copyright © 2024, Salem et al.
A Rare Case of Pleural Epithelioid Mesothelioma With a Prominent Myxoid Stroma Reported With Morphology, Fluorescent In Situ Hybridization, and Ultrastructural Findings. H. Sonobe, R. Omote, T. Habara, et al. 2024;16(6):e62212. Case report PubMed · Publisher · Free full text

Abstract

Herein, we report a rare case of pleural epithelioid malignant mesothelioma with a prominent myxoid stroma. To date, detailed morphological or molecular pathological findings have not been reported for this type of tumor. Hence, we aimed to describe the cytological, histological, immuno-cytohistological, electron-microscopic, and molecular pathological findings using fluorescence in situ hybridization (FISH) in such a case. The patient was a male in his mid-sixties with a history of asbestos exposure and had originally visited the hospital with a persistent cough and fever. Chest radiography revealed left pleural effusion, and laboratory examination revealed a high titer for hyaluronic acid in the effusion. Additionally, computed tomography revealed diffuse multinodular or cystic lesions in the left parietal pleura, and pleural effusion cytology revealed large epithelioid cells with mild nuclear atypia, which were considered reactive mesothelial cells. Cytologically, Giemsa staining revealed that these cells harbored variously sized intracytoplasmic vacuoles that were Alcian-blue-positive, suggesting hyaluronan production. Biopsy revealed large epithelioid cells that loosely proliferated against a prominent myxoid background. These cells were immuno-positive for calretinin, Wilms' tumor 1, D2-40, vimentin, and cytokeratin AE1/AE3 but not for carcinoembryonic antigen, Ber-EP4, or desmin. BRCA 1 associated protein 1 immunostaining showed nuclear loss, and FISH showed homozygous deletion of cyclin-dependent kinase inhibitor 2A (p16) on chromosome 9p21. Based on these findings, the lesion was diagnosed as an epithelioid mesothelioma with a prominent myxoid stroma. Electron-microscopy demonstrated a dense microvillus pattern on the surface of the tumor cells, indicating a mesothelial cell origin, and variously sized vacuoles in the cytoplasm, confirming the presence of intracytoplasmic vacuoles demonstrated on cytology. The tumor tissues obtained during surgery harbored prominent myxoid stroma, which proved that the present tumor was consistent with this type of mesothelioma. After informed consent was obtained, the patient and family wished for total resection of the tumor and postoperative chemotherapy, and the patient eventually died eight months after surgery.

Copyright © 2024, Sonobe et al.
Alloyed Airways: Chromium, Beryllium, and Titanium in the Lungs of an Aerospace Veteran. M.A. Potesta, A. Brown, A. Shibani. 2024;16(4):e58392. Case report PubMed · Publisher · Free full text

Abstract

Pneumoconiosis is a form of interstitial lung disease (ILD) that commonly occurs secondary to occupational or environmental exposures. This is an emerging disease as there are many potential forms of pathologic insults. Further adding to the complication is that clinical symptomatology secondary to pneumoconiosis can have long latent periods, as repetitive exposure over years leads to long-standing inflammation and subsequent irreversible damage. Exposure to asbestos, coal, silica, aluminum, talc, hay, and many more agents has the potential to cause pneumoconiosis. This case highlights a veteran, who made his career working with heavy metals such as chromium, beryllium, and titanium in the aerospace defense industry. This case discusses high-risk occupations, a workup for suspected pneumoconiosis, management, and the mechanism of lung injury underlying the three aforementioned pathologic agents. In each case of pneumoconiosis, a thorough history is essential, and diagnoses are made via the incorporation of the patient's historical risk factors, pulmonary function test (PFT) findings, and high-resolution chest computed tomography (HRCT).

Copyright © 2024, Potesta et al.
Ascites as a Rare Manifestation of Malignant Peritoneal Mesothelioma: A Case Report. S. Lief, S. Patibandla, A.Z. Ansari, et al. 2024;16(10):e70982. Case report PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm that originates from the mesothelial cells lining the parietal peritoneum or visceral peritoneum and extensively spreads within the abdominal cavity. It is a rare malignancy characterized by an insidious onset and poor prognosis. We present the case of a 79-year-old Caucasian male who experienced escalating abdominal pain for six weeks and acute abdominal distension. His medical history was significant for hypertension, gastroesophageal reflux disease (GERD), hypercholesterolemia, and prior coronary artery bypass grafting (CABG). The patient had a 30-pack-year smoking history and worked as a plumber and roofer until retirement. We also confirmed with the patient that he has never been diagnosed with asbestosis. He reported no family history of mesothelioma or related conditions. A computed tomography (CT) scan revealed a prior sternotomy, mild pleural calcifications, mild hepatic steatosis, diffuse peritoneal ascites, diffuse omental edema, and pelvic phleboliths. MPM was confirmed through histopathological examination, which revealed atypical mesothelial cells with high nucleus-to-cytoplasm ratios, prominent nucleoli, and irregular nuclear membranes. It also revealed tumor cells positive for p53, calretinin, WT1, and podoplanin (D2-40). This case highlights the importance of considering MPM in the differential diagnosis for patients with ascites and possible asbestos exposure, particularly with respect to occupational hazards, as it is a rare manifestation of the disease.

Copyright © 2024, Lief et al.
Biphasic Peritoneal Mesothelioma Is a Rare Tumor and a Diagnostic Challenge: A Case Report. E.A. Subahi, A. Fadul, A. Mohamed, et al. 2024;16(1):e51725. Case report PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare subtype of mesothelioma. There are three main histological subtypes of mesothelioma: epithelioid, sarcomatoid, and biphasic (mixed). Risk factors include asbestos exposure, previous radiation, and some germline mutations. Treatment includes surgical resection of amenable tumors or cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. We present a 34-year-old male who presented with weight loss, night sweats, and pleuritic chest pain and was found to have ascites with peritoneal nodularity on abdominal imaging. He had a history of tuberculosis contact, but no history of asbestos exposure. After a long challenging and interesting diagnostic process, he was subsequently diagnosed with biphasic MPM. The diagnostic challenge stems from not only the rarity of the tumor but also from the absence of risk factors, the unavailability of some special laboratory investigations, in addition to the potentially misleading effect of tuberculosis exposure history, a top differential diagnosis in the case. This is a case report of a really challenging and totally unexpected diagnosis of biphasic peritoneal mesothelioma in a patient with tuberculosis exposure, constitutional symptoms, but no history of asbestos exposure. It highlights the diagnostic process as well as the importance of early diagnosis to improve the overall survival of such malignancies.

Copyright © 2024, Subahi et al.
Challenging the Norm: Occurrence of Synchronous Pleural and Peritoneal Mesothelioma in a Female Patient. S. Reddy, K. M G, R. Gattu, et al. 2024;16(8):e67118. Case report PubMed · Publisher · Free full text

Abstract

Here, we present a unique case involving a female patient in her 40s with synchronous malignant pleural and peritoneal mesothelioma, despite lacking a history of asbestos exposure. The patient's initial symptoms included dyspnoea, chest pain, cough, fever, appetite loss, and weight loss over a month. Clinical evaluation led to the identification of right-sided pleural effusion, prompting consideration of differential diagnoses, such as tubercular or malignant pleural effusion. A thoracoscopy-guided biopsy, followed by histopathological examination and immunohistochemical staining, confirmed the diagnosis of mesothelioma. Chemotherapy was initiated as part of the treatment plan. The prognosis for this condition is generally bad; however, unusual cases of extended survival have been documented. The complexities of our case underscore the critical necessity for a thorough and aggressive evaluation of pleural effusion cases to unveil rare underlying causes, such as mesothelioma.

Copyright © 2024, Reddy et al.
Comprehensive Review of Mesothelioma Cases: From Diagnosis to Therapeutic Strategies. A. Qasim, S.V.V. Allu, P. Schmidt, et al. 2024;16(1):e52859. Case report PubMed · Publisher · Free full text

Abstract

Mesothelioma is a rare and aggressive malignancy typically associated with asbestos exposure. We present the clinical and diagnostic journey of a 63-year-old male carpenter, who presented with concerning symptoms of shortness of breath and total right lung "white-out" on imaging. Comprehensive medical evaluation revealed the presence of malignant pleural mesothelioma. This study underscores the importance of considering mesothelioma as a potential diagnosis in individuals with occupational asbestos exposure and highlights patterns in diagnosing and managing this devastating disease. Early recognition and intervention are essential in improving outcomes for patients diagnosed with mesothelioma.

Copyright © 2024, Qasim et al.
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Outcomes From a Tertiary Cancer Care Center in India. M. Ray, B. Pathak, R. Venugopal, et al. 2024;16(11):e73658. PubMed · Publisher · Free full text

Abstract

Background: Malignant peritoneal mesothelioma (MPM) is a rare and aggressive form of cancer arising from the peritoneum. The prognosis for MPM has historically been poor, and treatment options are limited. This study evaluated the impact of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) as a treatment modality for MPM.

Materials And Methods: This retrospective analysis included 15 patients diagnosed with MPM between 2012 and 2023 at a tertiary referral cancer care center in North India. Patients underwent CRS followed by HIPEC. The study assessed outcomes based on overall survival (OS) and postoperative morbidity rates.

Results: Demographic analysis revealed a female preponderance (n = 9, 60%) and a majority of younger patients, 80% (n = 12) of whom were younger than the age of 50. The mean peritoneal cancer index (PCI) was 14.0, with 60% (n = 9) of patients having a PCI above the mean. The completeness of cytoreduction (CC) varied, with 40% (n = 6) achieving CC0, 33.33% (n = 5) CC1, and 26.67% (n = 4) CC2. Adjuvant chemotherapy was administered to 60% (n = 9) of the patients. The median follow-up period was 25 months, revealing an overall median survival of 27.0 months, with one- and three-year survival rates of 86.7% and 33.3%, respectively.

Conclusion: CRS combined with HIPEC is a viable and effective treatment option for patients with MPM and offers improved survival rates and an acceptable safety profile. These findings support the integration of this treatment modality into the management plan for select patients with MPM, although optimal management is still evolving.

Copyright © 2024, Ray et al.
Decoding Cancer Risk: Understanding Gene-Environment Interactions in Cancer Development. A.P.S. Sandhu, Tanvir, K. Singh, et al. 2024;16(7):e64936. Review PubMed · Publisher · Free full text

Abstract

While lifestyle choices or behavioral patterns remain the most significant factors influencing cancer risk, environmental exposure to certain chemicals, both manufactured and natural, may also contribute to an individual's likelihood of developing cancer. This interplay of factors, coupled with an aging demographic and shifting lifestyle patterns, has led to an increasing prevalence of cancer in recent years. This study examines the environmental and behavioral factors that contribute to anomalies in the immune system and increase the risk of developing cancer. Significant environmental and occupational factors include the contamination of air and water, exposure to radiation, contact with harmful microorganisms and pathogens, and workplace exposure to carcinogens such as asbestos, certain chemicals, and industrial pollutants. Behavioral factors, such as food, physical activity, stress, substance misuse, and sleep patterns, have a substantial impact on immunological function and the likelihood of developing cancer. For example, pollutants like benzene and arsenic can disrupt immune function and raise the risk of developing cancer. Similarly, lifestyle variables such as inactivity and poor nutrition have been linked to an increased risk of cancer. Long-term stress and substance abuse can also decrease immunological responses, increasing the risk of developing cancer. The review underlines the complexities of examining gene-environment interactions, as well as the importance of using several perspectives to fully comprehend these pathways. Future investigations should emphasize improved methodology and larger sample sizes. Public health campaigns should aim to reduce human exposure to cancer-causing compounds known as carcinogens while also encouraging the adoption of healthy behaviors and habits. Tailored preventive approaches that account for individual genetic vulnerabilities have the potential to improve cancer prevention and treatment.

Copyright © 2024, Sandhu et al.
Diagnostic Differentiation Between Two Rare Entities-Metastatic Peritoneal Mesothelioma With Duodenal Involvement and Duodenal Synovial Sarcoma: A Case Report. B. Haueisen Figueiredo Zwetkoff, F. Maluf-Filho, F.E. Venco, et al. 2024;16(11):e74764. Case report PubMed · Publisher · Free full text

Abstract

This case report highlights the diagnostic challenges in distinguishing between metastatic peritoneal mesothelioma with duodenal involvement and synovial sarcoma of the duodenum, two rare and complex entities. A 59-year-old woman presented with nonspecific abdominal symptoms, and imaging revealed a heterogeneous lesion between the right hepatic lobe and duodenum. Endoscopic ultrasound-guided biopsy and subsequent histopathological analysis initially suggested synovial sarcoma, but further examination, including a FISH assay, confirmed the diagnosis of malignant peritoneal mesothelioma. This case underscores the importance of integrating detailed medical history, imaging, and advanced diagnostic techniques to achieve an accurate diagnosis in rare conditions. Early and precise identification of such diseases is crucial for appropriate therapeutic management and has significant implications for patient prognosis.

