Internal Medicine

Our medical research library holds 47 studies published in Internal Medicine (1994–2026). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 41 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it. For 1 study PubMed has no abstract for, we give the abstract printed in the article or, where there is none, a summary we wrote from it, each labeled as such.

About the journal

• Publisher: Japanese Society of Internal Medicine
• Published: 1992 to the present, Japan
• Language: English
• ISSN: 0918-2918 (print), 1349-7235 (electronic)
• Continues: Japanese Journal of Medicine
• Its record in the NLM Catalog

2020s

• Organizing Pneumonia in a Patient with Pulmonary Transthyretin Amyloidosis. Y. Tojo, Z. Watanuki, J. Sakurada, et al. 2026;65(18):2459-2464. Case report PubMed · Publisher · Free full text

  Abstract

  An 86-year-old man who was a retired tunnel construction worker with pleural plaques and chronic pleural effusion was referred for an evaluation of newly developed pulmonary infiltrates. A transbronchial lung biopsy revealed organizing pneumonia with transthyretin amyloid deposition in the alveolar septa. Genetic testing confirmed wild-type transthyretin amyloidosis. Corticosteroid therapy led to partial resolution of the pulmonary infiltrates. Few cases of pulmonary transthyretin amyloidosis associated with organizing pneumonia have been reported. This case highlights the potential involvement of transthyretin amyloidosis in the development of organizing pneumonia.

• Pseudo-hyperprogression of Malignant Pleural Mesothelioma Treated with Nivolumab. M. Yanai, T. Sakamoto, T. Nonaka, et al. 2025;64(15):2386-2389. Case report PubMed · Publisher · Free full text

  Abstract

  Currently, immune checkpoint inhibitors (ICIs) are the standard treatment for malignant pleural mesothelioma (MPM). The characteristic responses to ICI treatment include pseudoprogression (PP) and hyperprogressive disease (HPD), which require attention. Reports on PP of MPM are rare. We herein report a 59-year-old woman with MPM whose pleural lesions rapidly increased in size after initiating nivolumab treatment. This was initially judged as HPD but was subsequently diagnosed as PP owing to a marked reduction in tumor size. This case highlights the importance and difficulty of differentiating between PP and true progression, including HPD, during treatment of MPM with ICIs.

• Clinical Response of Primary Malignant Pericardial Mesothelioma with Peritoneal Dissemination to Nivolumab. S. Fujiwara, Y. Kano, Y. Maejima, et al. 2024;63(4):513-519. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pericardial mesothelioma (MPM) is extremely rare, and peritoneal dissemination has not yet been reported. There is no consensus regarding appropriate pharmacological treatment for MPM, including immune checkpoint inhibitors (ICIs). We herein report a 36-year-old man with MPM diagnosed by peritoneal dissemination and treated with an ICI. Cytology of the ascites revealed malignant peritonitis, and a re-evaluation of a pericardial biopsy performed at the previous hospital led to a diagnosis of MPM. The patient was treated with nivolumab and showed a clinical response despite several complications, such as renal dysfunction and performance status deterioration. This case report provides suggestive information for the diagnosis and ICI therapy of a rare type of mesothelioma.

• Pseudomesotheliomatous Carcinoma of the Lung with Morphological Characteristics of Signet Ring Cell Carcinoma: An Autopsy Case Report. T. Hirakawa, T. Tanimoto, Y. Hattori, et al. 2024;63(7):979-983. Case report PubMed · Publisher · Free full text

  Abstract

  A 50-year-old woman presented with left pleural effusion. A pleural fluid cell-block specimen and longitudinal lymph node needle biopsy suggested signet ring cell carcinoma (SRCC). Although computed tomography showed a consolidation shadow in the left lower lobe, a left lung biopsy could not be performed. Upper gastrointestinal endoscopy revealed no malignancies. We administered carboplatin, pemetrexed, ipilimumab, and nivolumab for lung cancer; however, she died due to progressive respiratory failure. Pathological autopsy revealed that the left pleura was thickened as in mesothelioma, based on which pseudomesotheliomatous carcinoma of the lung (PMCL) was diagnosed. PMCLs exhibiting an SRCC morphology are rare.

• Differences in Pleural Fluid Amylase Levels in Patients with Malignant Pleural Effusion Based on Cancer Type, Histologic Type, and Epidermal Growth Factor Receptor Mutations. M. Shimoda, Y. Tanaka, K. Morimoto, et al. 2023;62(24):3601-3607. PubMed · Publisher · Free full text

  Abstract

  Objective High pleural amylase levels have been reported in patients with malignant pleural effusion; however, the characteristics of this association are uncertain. Therefore, this study investigated the factors, such as cancer type and oncogenic drivers, related to pleural amylase levels in patients with malignant pleural effusion. Methods We retrospectively collected the data of 362 cancer patients [lung adenocarcinoma (n=256), lung squamous carcinoma (n=12), small-cell lung carcinoma (n=32), other lung cancers (n=