Copyright © 2024, Haueisen Figueiredo Zwetkoff et al.
Diagnostic Journey From Suspected Ovarian Mass to Rare Mesothelial Cyst. G. Franzese, D.J. Koh. 2024;16(10):e72505. Case report PubMed · Publisher · Free full text

Abstract

Mesothelial cysts are rare, benign formations originating from the mesothelial cells lining body cavities. These cysts are more prevalent in women of reproductive age but can also be found in men and children. We present the case of a 38-year-old woman with a large pelvic mass initially suspected to be ovarian in origin. Imaging studies revealed complex cystic structures, and surgical exploration was necessary for a definitive diagnosis. Pathological examination confirmed a benign mesothelial-lined cyst. Despite their rarity and benign nature, mesothelial cysts should be included in the differential diagnosis of pelvic cysts. Recognizing these lesions can help prevent misdiagnosis and ensure appropriate management and counseling. More research needs to be done, especially regarding any implication to fertility potential.

Copyright © 2024, Franzese et al.
Diffuse Pleural Mesothelioma: A Challenge in Early Diagnosis. A.A. Constantin, F.D. Mihaltan, A.S. Marghescu, et al. 2024;16(12):e74998. Case report PubMed · Publisher · Free full text

Abstract

We present the clinical case of a 58-year-old female patient, a smoker with occupational exposure to respiratory toxins, who was admitted to our clinic following evaluation in an emergency department, where she was diagnosed with a moderate right pleural effusion. Upon admission, the patient exhibited respiratory symptoms, including progressive dyspnea with a moderate exertion threshold, right posterior pleuritic chest pain radiating anteriorly, occasional episodes of low-grade fever, and persistent febrile symptoms lasting approximately two weeks. In this clinical context, the diagnostic process was guided by the presence of right pleural effusion syndrome, which was refractory to conservative medical therapy. This necessitated a careful and stepwise expansion of investigations, ultimately leading to the diagnosis of malignant pleural mesothelioma. This case underscores the diagnostic challenges posed by pleural effusion, the necessity of adhering to the diagnostic algorithm, and the critical role of the multidisciplinary team. The diagnostic approach, often complex and challenging, necessitates a multidimensional strategy that integrates the correlation and synthesis of data obtained through anamnesis, alongside advanced diagnostic procedures such as pleural biopsy, which remains the gold standard. This comprehensive process is essential for formulating a diagnostic suspicion, with the final diagnosis intended to be one of exclusion.

Copyright © 2024, Constantin et al.
Dual Malignancies Discovered: A Rare Case of Malignant Peritoneal Epithelioid Mesothelioma and Lung Adenocarcinoma. M.A. Potesta, E. Guld, J. Laman. 2024;16(5):e59962. Case report PubMed · Publisher · Free full text

Abstract

Clinicians diagnosing malignant peritoneal epithelioid mesothelioma (MPM or MPeM) have historically had challenges due to the low incidence of the disease, as well as the often vague symptomatology that patients present with. Newer advances in technology, specifically in immunocytochemistry, have provided a clearer path to diagnosis. Additionally, malignant mesotheliomas must be differentiated from carcinomas. This is done via histology, immunocytochemistry, as well as a careful incorporation of the patient's clinical history. In this case, we present an asymptomatic 73-year-old non-smoker female with no past medical history of asbestos exposure. She was diagnosed with MPM following a routine abdominal hernia repair. Subsequent workup revealed a lung infiltrate that was successfully biopsied and resected, evidently found to be adenocarcinoma. A careful review of the resulting pathology, as well as the interpretation of immunocytochemistry, supported the notion that the patient had two independent malignant processes occurring at once. This case underscores the rarity of two similar, yet distinct cancers, as well as epidemiology, symptomatology, histology, immunocytochemistry, and prognosis.

Copyright © 2024, Potesta et al.
Fusobacterium nucleatum-Induced Empyema Masquerading as Lung Cancer: A Diagnostic Challenge. A.R. Fadel, Y.N. Ahmed. 2024;16(12):e75003. Case report PubMed · Publisher · Free full text

Abstract

A 73-year-old man, an ex-smoker with a history of asbestos exposure and hypertension, presented with progressive shortness of breath, weight loss, loss of appetite, and fatigue. He was referred by a general practitioner for evaluation of a round lesion in the right lung. Chest computed tomography (CT) revealed a pleural-based mass and small right-sided pleural effusion that was not amenable to aspiration. Routine blood investigations revealed elevated levels of the inflammatory markers. He was discharged with a course of oral antibiotics, levofloxacin, and scheduled for a two-week follow-up on the lung cancer pathway. The patient returned with worsening shortness of breath and enlarged pleural effusion. Ultrasound-guided diagnostic aspiration yielded purulent fluid, with cultures identifying Fusobacterium nucleatum. Cytological examination of the pleural fluid yielded negative results for malignant cells. Further investigations ruled out septic thrombophlebitis of the internal jugular vein (Lemierre syndrome) and septic mediastinitis. After excluding all other possible infection sites and conducting an oral examination, the pleural infection was attributed to periodontal disease. Empyema was effectively managed with antibiotics and drainage. However, empyema resulted in a visceral pleural rind, leading to an unexpandable lung. Surgical intervention was not pursued because of the patient's comorbidities and clinical and biochemical resolution of the infection. This case highlights the importance of considering rare pathogens, such as Fusobacterium nucleatum, in pleural infections, particularly when linked to oral sources.

Copyright © 2024, Fadel et al.
Hepatic Benign Cystic Mesothelioma in Adults: A Case Report of a Rare Hepatic Cyst. A. Mohamed, S. Elsherif, R. Makary. 2024;16(1):e51832. Case report PubMed · Publisher · Free full text

Abstract

Benign cystic mesothelioma (BCM), also known as peritoneal inclusion cyst, is a benign mesothelial lined cystic lesion, nearly always described in the pelvis of adult females. The hepatic location of BCM is rarely reported in the literature. We report a case of hepatic benign cysts in a 65-year-old woman that was incidentally discovered by imaging studies 12 years ago as a small cyst. Recently, the patient started having abdominal discomfort, distension, and anxiety. A CT scan revealed two low-density fluid-filled cystic lesions, the largest in the caudate lobe measuring up to 10.7 cm and causing a mass effect on hepatic veins and inferior vena cava. Laparoscopic marsupialization of the large liver cyst was done without complications. On gross examination, the collapsed cyst wall was a thin partly translucent pale tan to pink membranous structure with fine vascularity. No discrete nodularity or solid lesion was identified. Microscopic examination showed a thin fibro-connective wall lined by a single layer of flat cuboidal cells with no cellular atypia. The cyst lining showed characteristic calretinin-positive immunohistochemical reactivity for mesothelium, supporting the diagnosis of BCM. Hepatic BCM is among a broad differential spectrum of cystic liver lesions ranging from developmental, reactive, inflammatory, and infectious lesions, benign to premalignant or frankly malignant neoplasms with different treatment strategies. Although BCM is the rarest among the long list of differential diagnoses of hepatic cysts, its identification in this rarely reported location is essential to avoid aggressive surgical treatment.

Copyright © 2024, Mohamed et al.
Identification and Management of Testicular Mesothelioma Identified Intraoperatively: A Case Series. T. Sweeney, I. Doan, R.L. Grubb. 2024;16(5):e61190. Case report PubMed · Publisher · Free full text

Abstract

Testicular mesothelioma lacks the characteristic presentation of testicular malignancy and often has normal biomarkers at the time of diagnosis causing this malignancy to be overlooked and diagnosed intraoperatively during elective scrotal surgery. We present two cases of testicular mesothelioma that were diagnosed incidentally during hydrocelectomy. These cases emphasize the importance of considering testicular mesothelioma during hydrocele and scrotal mass workup and demonstrate the need for standardized guidelines for the management of testicular mesothelioma.

Copyright © 2024, Sweeney et al.
Intra-Operative Diagnosis of Benign Multicystic Peritoneal Mesothelioma: A Case Report of Rare Entity and Lessons Learned. C.C. Wu, A. Bassi, A. Onitilo, et al. 2024;16(5):e60664. Case report PubMed · Publisher · Free full text

Abstract

Benign multicystic peritoneal mesothelioma (BMPM), also known as multicystic peritoneal mesothelioma (MCPM), is a rare cystic neoplasm arising from the mesothelium lining of the abdominal and pelvic peritoneum. This entity has been disproportionately described in women of reproductive age. Both the etiology and pathogenesis of the condition are not well understood. Preoperative diagnosis is challenging as differentials are varied and include endometriosis, lymphangioma, pseudomyxoma peritonei, cystic adenomatoid tumor, and malignant peritoneal mesothelioma. Management options include cytoreductive surgery (CRS) with or without heated intraperitoneal chemotherapy (HIPEC). In this case report, we highlight the complexity of preoperative diagnosis, presentation, workup, treatment, and management of BMPM. We report the case of a female patient presenting with abdominal pain and imagining consistent with cystic intra-abdominal lesions. After an inconclusive percutaneous biopsy and a multi-disciplinary tumor board discussion, the patient was offered CRS with HIPEC. Intra-operative frozen section indicated benign epithelial lined cysts. CRS and HIPEC were performed. After a second opinion, the lesions were confirmed by pathology and immunohistochemistry to be BMPM. In this report, we discuss the gold standard of care for patients with BMPM to improve the disease control rate. This pathway is proposed in our study, and, thus, we conclude that BMPM should be considered in the differential diagnosis of patients presenting with symptomatic multiple intraperitoneal cystic lesions.

Copyright © 2024, Wu et al.
Malignant Mesothelioma of the Tunica Vaginalis: About a Rare Clinical Case. J. Guerra, J.M. Pina, V. Andrade, et al. 2024;16(9):e69897. Case report PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma (MM) of the tunica vaginalis is an exceedingly rare neoplasm, with fewer than 300 cases reported in the medical literature. Due to its rarity, epidemiology, and risk factors are still unclear, and it is unknown whether asbestos or chronic inflammatory conditions play a role in etiology. This case study presents a 70-year-old male patient with MM of the tunica vaginalis, detailing the diagnostic challenges, treatment procedures, and eventual progression to palliative care. The study underscores the importance of accurate diagnosis and the aggressive nature of the disease despite treatment efforts.

Copyright © 2024, Guerra et al.
Malignant Mesothelioma: Overcoming Diagnostic Hurdles. P.D. R, S. Grace Priyadarshini, J. P. 2024;16(9):e68718. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma, an aggressive neoplasm frequently linked to asbestos exposure, is often detected at an advanced stage. This report details the case of a 58-year-old mason who presented with left-sided chest pain, and shortness of breath, accompanied by weight loss for a month. A positron emission tomography (PET) scan revealed increased uptake along the pleural surface, as well as in several mediastinal lymph nodes and the left supraclavicular lymph node. Thoracoscopy revealed the presence of multiple nodules on the costal pleura. Despite repeated negative results from pleural effusion cytology, cell block analysis, and pleural biopsies, the diagnosis of malignant mesothelioma (MM) was ultimately established through an ultrasound-guided (USG) biopsy of the left supraclavicular lymph node, with immunohistochemical confirmation using calretinin.

Copyright © 2024, R et al.
Mesothelial Cyst in the Uterine Myometrium: A Rare Localization. G. Arslan, Y. Acar Sabir. 2024;16(12):e75158. Case report PubMed · Publisher · Free full text

Abstract

Mesothelial cysts in the uterus are exceedingly rare. A 41-year-old patient presented with complaints of abdominal pain, and transvaginal ultrasonography revealed an enlarged uterus with a hypoechoic intramural cystic mass measuring 7.2 × 3.3 × 3.6 cm in the posterior uterine corpus. Suspecting a degenerated leiomyoma, the patient underwent a total laparoscopic hysterectomy and bilateral salpingectomy. Intraoperatively, a cystic lesion approximately 7 cm in size was observed within the myometrium of the posterior uterine wall. Pathological examination, supported by immunohistochemical findings, confirmed the diagnosis of a mesothelial cyst. Mesothelial cysts can mimic various clinical and radiological entities, and definitive diagnosis is typically established through pathological evaluation following complete excision of the lesion.

Copyright © 2024, Arslan et al.
Nanotechnology's Applications and Potential in Various Fields. A.K. Soni, R.K. Jha. 2024;16(4):e59234. Review PubMed · Publisher · Free full text

Abstract

Since ancient times, several sorts of nanoparticles have been employed in the quickly expanding field of nanotechnology. These features include size, shape, and chemical as well as physical properties. Because of their small size and huge surface area, carbon-based nanoparticles, including fullerenes, carbon nanotubes, graphene, graphene oxide, and carbon-based quantum dots, have attracted a lot of attention in a variety of sectors, including biomedical applications. Lipid bilayers form the spherical vesicles known as liposomes. Magnetic resonance imaging (MRI) contrast agents are iron oxide nanoparticles. These materials are perfect for drug and delivery of genes, bioimaging, and bone repair because of their remarkable mechanical, electrical, visual, and chemical properties. However, concerns about potential asbestos-related diseases have arisen due to their length-to-width aspect ratio. Ceramic nanoparticles, on the other hand, are a common material in daily life and play a crucial role in bone repair, multiscale hybridisation, and aerospace structures. These nanoparticles can enhance osseointegration and bone development by mimicking the nanocomposition and nanoscale characteristics of bone tissue and enhance osteoconductive and osteoinductive capacities. Ceramic nanoparticles, however, have the potential to generate oxidative stress, which can result in irritation of the reticuloendothelial system, cytotoxicity to the heart, liver, and lungs, as well as toxicity to the cells that are attached. Additionally, oxidative stress, cell damage, and genotoxicity might result from the generation of free radicals by ceramic nanoparticles. Metal nanoparticles exhibit linear optical properties similar to molecular systems but arise from a different physical process. Semiconductor nanocrystals (NCs) are made from various compounds, such as silicon and germanium. Polyandry nanoparticles are particles approximately 10 and 10000 nanometers (nm) in size that can contain active substances. They have applications in vaccine delivery, gene therapy, and polymer nanoparticles (nanomedicine) for therapeutic applications.

Copyright © 2024, Soni et al.
Pemetrexed-Induced Pseudocellulitis: A Diagnostic Conundrum. L.A. Horton, A.B. Lyons, M.C. Kwa, et al. 2024;16(1):e52114. Case report PubMed · Publisher · Free full text

Abstract

Pemetrexed, an anti-folate, antineoplastic agent, effectively treats various malignancies such as non-small cell lung cancer (NSCLC) and mesothelioma. Here, we report two cases of recurrent pemetrexed-induced lower extremity erythema and edema, one in a 60-year-old male and the other in a 47-year-old male, who were both treated for recurrent cellulitis on multiple occasions before finally being diagnosed with pemetrexed-induced pseudocellulitis (PIP), a rarely reported adverse effect. This is an important diagnostic pitfall for clinicians to be aware of, as early recognition may minimize patient morbidity and prevent unnecessary hospitalization and antibiotic use for presumed cellulitis.

Copyright © 2024, Horton et al.
Peritoneal Carcinomatosis: When Everything Is Not What It Seems. S. Perdigão, R. Cunha, C. Costa, et al. 2024;16(1):e52924. Case report PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare neoplasm with a low incidence rate worldwide but high morbidity and mortality rates. Due to its rarity, the studies are scarce. We present a case of a 73-year-old woman admitted to the internal medicine unit with constitutional syndrome, abdominal pain, and ascites. Throughout the investigation, aspects suggestive of peritoneal carcinomatosis were identified. An extensive study was then carried out in an attempt to identify the primary tumor, which proved to be unsuccessful. During the two weeks of hospitalization, the patient's clinical condition worsened, with an increase in ascites and a deterioration in her general health. This case was then discussed with an oncology consultant, and it was decided to biopsy a peritoneal implant with the support of interventional radiology. MPM was then diagnosed through histopathology. With this case, the authors intend to highlight that, although rare, this diagnosis should be considered when appropriate and that even in the suspicion of secondary disease, the primary tumor should always be identified, as localized MPM may be curable.

Copyright © 2024, Perdigão et al.
Safety of First-Line Nivolumab Plus Ipilimumab in Very Old (≥ 80 Years) Patients With Unresectable Malignant Pleural Mesothelioma: A Retrospective Single-Center Case Series. T. Shimamoto, Y. Morimoto, N. Nitta, et al. 2024;16(1):e52714. Case report PubMed · Publisher · Free full text

Abstract

Nivolumab plus ipilimumab as the first-line treatment results in superior survival outcomes in patients with malignant pleural mesothelioma (MPM). However, its safety in old (≥ 80 years) patients with MPM has not been elucidated yet. Three male patients with MPM, aged 80-90 years, were treated with nivolumab plus ipilimumab as the first-line treatment in our hospital. All of them discontinued the treatment due to adverse events. The overall survival from treatment initiation was 2.5, 3.5, and 4.0 months, respectively. Nivolumab plus ipilimumab should be used cautiously in very old patients with MPM.

Copyright © 2024, Shimamoto et al.
Sarcomatoid Mesothelioma With New Pancreatic Lesions Presenting As Acute Pancreatitis: A Case Report. F. Al-Moussally, F. Alamin, S. Khan, et al. 2024;16(7):e64088. Case report PubMed · Publisher · Free full text

Abstract

Sarcomatoid mesothelioma is a rare, aggressive malignancy that usually follows asbestos exposure. It is the least common subtype of mesotheliomas, following epithelial and biphasic subtypes. Pleural mesothelioma can metastasize, with the liver, kidneys, adrenal glands, and opposite lungs being the most commonly reported sites for metastasis. Metastasis of the pancreas is extremely rare, which is why the authors of this case report intend to present the case of a 78-year-old male who was found to have acute pancreatitis, most likely secondary to metastatic lesions.

Copyright © 2024, Al-Moussally et al.
Spindle Cell Malignancy and Asbestos Exposure: A Case Report. N. Walker, C. Okafor, N. Gandhi, et al. 2024;16(2):e54382. Case report PubMed · Publisher · Free full text

Abstract

We outline the presentation of a 68-year-old woman who received a chest radiograph due to her insurance requirements, resulting in the discovery of a left-sided pleural effusion. The effusion was further characterized as loculated on subsequent imaging. Thoracentesis yielded exudative fluid, leading to the patient undergoing video-assisted thoracoscopic surgery (VATS). During this procedure, a cystic mass was visualized, with the conversion of the operation to an open thoracotomy and left lower lobe lobectomy. Pathology was positive for spindle cell sarcoma. A thorough history of the patient revealed a decades-long occupational exposure to asbestos. The significance of this report is to illustrate the clinical presentation, immunohistochemical characteristics, and management of a rare spindle cell malignancy. Our case also raises the importance of screening patients on an individualized, shared decision-making basis.

Copyright © 2024, Walker et al.
Timely Surgical Resection Achieved Prolonged Remission in Patients With Malignant Mesothelioma of the Tunica Vaginalis Testis and Retroperitoneal Recurrence. M. Radovanovic, U. Kojic, A. Zubelic, et al. 2024;16(4):e59052. Case report PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare tumor of the testicular sheath. More than 50% of cases initially present as recurrent hydrocele, but there have also been documented cases with hematocele, inguinal hernia, or epididymitis. Due to the non-specific symptoms and signs of the disease, it is almost always diagnosed intra- or postoperatively. The lack of standardized therapy protocols, as well as the lack of evidence supporting systemic chemotherapy, have fueled arguments in favor of the necessity of retroperitoneal lymph node dissection (RPLND) in the treatment of the disease, especially in the case of lymph node metastasis. We present a case of MMTVT achieving prolonged remission after timely and extensive surgical treatment.

Copyright © 2024, Radovanovic et al.
Tumor-Induced Oblique Abdominal Muscle Paralysis Syndrome: A Case of Position-Dependent Abdominal Distension and Umbilical Displacement. Y. Ishikawa, K. Sakai, S. Teramura, et al. 2024;16(12):e75341. Case report PubMed · Publisher · Free full text

Abstract

Unilateral paralysis of the oblique abdominal muscles is commonly linked to non-malignant conditions, such as herniated discs, shingles, and phrenic nerve injury, each leading to localized muscle weakness through nerve impairment. However, oblique abdominal muscle paralysis caused by malignant tumors is exceedingly rare. This report presents a unique case of left oblique abdominal muscle paralysis induced by malignant pleural mesothelioma (MPM), demonstrating a distinct pattern of position-dependent abdominal bulging and umbilical displacement. The patient, a male in his 70s, was initially treated with chemotherapy for left-sided MPM and later received radiation therapy (RT) for pleural lesions causing pain. As the disease progressed, he developed a visible bulging of the left lateral abdomen, which was more pronounced in upright positions (standing or sitting) and resolved in the supine position. CT imaging showed atrophy of the left oblique abdominal muscle and a displacement of the umbilicus to the right, findings were consistent with intercostal nerve impairment due to tumor invasion. This case underscores the importance of conducting abdominal examinations in various positions when nerve impairment by a tumor is suspected. The presence of position-dependent lateral abdominal bulging, lateral displacement of the umbilicus, and lack of intraperitoneal abnormalities should raise suspicion for tumor-induced oblique abdominal muscle paralysis. We propose defining such cases as "tumor-induced oblique abdominal muscle paralysis syndrome" to improve diagnostic accuracy and aid in the effective management of malignancy-associated abdominal neuropathies.

Copyright © 2024, Ishikawa et al.
Validity of Pleuroscopy in Evaluating Pleural Effusions of Uncertain Etiology at the Cardiothoracic Unit of Minia University Hospital, Egypt. A. Abdelaziz, R. Hassan, R. Abdelfattah, et al. 2024;16(4):e59300. PubMed · Publisher · Free full text

Abstract

Introduction: Pleural effusion is a medical condition where an excessive amount of fluid accumulates in the pleural space. This can be caused by inflammation or malignant growth in the body. Doctors use medical thoracoscopy for both diagnostic and therapeutic purposes. This technique allows them to view the internal pleural surfaces and take biopsies of any abnormal lesions within the pleural cavity.

Objective: This work aimed to evaluate the diagnostic value of pleuroscopy in patients with undiagnosed exudative pleural effusion.

Patients And Methods: A study was conducted on 61 patients who had undiagnosed exudative pleural effusion and were admitted to the chest department at the cardiothoracic unit of the Minia University Hospital. All patients provided written consent and underwent a complete history and clinical examination. Standard laboratory tests, including routine liver and kidney function tests, a complete blood count, and a coagulation profile, were conducted on all patients, along with chest X-rays. If necessary, a chest CT scan was also performed. Diagnostic thoracentesis was done, and the pleural fluid was analyzed for sugar, protein, and lactate dehydrogenase and sent for bacteriological analysis (Gram stain, culture, and acid-fast bacilli smear) and cytopathological examination. Medical thoracoscopy was performed in cases where an etiological diagnosis was not established.

Results: A total of 61 patients with undiagnosed exudative pleural effusions were included. A definitive etiological diagnosis was reached in 58 (95%) patients. In 47 (77%) of the studied group, malignant etiology was confirmed; nine (14.8%) had tuberculous pleurisy, one (1.6%) had empyema, and one (1.6%) had inflammatory/autoimmune pleurisy. A definite diagnosis was not reached in three (5%) patients. The malignant pathology was caused by bronchogenic carcinoma in 20 (42.5%) cases, malignant mesothelioma in 10 (21.3%) cases, metastatic malignant deposits from other organs in six (12.7%) cases, and lymphoma in three (6.5%) cases. No serious adverse events related to the procedure were recorded. The most common minor complications were transient chest pain in 34 (55.7%) patients, followed by surgical emphysema in 10 (16.4%) patients.

Conclusion: Pleuroscopy is an effective diagnostic tool for identifying the cause of pleural effusion when it is unclear. It is a minimally invasive and straightforward procedure associated with high diagnostic accuracy and low complication rates.

Copyright © 2024, Abdelaziz et al.
A Case of Rosai-Dorfman Disease Presenting as an Isolated Pleural Plaque. A. Rathinam, S. Gupta, R. Khanam, et al. 2023;15(7):e41334. Case report PubMed · Publisher · Free full text

Abstract

Rosai-Dorfman disease (RDD) is a rare non-Langerhans histiocytic disorder primarily involving lymph nodes. Extranodal RDD has a heterogenous presentation, and isolated pulmonary involvement is rare. We report the only case of RDD presenting as an isolated pleural mass. Our patient was a 55-year-old female with multiple comorbidities who presented with chest pain. Imaging revealed an enlarging pleural-based lesion. She underwent resection of the pleural mass, showing an atypical histiocytic infiltrate in a prominent background of collagenous fibrosis. Immunohistochemistry shows CD1a-negative and S100-positive atypical histiocytic cells demonstrating emperipolesis, confirming the diagnosis of RDD. She is currently on six-month CT surveillance with no recurrence of the disease. This case highlights the unique pulmonary presentation of RDD. It also underscores that observations may be appropriate in isolated asymptomatic pleural involvement cases.

Copyright © 2023, Rathinam et al.
A Gelatinous Pleural Effusion as a Diagnostic Clue. D. Barroso, R. Rego. 2023;15(3):e35942. Case report PubMed · Publisher · Free full text

Abstract

Pleural effusion is a common presentation of several pathologies, and the determination of its cause is facilitated by macroscopic, biochemical, microbiological, and cellular analysis. A systematic approach to analyzing the fluid allows for a reduction in clinical diagnoses. Only a select number of diagnoses can be established definitively by thoracentesis, including effusions because of malignancy. We report the case of an 84-year-old male with a right large-volume pleural effusion with an initial diagnostic thoracocentesis demonstrating an exudate with a gelatinous appearance and exudate characteristics. The physical characteristics of the pleural effusion quickly raised the suspicion of mesothelioma, a rare tumor associated with a poor prognosis. In most diseases related to pleural effusion, fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Malignant pleural mesothelioma may present as a viscous pleural effusion with gelatinous characteristics, which may immediately raise suspicion and contribute as a diagnostic clue in the initial study of a pleural effusion. This article was previously presented as a meeting abstract at the 28º Congresso Nacional de Medicina Interna in October 2022.

Copyright © 2023, Barroso et al.
A Worsening Cough: An Unusual Presentation of Malignant Mesothelioma. Y. Alsalihi, C. Kandaswamy. 2023;15(8):e43205. Case report PubMed · Publisher · Free full text

Abstract

Localized malignant pleural mesothelioma (LMPM) is a rare cancer with poor survival rates. Often affecting males with asbestos exposure, we report a case of a 56-year-old female with no history of occupational exposure presenting with a worsening cough. A radiological examination revealed left pleural effusion and pleural thickening. Cytological and pathological reports of pleural samples were consistent with malignant mesothelioma of epithelioid type, with the histological examination via video-assisted thoracoscopic surgery (VATS) consistent with a clear cell epithelioid mesothelioma. We discuss the rapid presentation of the disease with emphasis on considering the disease in young patients with no prior asbestos exposure.

Copyright © 2023, Alsalihi et al.
Asbestos Exposure and Development of Pulmonary Pleomorphic Carcinoma in a Non-smoker: A Rare Non-small Cell Lung Cancer. A.L. Alejo, R.A. Patel, K.K. Pandya, et al. 2023;15(4):e37860. Case report PubMed · Publisher · Free full text

Abstract

Pulmonary pleomorphic carcinoma (PPC) is a subtype of non-small cell lung cancer that is extremely rare and carries a poor prognosis due to its inadequate response to treatment. Patients that present with PPC often exhibit similar symptoms of other malignancies of the lung, making it hard for clinicians to distinguish between each type. However, cytology and gene mutation testing are two approaches that can aid physicians in an accurate and definitive diagnosis. We present a case of an 88-year-old male patient with a diagnosis of pulmonary pleomorphic carcinoma after experiencing recurrent sanguineous pleural effusions. The patient had no smoking history but did have a history of asbestos exposure and pulmonary fibrosis. The patient underwent thoracotomy with pleurodesis and analysis of the surgical pleural biopsy specimen stained positive for markers indicative of PPC. The pathology report was also consistent with the associated cell morphology. Lung cancer is the leading cause of mortality due to cancer in the United States, and exposure to certain substances contributes to the development of these poorly treatable lung malignancies. Smoking and asbestos exposure are well known to act synergistically with each other as risk factors in developing these lung malignancies. In addition to clinical suspicion, screening for these risk factors with laboratory values and imaging is important to diagnose these rare cases of lung malignancies.

Copyright © 2023, Alejo et al.
Brain Metastases With Malignant Peritoneal Mesothelioma: Never Reported Before. D. Lal, M. Misiura, W. Adeel, et al. 2023;15(8):e43744. Case report PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a very rare diagnosis. Malignant mesotheliomas arise from surface linings of pleura, peritoneal cavity, or tunica vaginalis and pericardium with pleural malignant mesotheliomas being the most common. The incidence of brain metastases has been very low with malignant pleural mesotheliomas, but to date, there have not been any cases reported of brain metastasis with malignant peritoneal mesotheliomas. We present a patient diagnosed with malignant peritoneal mesothelioma and was successfully treated with immunotherapy for over two years but later presented with brain metastases. Although the patient had a surgical resection followed by brain radiation, he died three months after his diagnosis of brain metastases. Immunotherapy has revolutionized the treatment of malignant mesothelioma, and patients are living longer than before. We present this patient to increase awareness of brain metastases with malignant peritoneal mesothelioma. This case also highlights that we need to investigate different treatment options for brain metastases in patients with malignant mesothelioma as conventional treatment options like surgical resection and brain radiation are not very effective.

Copyright © 2023, Lal et al.
Does the Presence of Asbestos-Containing Materials in Buildings Post-construction and Before Demolition Have an Impact on the Exposure to Occupants in Non-occupational Settings?. R. Singh, A.L. Frank. 2023;15(4):e37305. Review PubMed · Publisher · Free full text

Abstract

This narrative review aims to determine if asbestos-containing materials in buildings pose a hazard to building occupants in non-occupational settings. This paper is limited to the post-construction and pre-demolition stages of a building. The researchers selected 19 studies from the 126 studies screened, concerning exposure to asbestos fibers in non-occupational building settings, with a focus on post-construction and pre-demolition phases. The literature review found that certain conditions, such as the measurement techniques, standards, and previous data availability, prevent a conclusive answer to the research question. Some studies have pointed towards an effect of asbestos-containing materials on health of occupants in non-occupational settings. But, there are some that do not suggest a positive relationship between non-occupational exposure and the presence of asbestos-containing materials, and therefore these provide scope for further research, as these studies also do not rule out the relationship completely. The present study highlights the gaps in current knowledge and indicates areas for further research. Until conclusive evidence based on revised threshold standards and accurate measurement techniques is available, asbestos-containing materials may be considered unsafe for use in non-occupational settings, especially ones that young people and children occupy.

Copyright © 2023, Singh et al.
Malignant Peritoneal Mesothelioma: A Case Report. B. Sousa, J. Silva, N. Monteiro, et al. 2023;15(8):e42902. Case report PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare tumor of the serous membranes of the peritoneum and has been linked to exposure to asbestos and other risk factors. The clinical manifestations are vague, with a wide clinical spectrum, predominantly related to the abdominal involvement of the disease. Localized mesothelioma is an uncommon manifestation of the disease. Common symptoms include abdominal pain or abdominal distention, nausea, anorexia, and weight loss. Rarely, patients present with paraneoplastic syndrome. Due to the nonspecific symptoms, many patients already have advanced disease at the time of diagnosis. The authors report a case of a 75-year-old female patient who presented with symptoms of asthenia, anorexia, progressive paleness, and weight loss lasting five months. She reports later new-onset symptoms of diffuse abdominal pain and diarrhea associated with nausea. Laboratory tests showed anemia, mild leukocytosis, thrombocytosis, elevated C-reactive protein (CRP), and elevated liver enzymes. An abdominal and pelvic computed tomography (CT) scan revealed marked tissue thickening of an irregular and striated configuration of the leaflets and peritoneal reflections in an omental cake pattern, and a chest CT scan showed multiple bilateral pulmonary nodules, suggesting diffuse malignant disease. A CT-guided biopsy of a peritoneal implant was performed, establishing the diagnosis of malignant peritoneal mesothelioma. Due to rapid clinical deterioration, the patient did not receive any systemic treatment, surgery, or radiotherapy and was transitioned to comfort care. As in the presented case, most cases of MPM have diffuse peritoneal involvement at the time of diagnosis, although extra-abdominal involvement is very rare. This disease presentation is associated with high morbidity and mortality compared to cases of localized disease. There is no specific imaging diagnostic modality or valuable tumor markers for MPM. Although a CT scan remains important in the diagnostic approach, the changes found are not specific. Radiographically, MPM may present as mesenteric or parietal peritoneal nodules, visceral peritoneal thickening, ascites, or omental masses. Although these features may raise suspicion of MPM, a biopsy is necessary to confirm the diagnosis. Therefore, due to the rarity of this disease and its nonspecific signs or symptoms, MPM is difficult to diagnose, and the prognosis remains poor.

Copyright © 2023, Sousa et al.
Malignant Pleural Mesothelioma (MPM) Presenting as Hydropneumothorax. M. Kuramochi, T. Muraoka, M. Shinonaga, et al. 2023;15(7):e41243. Case report PubMed · Publisher · Free full text

Abstract

An 86-year-old man presented with bilateral lower limb edema and was found to have hydropneumothorax on chest radiography. CT revealed a substantial pleural effusion and plaques. The patient had a history of working in a stone workshop, but the extent of asbestos exposure remained unknown. Thoracic drainage and subsequent thoracoscopic surgery confirmed the presence of biphasic malignant mesothelioma through pathological examination. Hydropneumothorax as a presentation of malignant pleural mesothelioma (MPM) is rare, with only a few similar cases reported. Remarkably, despite the coexistence of plural effusion and pneumothorax, the patient did not experience dyspnea. The examination also revealed tumor rupture and disruption of the pleura. Considering the possibility of MPM in patients with asymptomatic hydropneumothorax is essential for early diagnosis and appropriate management.

Copyright © 2023, Kuramochi et al.
Modern Malignant Mesothelioma Manifestation. A.N. Razzak, A. Syed, E.R. Procknow, et al. 2023;15(3):e36479. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) involves the uncontrolled growth of mesothelial cells that form the lining of pleural serous layers. MPM has been linked with asbestos exposure in mining and manufacturing occupations with an unforgiving prognosis of 4-18 months. In this case report, we present a 56-year-old male with a significant past medical history of hypertension, hyperlipidemia, hepatic steatosis, and ulcerative colitis who presented to the emergency department for worsening cough, eight-pound weight loss over the previous year, night sweats, and fatigue. The patient was admitted due to right pleural effusion with lower lobe collapse seen on imaging; upon diagnostic workup including pleural biopsy, results were consistent with malignant mesothelioma of the epithelioid type. Over the course of six months post-diagnosis, the patient underwent multiple hospital admissions due to acute hypoxic respiratory failure from the segmental left upper lobe and subsegmental right upper lobe pulmonary emboli, recurrent pleural effusion, and anemia. Given the aggressive nature of MPM, the patient was determined not to be a surgical candidate and underwent palliative chemotherapy sessions until his passing. As the patient worked in heating/ventilation/air conditioning with asbestos exposure, taking a full occupational history was crucial. MPM is relatively rare; however, the incidence has increased over the last decade due to tumor development lag time post-asbestos exposure and an increase in do-it-yourself projects. There is no cure for MPM. Multimodal treatment approaches with surgery, chemotherapy, radiotherapy, and immunotherapy have been noted in the literature.

Copyright © 2023, Razzak et al.

In plain English

This case report described one patient, a 56-year-old man whose medical history included hypertension and ulcerative colitis. He first went to an emergency department with tongue swelling and a minor cough, which were attributed to his blood-pressure drug. Ten days later he returned with a worsening cough, an 8-pound weight loss over the prior year, night sweats and fatigue. A CT scan showed thickening of the right pleura (the lung lining) and fluid around the right lung. An early workup favored a reactive, non-cancerous change. A right pleural biopsy was later reported as consistent with malignant mesothelioma of the epithelioid type. He reported past work in heating, ventilation and air conditioning (HVAC) and maintenance at old construction sites with asbestos exposure. The article does not name a fiber type. He developed blood clots in his lungs and was judged not a surgical candidate. He had five palliative chemotherapy sessions, deteriorated over six months, and died at home in hospice care. The authors concluded that the case highlighted the importance of taking an occupational history.

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.
Peritoneal Inclusion Cyst in a Young Patient With a Long History of Abdominal Surgeries: A Case Report. J.O. AlTamimi, E.A. Alzahrani, A. Fallatah, et al. 2023;15(2):e35230. Case report PubMed · Publisher · Free full text

Abstract

Peritoneal inclusion cysts (PICs) are reactive, fluid-filled lesions of the peritoneal lining, usually affecting women of reproductive age and with previous abdominal surgeries. Paraovarian cysts, hydrosalpinx, and low-grade cystic mesothelioma are usually considered in the differential diagnosis of PICs. In this case report, we present an 18-year-old female with a known case of bladder exstrophy and chronic urinary incontinence and a previous history of surgical bladder repair. She presented to the emergency department (ED) with urinary incontinence and lower abdominal pain. A computed tomography was ordered for her to rule out hydronephrosis, and incidentally, ovarian cysts were discovered that were then bilaterally excised via laparotomy. Our case report emphasizes the significance of considering such a diagnosis when coming across patients whose risk factors and symptoms match the diagnosis.

Copyright © 2023, AlTamimi et al.
Pleural Mesothelioma: A Rapid Evolution of an Indolent Disease. M. Romano, P. Pinto, R. Afonso, et al. 2023;15(1):e33965. Case report PubMed · Publisher · Free full text

Abstract

Mesothelioma is a rare and insidious neoplasm and is characterized by its highly malignant and aggressive nature. The most common etiology is asbestos exposure, but there are some reports without known asbestos exposure and other factors leading to malignant pleural mesothelioma (MPM). Here, we present the case of a 58-year-old woman with pleuritic chest pain, dyspnea, and fever on presentation to the emergency department (ED), which caused several admissions to the ED in 20 days. The patient was then admitted to the internal medicine department with a diagnosis of community-acquired pneumonia with parapneumonic effusion. During hospitalization, a positron emission tomography (PET) scan, thoracic computed tomography (CT), and pleural biopsy were performed and a final diagnosis of malignant epithelioid pleural mesothelioma was made. Six weeks after the onset of symptoms, the patient presented with an exponential disease progression, dying two months after the diagnosis, despite the initiation of chemotherapy. MPM remains a diagnostic and therapeutic challenge with a very poor prognosis. However, studies show that mesothelioma patients who undergo treatment live at least twice as long as patients who do not receive treatment. This case report is particularly significant because, although it was epithelioid mesothelioma, multiple solid masses were noted on CT and the patient exhibited rapid disease progression, dying a few weeks after starting treatment.

Copyright © 2023, Romano et al.
Transient Thyroiditis Followed by Exacerbation of Hypothyroidism After Immune Checkpoint Inhibitor Therapy (Nivolumab and Ipilimumab) in a Patient With Pre-existing Autoimmune Hypothyroidism: A Case Report. G. Hayakawa, M.M. Leibowitz, S. Datta, et al. 2023;15(5):e39439. Case report PubMed · Publisher · Free full text

Abstract

Treatment with immune checkpoint inhibitors has improved the prognosis of solid tumors. However, immune-related adverse events (IRAEs), including exacerbation of pre-existing autoimmune disease, are common and have become more frequent with combination therapy. The literature is scanty regarding reports of the use of combination immune checkpoint therapy in patients with pre-existing autoimmune hypothyroidism. We report a case of a man with a history of hypothyroidism, who developed transient thyroiditis, characterized by a thyrotoxic phase followed by a severe hypothyroid phase soon after receiving combination therapy (nivolumab and ipilimumab) for the treatment of a malignant pleural mesothelioma. He had been on a stable low dose of levothyroxine for 12 years prior to this episode. His levothyroxine requirement markedly increased soon after the episode of immune checkpoint inhibitor-induced thyroiditis. Immune checkpoint inhibitors can cause destructive thyroiditis followed by exacerbation of hypothyroidism in patients with pre-existing autoimmune hypothyroidism, such that patients end up on a higher dose of levothyroxine. This case will add to the growing literature regarding thyroid IRAEs associated with the use of immune checkpoint inhibitors in patients with pre-existing autoimmune thyroid disease.

Copyright © 2023, Hayakawa et al.
A Case Report of Hypophosphatemia Leading to the Diagnosis of Mesothelioma. Z.W. Goh, F. Hasan. 2022;14(5):e25285. Case report PubMed · Publisher · Free full text

Abstract

Hypophosphatemia can be commonly encountered as an electrolyte imbalance and is defined as a value less than 0.8 mmol/l (2.5 mg/dl). It can be an incidental finding, but it is not uncommon to see it presenting with varied symptoms. It is good to have a clear diagnostic approach to this so adequate treatment can be instated. We present a 66-year-old gentleman who presented with hypophosphatemia. Investigations confirmed renal phosphate wasting secondary to fibroblast growth factor-23 (FGF-23). Imaging showed right pleural effusion, and pleural biopsy confirmed malignant mesothelioma. This may just be an association rather than the cause of his hypophosphatemia. It does however highlight the importance of further investigations for patients with tumor-induced osteomalacia.

Copyright © 2022, Goh et al.
A Case Report of Mesothelioma Response to Endocrine Therapy in Synchronous Breast Cancer and Pleural Epithelioid Mesothelioma: A Double Exemestane Effect. M. Pina, R. Fernandes, D. Fonseca, et al. 2022;14(11):e31579. Case report PubMed · Publisher · Free full text

Abstract

Synchronous pleural mesothelioma (PM) and breast cancer are extremely rare. We present the case of a 53-year-old female diagnosed with localized breast cancer. She was radically treated with surgery, but during the adjuvant radiotherapy, the patient developed fever and dyspnoea, and pleural thickening was found on a CT scan. The biopsy confirmed the diagnosis of a synchronous malignancy - pleural epithelioid mesothelioma. The patient stopped radiotherapy and started adjuvant endocrine therapy with exemestane, a third-generation aromatase inhibitor, with an unexpected partial response to the PM. The patient remains on exemestane with a sustained partial response. This is a rare case of synchronous tumours that show a real-life benefit of exemestane in the treatment of pleural mesothelioma, which was only described in vitro, with a good sustained response. This suggests a potential for exemestane in the treatment of mesothelioma, which is an aggressive form of cancer with few therapeutics with sustained results.

Copyright © 2022, Pina et al.
Biphasic Peritoneal Mesothelioma: A Lethal Clinical Entity. A. Waheed, S. Foroutan, A. McCloskey, et al. 2022;14(2):e22638. Case report PubMed · Publisher · Free full text

Abstract

Mesotheliomas are a rare malignancy of the serosal membrane. Mainly it affects the pleural surfaces followed by the second most common location, "peritoneum." The disease follows an aggressive pattern of spread, and by the time the diagnosis is established, the condition significantly spreads to distant locations. Diagnosis of malignant peritoneal mesothelioma is typically made by tissue biopsy. The standard treatment is radical resection; however, patients have benefited from several other modalities. The current case report describes a unique case of malignant mesothelioma, biphasic peritoneal mesothelioma (BPM), which comprises less than 25% of all peritoneal mesotheliomas. The diagnosis and treatment do not differ from other subtypes; however, the prognosis is poor, and if untreated, the survival is typically less than six months.

Copyright © 2022, Waheed et al.
Haemorrhagic Brain Metastasis From Malignant Pleural Mesothelioma: A Rare Case. C. Furtado, S. Srivastava, S. Nayak, et al. 2022;14(10):e30345. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) typically has a short median survival of only a few months from diagnosis, with death usually due to thoracic disease. This has led to the belief in the past that mesothelioma rarely has distant metastasis, with cerebral metastasis accounting for only 3%. The multiple cases of brain metastasis from MPM recorded so far were discovered after death at autopsy. This report describes a rare case of known malignant mesothelioma with distant haemorrhagic metastasis to the brain, reviews current literature about its metastatic potential to the brain and discusses prognosis and management. We also review the imaging evaluation in known MPM patients with suspected intracranial involvement and describe typical imaging findings of parenchymal brain metastasis on computed tomography (CT) and magnetic resonance imaging (MRI).

Copyright © 2022, Furtado et al.
Malignant Peritoneal Mesothelioma Presenting with High Protein, High Serum-Ascites Albumin Gradient. Z.P. Kerosky, C.R. Powell, P.C. Lindholm. 2022;14(7):e27286. Case report PubMed · Publisher · Free full text

Abstract

Mesothelioma is a difficult-to-detect neoplasm that rarely develops in the peritoneum. In patients with unexplained ascites, pleural fluid analysis and ultrasonography is often the first step to achieving a diagnosis. This case report shares a unique presentation in which a patient who presented with unexplained ascites, was initially thought to have cirrhosis but was later found to have malignant peritoneal mesothelioma after cross-sectional imaging and tissue acquisition. This case illustrates the importance of a high clinical index of suspicion for mesothelioma given its variety of clinical presentations, as well as the utility of early cross-sectional imaging in such cases.

Copyright © 2022, Kerosky et al.
Malignant Peritoneal Mesothelioma: A Challenging Case for Palliative Care. C. Vidal, I. Romero, I. Neto. 2022;14(8):e27580. Case report PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare and very aggressive malignancy of serosal membranes, which typically presents with abdominal pain, distension, and ascites. Due to its rarity and nonspecific symptoms, it is usually diagnosed late, when the disease burden is extensive and the therapy is inevitably palliative. It represents a complex challenge for clinicians because the treatment options are very poor and the illness has a great impact on patients' life. We present a complex case of a young patient with MPM who was admitted to our palliative care unit.

Copyright © 2022, Vidal et al.
Pericardial Mesothelioma Presenting as Constrictive Pericarditis. B. Shrestha, R. Handa, B. Poudel, et al. 2022;14(4):e24270. Case report PubMed · Publisher · Free full text

Abstract

This case report presents a 60-year-old gentleman with a significant smoking history and possible asbestos exposure who was referred to the emergency department for atrial fibrillation with a rapid ventricular rate and symptoms of heart failure. Labs showed normal brain natriuretic peptide and troponin I. His echocardiography finding suggested constrictive pericarditis with an ejection fraction of 60%. A computed tomography scan was concerning for a pericardial mass. Left and right heart catheterization hinted more toward constrictive physiology; however, some findings were concerning for restrictive physiology. Hence, cardiac magnetic resonance imaging was done, which established the diagnosis of constrictive pericarditis. Pericardiectomy was planned with a maze procedure for atrial fibrillation. However, a malignant neoplasm was seen on a frozen biopsy. Hence, surgery was limited to partial pericardiectomy, as the patient had advanced infiltrative neoplasm that had resulted in constrictive pericarditis. The final pathology report confirmed the diagnosis of malignant pericardial mesothelioma mixed type. Malignancy is usually diagnosed in an advanced stage, like in our case, due to nonspecific initial presentation. A literature review suggests that there is a lack of established consensus on treatment. The response to therapy also seems to be poor and results only in palliation of symptoms, with a median survival of six months from diagnosis despite optimum medical management.

Copyright © 2022, Shrestha et al.
Radiation Induced Abscopal Effect in a Patient With Malignant Pleural Mesothelioma on Pembrolizumab. R. Rittberg, E. Chan, S. Yip, et al. 2022;14(2):e22159. Case report PubMed · Publisher · Free full text

Abstract

Abscopal effect is a rare phenomenon in which treatment benefit from radiotherapy (RT) is seen outside the target field due to activation of the immune system inducing an anti-tumor effect. This phenomenon has been reported in cancer patients receiving immune checkpoint inhibitors (ICI). Here we report a case of presumed abscopal effect in malignant mesothelioma. The patient received second-line single-agent pembrolizumab however had disease progression after four cycles leading to palliative RT (20 Gray) to the right mainstem bronchus. Follow-up radiographic imaging confirmed benefit and pembrolizumab was continued. Follow-up computed tomography (CT) five months after RT, showed marked radiographic improvement of all measurable diseases with improvement in right-sided aerated lung volume. Because of the original disease progression on pembrolizumab, with marked improvements within and outside the RT field after RT, treatment response was presumed due to the abscopal effect.

Copyright © 2022, Rittberg et al.
Saved by the Scan: A Case of Early Detection of Sarcomatoid Mesothelioma. H. Choudhury, J. Budde, N. Ahmed, et al. 2022;14(7):e26793. Case report PubMed · Publisher · Free full text

Abstract

We report a case of localized sarcomesothelioma detected during screening via a low-dose CT (LDCT) scan. The patient is a 71-year-old female, a current 56-pack-year cigarette smoker with a past medical history of myocardial infarction and stroke with a Zubrod score of zero. A screening LDCT revealed a 1.9 cm × 1.8 cm × 1.4 cm right lower lobe lesion with smooth margins and close association with the hemidiaphragm. A wedge resection with biopsy showed high-grade sarcomatoid mesothelioma with extensive desmoplastic morphology and negative margins. The patient opted for imaging surveillance, and at 12 months has shown no evidence of tumor recurrence on positron emission tomography (PET)/CT. The case shows that LDCT screening discovers cancers and saves lives. It also presented a dilemma for the patient and her oncologist because common guidelines do not define a recommended treatment.

Copyright © 2022, Choudhury et al.
Simultaneous Use of Endobronchial and Endoscopic Ultrasound Guidance as Primary Tools in the Diagnosis of Malignant Pleural Mesothelioma. B. Mankidy, J. Sparkman, S. Boddu, et al. 2022;14(12):e32110. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is related to exposure to asbestos. It is insidious in nature and is generally diagnosed at an advanced stage. MPM is aggressive and portends a poor prognosis. Definitive diagnosis is usually established by obtaining pathological samples of the pleura by medical or surgical thoracoscopy. However, these procedures are invasive and carry a risk of seeding of biopsy sites with tumors. We herein report an infrequently encountered case of simultaneous use of endobronchial ultrasound and endoscopic ultrasound-guided biopsy of malignant pleural mesothelioma in a 48-year-old female patient.

Copyright © 2022, Mankidy et al.
Synchronous Jejunal Sarcomatoid Carcinoma and Incidentally Associated Localized Peritoneal Malignant Mesothelioma. M. Tachibana, M. Nozawa, K. Kamimura, et al. 2022;14(6):e26270. Case report PubMed · Publisher · Free full text

Abstract

Sarcomatoid carcinoma (SCA) of the small bowel is a rare aggressive variant of small intestinal cancer accompanying a poor prognosis. The tumor primarily affects middle-aged and elderly patients. We report herein a 67-year-old Japanese male who manifested anemia. He had a history of asbestos exposure 30 years earlier. An abdominal computed tomography (CT) scan showed a 6.5-cm aneurysmal, dilated mass of the small intestine. Capsule endoscopy revealed a large circumferential hemorrhagic ulcerative lesion in the jejunum. Biopsy indicated sarcomatoid carcinoma, and partial resection of the small bowel and adjacent transverse colon and omentum was performed. In addition to the T3N0M0 jejunal giant sarcomatoid carcinoma (SCA), a 3-mm small localized peritoneal (omental) malignant mesothelioma (LMM) was also incidentally included. Synchronous presentation of small intestinal and mesothelial malignancies is extremely rare, and the avoidance of incorrect clinical staging is critically important. Surgical resection is still considered the best first-line therapy, because of a poor response to chemotherapy and radiotherapy. Dual-color fluorescent in situ hybridization (FISH) for p16/CDKN2A and chromosome 9 indicated homologous deletion of p16/CDKN2A in SCA and a normal pattern in LMM. Methylthioadenosine phosphorylase (MTAP) was negative in SCA but positive in LMM. Both tumors consistently expressed BRCA1-associated protein 1 (BAP1). Tumor necrosis factor receptor-associated factor 7 (TRAF7) was suppressed, and neural cell adhesion molecule L1 precursor (NCAML1/L1CAM) was agitated in both tumors. Diffuse and strong expression of programmed death-ligand 1 (PD-L1) and the association of tumor-infiltrating lymphocytes in SCA may indicate a potential for PD-L1-targeted immunotherapy for treating this type of aggressive cancer. PD-L1 was focally expressed in LMM. The postoperative course was uneventful for two years.

Copyright © 2022, Tachibana et al.
Unexplained Pleural Effusion Leads to the Revelation of a Malignant Mesothelioma: A Case Report. M. Rhazari, O. Moueqqit, S. Gartini, et al. 2022;14(4):e24478. Case report PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a rare and aggressive cancer that usually affects subjects with prior asbestos exposure, a major risk factor that has been widely known as carcinogenic, and its use is now controlled if not banned in many areas of the world. Malignant mesothelioma originates from mesothelial surface cells covering the serous cavities, and the pleura is its most common site. Malignant pleural mesothelioma (MPM) typically presents with pleural effusion and chest wall pain with wide pleural thickening at radiological investigation. Although the histological examination along with immunohistochemistry helps yield the diagnosis, clinicians and experts face many challenges in diagnosing malignant mesothelioma not only due to the rarity of the disease but also due to the similarities that the disease share with other malignancies. Here, we report a case of a 55-year-old male patient with a history of chronic asbestos work exposure for 12 years who initially presented with unexplained pleural effusion and chest wall pain and was lost to follow-up but came back later with a worsening clinical state. This case is specially presented to raise awareness against cases of unexplained pleural effusion and chest pain.

Copyright © 2022, Rhazari et al.
"Omental Cake" in a Patient With Asbestosis Leading to the Diagnosis of Malignant Peritoneal Mesothelioma. A. García Martínez, I. Pavón Guerrero, L. Campos Gonzaga. 2021;13(5):e15116. Case report PubMed · Publisher · Free full text

Abstract

We report a case of a 68-year-old man with medical history of pleural asbestosis and diagnosed with malignant peritoneal mesothelioma. This neoplasm is rare, has a poor prognosis, and is associated with asbestosis in many cases. It manifests clinically insidiously and in relation to the intra-abdominal locoregional effect. Radiological findings are variable, although the finding of "omental cake" by CT scan is characteristic but not pathognomonic, as seen in our case. A biopsy is required for the diagnosis, which can be guided by radiology or surgery. Treatment options available are cytoreductive surgery with intraperitoneal hyperthermic chemotherapy or systemic chemotherapy. However, new therapeutic options are emerging, which are still under development and research.

Copyright © 2021, García Martínez et al.
A Rare Case of Malignant Pleural Mesothelioma in a Young Healthy Male Without Asbestos Exposure. S. Khatib, O. Asad, H. Asad, et al. 2021;13(8):e17199. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a highly aggressive malignant tumor that arises from mesothelial cells of pleural cavity. The main risk factor for MPM is asbestos exposure with most cases discovered in elderly males after a long latency period. However, here we report a rare case of MPM diagnosed in a healthy young male patient without significant asbestos exposure. We report the case of an otherwise healthy 47-year-old male who presented with one week of exertional dyspnea and chest pain. Chest X-ray showed unilateral large pleural effusion. Chest CT scan revealed confluent right hilar mass and pleural thickening. Pleural fluid analysis showed exudative features. Cytology was negative for malignant cells. Core tissue biopsy showed features of epithelioid mesothelioma. Although most cases of MPM have been reported in elderly male patients with significant asbestos exposure, more research is needed to explain the pathogenesis of MPM in young patients without asbestos exposure.

Copyright © 2021, Khatib et al.
A Review of Pirfenidone as an Anti-Fibrotic in Idiopathic Pulmonary Fibrosis and Its Probable Role in Other Diseases. P.V. Shah, P. Balani, A.R. Lopez, et al. 2021;13(1):e12482. Review PubMed · Publisher · Free full text

Abstract

Fibrosis is the result of chronic inflammation and is known to pathologically occur in many organs and systems. Pirfenidone (PFD) is an anti-fibrotic known for its use in idiopathic pulmonary fibrosis (IPF). In addition to being an anti-fibrotic, it acts as an anti-inflammatory and antioxidant as well. There have been studies on PFD in other diseases, some clinical and others preclinical. We have compiled and reviewed them to highlight just how widespread PFD use could be. Among many benefits of PFD in IPF, PFD has effectively improved patients' survival in those who had an acute exacerbation of IPF and has reduced respiratory-related hospitalization, among few others. PFD also has shown an improvement in vital capacity in patients with chronic hypersensitive pneumonitis. Also, it has demonstrated anti-fibrotic effects in systemic sclerosis-associated interstitial lung disease. In other diseases outside the lungs, PFD has reversed insulin resistance and proven to be effective in non-alcoholic steatohepatitis (NASH). It has prevented blindness post-alkali injury to the eye and has proven to decrease the proliferation of mesothelioma cells, just to name a few. This review encourages further research in connection with PFD and its use in other diseases and PFD pros in IPF.

Copyright © 2021, Shah et al.
Benign Multicystic Peritoneal Mesothelioma Presenting as a Colonic Mass. K. Pierre, N.F. Gomez, S. Bing, et al. 2021;13(6):e15540. Case report PubMed · Publisher · Free full text

Abstract

Benign multicystic peritoneal mesothelioma (BMPM) is a rare neoplasm of the abdominal mesothelium (i.e., peritoneum, mesentery, and omentum). We present the case of a 74-year-old male who presented with a right paracolic gutter fluid collection and cystic mass. The patient underwent diagnostic laparoscopy with resection of the mass. The final pathology revealed BMPM. The pathogenesis may have been related to longstanding diverticular disease, which could prove to be an underrecognized risk factor for the development of BMPM. Therefore, this case suggests a broadened differential diagnosis to include BMPM in specific cases of pre-operatively diagnosed colonic masses. The patient is disease-free 11 months post-operatively.

Copyright © 2021, Pierre et al.
CD26/Dipeptidyl Peptidase IV and Its Multiple Biological Functions. K. Pan, K. Ohnuma, C. Morimoto, et al. 2021;13(2):e13495. Review PubMed · Publisher · Free full text

Abstract

CD26/Dipeptidyl peptidase IV (DPPIV) is a cell surface glycoprotein with numerous roles including glucose metabolism, immunomodulation, and tumorigenesis. CD26/DPPIV is well recognized in diabetes, with DPPIV inhibitors being a class of oral hypoglycemic drugs called gliptins that are commonly used to treat type two diabetes mellitus. Recent work also indicated a potential role for CD26 in infectious diseases, including COVID-19, and immune-mediated disorders such as rheumatoid arthritis, inflammatory bowel disease, and graft-versus-host disease. In cancer, CD26/DPPIV expression has been characterized in numerous tumors such as hematologic malignancies, malignant pleural mesothelioma (MPM), renal cell carcinoma (RCC), hepatocellular carcinoma (HCC), gastrointestinal stromal tumor (GIST), and prostate, lung, colorectal, and ovarian (PLCO) cancer. Hence, CD26 has been frequently studied as a tumor biomarker and therapeutic target. CD26/DPPIV-targeted therapies have been evaluated in various cancers, including the use of anti-CD26 monoclonal antibodies as anticancer treatment in selected neoplasms. This review highlights our current understanding of the role of CD26 in cancer, diabetes, immune-mediated diseases, and infectious diseases. Enhanced understanding of CD26 biology and function may lead to novel therapeutic approaches in multiple human diseases.

Copyright © 2021, Pan et al.
False-Negative 18F-Fluorodeoxyglucose PET/CT in Malignant Pleural Mesothelioma. H. Corbin, C.D. Packer. 2021;13(8):e17263. Case report PubMed · Publisher · Free full text

Abstract

We report a diagnostically challenging case of a 77-year-old man who presented with shortness of breath and was found to have a large right hydropneumothorax with collapse of the right lung. A malignancy was suspected, but pleural fluid cytology and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging were negative. He then underwent video-assisted thoracoscopy with biopsies of the pleura and chest wall which revealed malignant pleural mesothelioma (MPM). Older patients with early stage MPM are more likely to have false-negative FDG PET/CT results. Pleural biopsy is essential when there is clinical suspicion for mesothelioma, even with negative initial FDG PET imaging.

Copyright © 2021, Corbin et al.
Malignant Pleural Mesothelioma Epidemiology in the United States From 2000 to 2016. A. Thomas, S. Karakattu, J. Cagle, et al. 2021;13(4):e14605. PubMed · Publisher · Free full text

Abstract

Introduction Pleural mesothelioma constitutes about 80% of all mesotheliomas. The peak incidence of malignant mesothelioma estimated using the cancer registries was in early 1990 to 2000 in the United States. The disease is primarily associated with asbestos exposure. The latency period between asbestos exposure and the development of malignant pleural mesothelioma (MPM) can range anywhere from 15 to 60 years. Asbestos exposure was peaked during the industrial revolution and World War II due to military and shipyard exposures. It is often difficult for the pathologist to distinguish different histological subtypes; due to the disease's rarity and the inadequate tissue sample obtained. There is no available data on the difference in epidemiology of different subtypes of MPM. Surveillance Epidemiology and End Results (SEER), cancer incidence data include population-based registries covering approximately 34.6% of the U.S. population. Here in our study, we analyze malignant pleural mesothelioma epidemiology in the United States, emphasizing different histological subtypes. Methods SEER data from 2000 to 2016 was used in our study. The primary site of cancer is selected as pleura, and malignant behavior only is selected as the filter. Data were analyzed using the SEER stat program. Overall epidemiology of MPM and epidemiology of epithelioid, fibrous, and biphasic histological subtypes were analyzed separately. We used annual percentage change (APC) to evaluate the trend in the epidemiology of MPM. Results summary A total of 11,857 cases of MPM were included in the primary cohort from the SEER 18 registry from 2000 to 2016. The total prevalence of MPM was highest in 2009 and was lowest in 2016. The APC in MPM incidence during this period is -2.0. After removing 5,989 cases with non-specified histology during the same period, the APC for each histological type is -0.7 for fibrous type, 1.8 for epithelioid type, and 2.9 for biphasic type. Out of 17 regional registries included in the study, the greatest statistically significant change in APC was seen in the Hawaiian registry -4.1. In contrast, the lowest statistically significant difference was seen in Seattle (Puget Sound) registry -1.7. The APC in the incidence of MPM among males during the study period was -2.4 while that of females was -0.9. The Iowa registry showed a statistically significant increase in APC of the epithelioid malignant mesothelioma with a statistically insignificant reduction in the overall MPM APC. Conclusion The overall incidence of MPM in the United States is declining, while the data showed an increase in the incidence of epithelioid and biphasic histological subtypes. The authors believe that these conflicting results can be attributed to improved histological diagnosis and improved biopsy techniques.

Copyright © 2021, Thomas et al.
Primary Pericardial Mesothelioma: A Rare but Serious Consideration. S. Seal, H. Simon. 2021;13(11):e19966. Case report PubMed · Publisher · Free full text

Abstract

Primary pericardial mesothelioma (PPM) is an extremely rare malignancy with a very poor prognosis. It poses a diagnostic challenge given its often late and non-specific presentation. This report describes a 74-year-old man who presented with central pleuritic chest pain and mild breathlessness. The patient was febrile and mildly tachycardic with crepitations in the right lung base. Blood tests revealed raised inflammatory markers and chest X-ray showed no acute pathology. Following admission, CT pulmonary angiogram showed a large left-sided mediastinal mass (approximately 110 x 70 x 85 mm) centered on the pericardium. Further post venous phase CT imaging identified possible myocardial invasion alongside suspicious liver nodules. Later, outpatient fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging highlighted further FDG avid pleural and liver lesions. CT-guided biopsy of the pericardial lesion was undertaken, with histology and immunohistochemistry indicating epitheliod-type mesothelioma. A significant malignant pericardial effusion was also identified, which ultimately required pericardial window formation. Immunotherapy was commenced utilizing dual nivolumab and ipilimumab, a novel regime for the treatment of mesothelioma. Palliative radiotherapy to the pericardial lesion will also be performed. Here, we demonstrate the diagnostic challenge of this vanishingly rare condition, which is usually diagnosed upon the development of associated complications. Early recognition gives the best chance of improved mortality, however, diagnosis requires a high index of clinical suspicion alongside prompt investigation, primarily involving cross-sectional imaging.

Copyright © 2021, Seal et al.
Round Atelectasis: A Peculiar Pseudotumor Seen on Echocardiogram. N. Abdelsayed, L. Check, M. Faris. 2021;13(12):e20646. Case report PubMed · Publisher · Free full text

Abstract

Round atelectasis (RA) is a rare disorder most commonly occurring in the presence of chronic pleural effusions due to the formation of adhesions and resultant pulmonary collapse. The most common culprit to this disease is asbestosis, but other causes of pleural effusions such as congestive heart failure and pneumonia are reported in the literature. RA can occasionally mimic pulmonary cancers and should be identified to prevent the associated morbidity of tumor workup. We present a case of RA seen on echocardiogram, and then later on computed tomography mimicking a pleural tumor in a 58-year-old female with preexisting heart failure and recurrent pleural effusions. Consultation with radiology and recognition of RA prevented the unnecessary potential morbidity and mortality of further workup.

Copyright © 2021, Abdelsayed et al.
The Rarest of the Rare: A Case of BAP1-Mutated Primary Peritoneal Mesothelioma. A. Gupta, A. Vasileva, S. Manthri. 2021;13(9):e18380. Case report PubMed · Publisher · Free full text

Abstract

Malignant mesotheliomas (MM), as described are rare tumors that are mostly associated with occupational exposure to asbestos. They most commonly occur in the pleura. Other unfamiliar sites where they can occur are the peritoneum, pericardium, and tunica vaginalis. There is no significant correlation between the amount and duration of asbestos exposure to mesothelioma development as reported by various studies over the years. Apart from the environmental exposure, the development of malignant mesothelioma has been linked to a mutation in the BAP1 gene, which can predispose the patient to develop other malignancies associated with BAP1 mutation. We report a case of a 43-year-old man without any significant risk factors, who presented with a complaint of abdominal discomfort and was found to have malignant peritoneal mesothelioma (MPM). With a known familial history of mesothelioma and melanoma, our patient underwent genetic testing which revealed a mutation in BAP1, affirming the strong association with the development of MPM. Young patients who develop malignant mesothelioma without risk factors for MM should have germline testing for BAP1. This case report is unique and highlights a familial variant of mesothelioma, even rare with peritoneal mesothelioma in our patient.

Copyright © 2021, Gupta et al.
Utilization of Isometric Strength Training and Interval Training With a Patient With Cancer in the Acute Care Setting. A. Chongaway. 2021;13(6):e15570. Case report PubMed · Publisher · Free full text

Abstract

The onset of cancer and subsequent treatments often result in deficits in physical function and quality of life (QoL). Available research has demonstrated that an individualized exercise program has the ability to reduce fatigue, optimize physical function, and improve QoL. However, the exercise program is often lacking appropriate intensity and volume resulting in negligent improvement or even further reduction in function. Thus, the purpose of this case report is to demonstrate the application of isometric strength training (IST) and high-intensity interval training (HIIT) in the acute care setting with an individual with a history of malignant mesothelioma. The patient demonstrated improvement in functional mobility evidenced by improvement in Activity Measure for Post-Acute Care (AM-PAC) score through the hospitalization along with increased ambulation distance. No adverse events occurred during any physical therapy (PT) visits while utilizing HIIT or IST.

Copyright © 2021, Chongaway et al.
Coronavirus Disease 2019 Presenting as Abdominal Distension in a Mesothelioma Patient: Do We Need to Think Outside the Box?. M. Irfan, T. Almas, I. Ullah, et al. 2020;12(8):e9947. Case report PubMed · Publisher · Free full text

Abstract

The coronavirus disease 2019 (COVID-19) remains a major source of mortality globally. Although it usually presents with flu-like symptoms such as fever and sore throat, the intensity of the symptoms varies, constituting a spectrum ranging from asymptomatic to severe cases of acute respiratory failure. The highest proportion of severe cases occurs in older individuals and in those who have underlying health conditions and chronic comorbidities. We chronicle an atypical case of a 46-year-old male with stage IV mesothelioma who presented exclusively with complaints of acute abdominal pain and distension. Despite his cancer status, the patient's respiratory functions remained unremarkable, accentuating the peculiarity of the case.

Copyright © 2020, Irfan et al.
Intermittent Superior Vena Cava Syndrome Secondary to Malignant Pericardial Mesothelioma. S.A. Alwusaibie, J.S. Alsayigh, D. Alfaraj, et al. 2020;12(12):e12107. Case report PubMed · Publisher · Free full text

Abstract

Malignant pericardial sarcomatoid mesothelioma is a massively rare tumor accounting for 0.8% of all cases of mesothelioma. Superior vena cava syndrome (SVCS) occurs due to a partial obstruction or compression to the superior vena cava, which hinders the blood outflow to the upper body. It can be caused by an intrinsic factor such as thrombosis, or by an extrinsic factor such as tumors. Clinical presentation includes edema of the face and upper limbs, plethora, dyspnea, dysphagia, stridor and cough. we are reporting a case of a 56-year-old female, who is a known case of hypertension on angiotensin-converting enzyme inhibitors (ACEIs). Presented to the emergency department with intermittent facial swelling and dyspnea. Imaging and pathology reports confirmed the diagnosis of intermittent SVCS secondary to pericardial sarcomatoid mesothelioma with pericardial effusion. What makes our case unique is that both the etiology and the presenting complaint are rare entities, as most SVCS cases are continuously symptomatic throughout the disease course, and are usually caused by a lung cancer or lymphoma.

Copyright © 2020, Alwusaibie et al.
Medical Challenge Posed by Retroperitoneal Fibrosis: Case Reports and Literature Review. S. Cervera-Bonilla, M. Garcia Mora, P. Rodriguez Ossa, et al. 2020;12(1):e6624. Case report PubMed · Publisher · Free full text

Abstract

Idiopathic retroperitoneal fibrosis (RPF) is a rare fibro-inflammatory disease, with a low incidence worldwide, which occurs around the abdominal aorta and the iliac arteries. It spreads through the retroperitoneum causing ureteral obstruction with associated renal failure and obstruction of other adjacent structures. RPF can be idiopathic or secondary to neoplastic processes, infections, or medications. RPF is considered part of the spectrum of the disease related to immunoglobulin G4 (IgG4) and other autoimmune disorders. Occupational exposure to asbestos and tobacco smoke are important risk factors for the development of idiopathic RPF. The clinical picture is nonspecific, from pain to symptoms due to ureteral compression, this being the main complication associated. Imaging studies are essential in the diagnosis; computed tomography (CT) and magnetic resonance imaging (MRI) are the most reliable imaging modalities. The goal of treatment is to stop the progression of the fibroinflammatory reaction. The first line of treatment is usually with medical management. Biological agents, such as rituximab and infliximab, have also been used, even with scarce data in the literature. Surgery is usually performed to improve a ureteral obstruction and should always be accompanied by systemic steroid treatment. The conservative approach given by systemic therapy and ureteral stent placement or nephrostomies has been recommended, thus reserving surgical treatment for refractory cases. We present two clinical cases of idiopathic RPF, one of them associated with IgG4.

Copyright © 2020, Cervera-Bonilla et al.
Pembrolizumab-Induced Ocular Myasthenic Crisis. C.J. Lorenzo, H. Fitzpatrick, V. Campdesuner, et al. 2020;12(7):e9192. Case report PubMed · Publisher · Free full text

Abstract

Pembrolizumab, one of many novel immune checkpoint inhibitors (ICPi), is a monoclonal antibody that enhances immunity against cancer cells. Extensive escalation in immune activity predisposes to unsought immune-related adverse events. Due to progressive mesothelioma, a 67-year-old man was referred to the research unit and enrolled in a clinical trial with a cluster of differentiation (CD) 27 chemotherapeutic agent. He began crossover treatment and received just two doses of pembrolizumab, 33 and 16 days prior to admission. He subsequently presented to the emergency department with three days of acute onset severe diplopia and a drooping left eye. Acetylcholine receptor (AChR) antibodies returned positive at 13.9 nmol/L, and a diagnosis of ocular myasthenia gravis (OMG) was made. During his hospitalization, the patient was managed with methylprednisolone 80 mg intravenously daily, with conversion to prednisone 60 mg by mouth daily at time of discharge. Neuro-ophthalmology consultation was sought in the outpatient setting, and the patient was started on pyridostigmine. He was readmitted two weeks later with symptoms of progressive diffuse weakness, unsteady gait, and dysphagia, all in the setting of persistent diplopia. Intravenous immunoglobulin (IVIG) was promptly initiated, in addition to the pyridostigmine previously initiated in the outpatient setting. Unfortunately, after three IVIG treatments, the patient had experienced little improvement in his symptoms, and therefore elected hospice care. Although ICPis have revolutionized the management of a multitude of malignancies, recognition of immune-related adverse events is of critical importance.

Copyright © 2020, Lorenzo et al.

2010s

A Rare Case of Malignant Mesothelioma Presenting with Systemic Lupus Erythematosus Seropositivity: A Case Report and Review of Literature. A. Rakhra, A. Munir, R.S. Chilukuri, et al. 2019;11(2):e4092. Case report PubMed · Publisher · Free full text

Abstract

While malignant mesothelioma may initially present in a variety of ways, it is uncommon to present with systemic lupus erythematosus (SLE) seropositivity and thus obscuring its diagnosis. Our case involves a 75-year-old Caucasian male with a past medical history of essential hypertension, remote prostate cancer status post prostatectomy, and lifetime nontobacco use presenting with progressive shortness of breath over one month. After a negative cardiac assessment, a postcardiac catheterization chest X-ray (CXR) revealed a right-sided moderate-to-large pleural effusion that, on further workup, was found to be exudative. Effusion studies were negative for malignancy and bacterial growth. Recurrent accumulation of fluid after a thoracentesis one week prior prompted an autoimmune work up. Positive markers included antinuclear antibodies, anti-double stranded DNA antibodies, and anti-histone antibodies, while anti-Smith antibodies were negative. Although SLE was initially suspected based on serologies, no clinical signs or symptoms were present to fulfill the diagnosis criteria. A trial of oral prednisone resulted in decreased pleural effusion size with no further recurrence. Additional studies included a CT scan of the chest that showed pleural masses confirmed with biopsy to be epithelioid mesothelioma. Given the patient's age and new diagnosis of malignant mesothelioma, we hypothesized that the presence of autoantibodies was likely false positives due to acquired autoantibodies with age, hyperactivity of the immune system from malignancy, and possible prior asbestos exposure.
First-ever Abscopal Effect after Palliative Radiotherapy and Immuno-gene Therapy for Malignant Pleural Mesothelioma. A.R. Barsky, K.A. Cengel, S.I. Katz, et al. 2019;11(2):e4102. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a highly aggressive disease, with few, if any, curative interventions. While there is growing interest in using immunotherapy and immuno-gene therapy to treat MPM, very limited data currently exist for combining these modalities with radiotherapy. Preclinical data suggest that radiotherapy may be combined with immunotherapy to produce disease regression, with abscopal effects in mice with MPM. We report the first-ever case of abscopal effect in a patient with MPM, following radiotherapy and immuno-gene therapy. The patient was a 67-year-old male with prior asbestos exposure who presented with progressive dyspnea and thoracic pain. He underwent partial right pleurectomy, pleural biopsy, and talc pleurodesis, with pathology revealing epithelioid MPM. A subsequent chest computed tomography (CT) scan and fluoro-deoxyglucose positron-emission tomography (FDG-PET) CT scan showed extensive, right-sided, fluoro-deoxyglucose (FDG) avid mass-like pleural thickening encasing the right lung, with likely mediastinal extension, nodal metastases, and vascular compression. He enrolled in a clinical trial in which he received intrapleural interferon-alpha gene therapy but needed to discontinue therapy due to supraventricular tachycardia and superior vena cava syndrome induced from tumor burden. He was emergently treated with palliative radiotherapy to 30 Gy in 10 fractions. He was then started on pemetrexed and cisplatin chemotherapy. His subsequent chest CT scan two months after radiotherapy completion showed a dramatic treatment response within, as well as outside of, the irradiated field. After completion of radiotherapy, he did experience radiation esophagitis requiring nasogastric tube placement. Herein, we highlight the feasibility and efficacy of combining immuno-gene therapy with palliative radiotherapy to produce a substantial treatment response and an abscopal effect in a patient with unresectable MPM.
Malignant Peritoneal Mesothelioma Mimicking Recurrent Diverticulitis. E.S. Robalino Gonzaga, P. Guzman Rojas, V. Vanar. 2019;11(1):e3906. Case report PubMed · Publisher · Free full text

Abstract

Mesothelioma is an uncommon type of cancer arising from the mesothelial cells that form the lining of several cavities in the body. Exposure to asbestos is the leading known cause of mesothelioma. We present a 73-year-old male with a significant asbestos exposure and a recent history of recurrent diverticulitis who reported persistent left lower quadrant (LLQ) pain despite several courses of empiric antibiotic therapy. A recent computed tomography (CT) performed due to nonresolving symptoms showed possible nodularity of the mesentery and subsequent positron emission tomography (PET) scan demonstrated multiple hypermetabolic mesenteric lesions, notably in the left paracolic gutter. A colonoscopy was subsequently performed which demonstrated severe diverticulosis, but no obvious luminal lesions. The patient underwent an exploratory laparoscopy showing extensive peritoneal carcinomatosis involving all mesenteric surfaces and partial involvement of the right diaphragm. Final pathology revealed malignant epithelial mesothelioma with peritoneal seeding. The patient was referred to oncology and was started on hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS). Our case highlights a challenging presentation of malignant peritoneal mesothelioma (MPM), which is often initially misdiagnosed due to vague symptoms. Physicians should consider further diagnostic workup for unrelenting LLQ abdominal pain after diverticulitis has been treated.
Metastatic Pleural Effusion: An Unusual Presentation of Urothelial Bladder Carcinoma. I.N. Javed, T. Abdo, N. Ahmad, et al. 2019;11(5):e4619. Case report PubMed · Publisher · Free full text

Abstract

Pleural effusions are frequently encountered in clinical practice. In the United States, malignancy is the third leading cause of pleural effusion after heart failure and pneumonia. The most common cause of malignant pleural effusion (MPE) is lung cancer, followed by breast cancer, lymphoma, and mesothelioma. Genitourinary cancers rarely metastasize to the pleura. Although several atypical patterns of thoracic metastasis from genitourinary cancers have been described in the literature, genitourinary cancers rarely give rise to MPEs. We describe a case where the workup of a unilateral pleural effusion led to the diagnosis of high-grade urothelial bladder carcinoma.
Prostate Carcinoma and Pleural Mesothelioma: An Extremely Rare Co-occurrence. T.P. Soni, S. Soni, N. Somani, et al. 2019;11(5):e4655. Case report PubMed · Publisher · Free full text

Abstract

Pleural mesothelioma and carcinoma prostate as metachronous double malignancy is extremely rare co-occurrence. A 67-year-old male, diagnosed case of carcinoma prostate with bone metastasis, was treated with chemotherapy and hormone therapy. He responded well to chemotherapy and hormone therapy. He remained asymptomatic for two years with serum prostate-specific antigen (PSA) values within normal limits. After two years of diagnosis of carcinoma prostate, he developed left lung pleural sarcomatoid mesothelioma as a second metachronous tumor. Malignant pleural mesothelioma as a metachronous second tumor in a case of carcinoma prostate is rarely reported in the literature. The long-life expectancy, old age, late effects of the treatment, genetic predisposition and lifestyle factors of patients with carcinoma prostate expose them to the possibility of developing second primary tumor.
Fluorodeoxyglucose versus Choline Positron Emission Tomography/Computed Tomography Response Evaluation in Two Malignant Pleural Mesothelioma Patients Treated with Talc Pleurodesis and Neoadjuvant Chemotherapy. K. Kitajima, T. Nakamichi, S. Hasegawa, et al. 2018;10(11):e3654. Case report PubMed · Publisher · Free full text

Abstract

Talc pleurodesis has been reported to increase fluorodeoxyglucose (FDG) uptake in the high attenuation areas of pleural thickening, making it difficult to distinguish between benign granulomatous inflammatory processes and malignancies, which may therefore interfere with the post-chemotherapy disease evaluation on FDG-positron emission tomography/computed tomography (PET/CT). We present two cases of malignant pleural mesothelioma treated with talc pleurodesis and neoadjuvant chemotherapy (NAC) before pleurectomy/decortication in which post-NAC FDG-PET/CT showed intense FDG uptakes in the high attenuation areas of pleural thickening with false positive result, whereas post-NAC 11C-choline PET/CT showed mild choline uptake of pleural talc deposit, which did not interfere with the post-chemotherapy disease evaluation. Thus we suggest choline-PET/CT may show little choline uptake to granulomatous inflammation and evaluate treatment response in malignant pleural mesothelioma patients treated with talc pleurodesis and NAC.
Malignant Pleural Mesothelioma, Biphasic Type: An Unusual and Insidious Case of Rapidly Progressive Small Blue Cell Tumor. C. Salazar, N. Kanter Md, A. Abboud. 2018;10(6):e2749. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare neoplasm. It predominantly affects elderly individuals aged over 70 years presenting with a unilateral pleural tumor usually associated with previous asbestos exposure. The respiratory symptoms are associated with ipsilateral pleural involvement with concomitant pleural effusions. The diagnosis of MPM is established by the morphologic and immunohistochemical features of a cytologic specimen. MPM can present as three histologic subtypes: epithelioid, sarcomatoid, or biphasic. We present a case of an 85-year-old Caucasian female with a history of occupational asbestos exposure. She complained of 1-week history of progressive sharp right flank and scapular pain with mild shortness of breath, dry cough and pleuritic chest pain. CT of the chest showed a large loculated right pleural effusion with adjacent pleural thickening. CT abdomen and pelvis was negative for other neoplastic findings. CT-guided core biopsy of the right pleural-based mass was positive for a spindle to plasmacytoid small blue cell tumor. An extensive immunohistochemical panel was non-specific. A focal OSCAR keratin and WT-1 expression in the absence of carcinoma markers, a malignant mesothelioma, biphasic type was diagnosed. Further workup with PET-CT and cytotoxic chemotherapy combined with immunotherapy or tyrosine kinase inhibitors was recommended by oncology. The patient refused further imaging and treatment, and palliative care was consulted.
A Case of Well-Differentiated Papillary Mesothelioma of the Male Peritoneum: Successful Treatment by Systemic Chemotherapy. A. Bazine, M. Fetohi, T. Namad, et al. 2017;9(3):e1104. Case report PubMed · Publisher · Free full text

Abstract

Well-differentiated papillary mesothelioma of the peritoneum (WDPMP) is a rare subtype of epithelioid mesothelioma, which is usually seen in young women without a history of asbestos exposure, and generally, has an indolent course. The relative rarity of this neoplasm in males prompted us to report this case of a well-differentiated papillary mesothelioma of the peritoneum in a 36-year-old man. The patient, who had no history of asbestos exposure, presented with abdominal pain and ascites of unknown etiology. Computed tomography showed abundant ascites with nodules of the peritoneal cavity. Laparoscopic examination revealed a large number of white miliary nodules diffusely covering the peritoneum. Pathology revealed a diagnosis of well-differentiated papillary mesothelioma of the peritoneum, based on histomorphology and immunohistochemistry. The patient started chemotherapy with cisplatin and pemetrexed. After six cycles of chemotherapy, the effectiveness of this chemotherapy was checked by only the computed tomography. PET scan was not used because it is not routinely recommended in WDPMP. Few data are currently available in the literature regarding the performance of the PET scan in WDPMP. Nine months later, the patient was free of symptoms. Based on reviewing the literature and our observations in this case, consultation of other pathologists is highly recommended to discern WDPMP from other disseminated peritoneal diseases, in order to offer the most effective and safe therapeutic strategy. Chemotherapy should be strongly considered if the tumor is unresectable and accompanied by symptoms. Cisplatin and pemetrexed chemotherapy could be a promising therapeutic choice.
Malignant Mesothelioma of Tunica Vaginalis Testis: Macroscopic and Microscopic Features of a Very Rare Malignancy. E. Arda, M.G. Arıkan, G. Cetin, et al. 2017;9(11):e1860. Case report PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is an extremely rare tumour, usually mimicking benign pathologies of the scrotum. Our case is an 84-year-old male patient who appealed with a painless, left-sided scrotal swelling longer than 2 months. Although the level of tumour markers was normal, ultrasonographic examination results forced us to perform an inguinal scrotal exploration. Multiple small papillary tumours, both on tunica vaginalis and tunica albuginea, were detected intraoperatively. Due to these findings, radical orchiectomy was performed. A pathological evaluation showed malignant mesothelioma (MM) of the tunica vaginalis testis. Exposure to asbestos is a well-known risk factor. Furthermore, a history of trauma, herniorrhaphy and chronic hydroceles is blamed as a possible risk factor. Scrotal ultrasonography is the mainstay of primary diagnosis and, therefore, it should not be overlooked when dealing with benign scrotal cysts or hydroceles, which are very common pathologies at these decades, too. Radical inguinal orchiectomy is the primary treatment choice for localised MMTVT disease, whereas in signs of lymph node metastasis, inguinal lymph node dissection is required. Radical resection should be completed with chemotherapy and/or radiotherapy for an advanced or recurrent disease. This case, which is very rarely reported in the literature and detected during inguinal exploration, along with the pathological works that supported the diagnosis, was presented with this report.
Proton Therapy for Malignant Pleural Mesothelioma: A Three Case Series Describing the Clinical and Dosimetric Advantages of Proton-Based Therapy. H. Lee, J. Zeng, S.R. Bowen, et al. 2017;9(9):e1705. Case report PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a malignancy of the pleural cavity that typically presents at an advanced stage. Due to its large, circumferential clinical target volume (CTV) and proximity to major structures, including the heart and contralateral lung, delivering hemithoracic intensity-modulated radiotherapy (IMRT) with photon therapy to achieve loco-regional control following macroscopic complete resection is challenging. Intensity-modulated proton therapy (IMPT) has been shown to be a method for achieving higher therapeutic doses while limiting exposure to organs at risk (OARs), but patient outcomes after treatment have yet to be reported. We present three patients who received IMPT to 54 Gy after extrapleural pneumonectomy (EPP), with two patients receiving boosts to 66 and 60 Gy. All three tolerated treatment well and received doses to OARs markedly lower than those seen in comparison volumetric-modulated arc therapy (VMAT) IMRT photon plans. Radiation pneumonitis, a highly morbid and potentially fatal toxicity in patients receiving thoracic radiotherapy, was not observed even with boost treatments. In practice, IMPT appears to match dosimetric predictions as a feasible and safer alternative to photon IMRT-based radiotherapy.
Cerebral Metastasis of a Malignant Pleural Mesothelioma: A Case Report and Review of the Literature. A. Chari, A.G. Kolias, K. Allinson, et al. 2015;7(1):e241. Case report PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive malignant neoplasm that was thought to be a localised disease with limited metastatic capability. However, recent post-mortem studies have identified metastases to the central nervous system (CNS) in about 3% of cases.

Case Description: We present the case of a 65-year-old with a solitary supratentorial metastatic deposit of MPM treated with surgical resection and adjuvant whole brain radiotherapy. Despite a good surgical outcome with symptomatic recovery, the patient died of cardiopulmonary compromise five months postoperatively.

Conclusions: Although rare, CNS metastasis of MPM is a condition that neurosurgeons should be aware of. CNS metastases may occur via three distinct mechanisms, namely perineural spread, leptomeningeal carcinomatosis and, most commonly, haematogenous spread leading to parenchymal deposits. Surgical resection of these deposits can lead to symptomatic improvement, and together with radiotherapy, to local disease control. However, the overall survival remains poor.

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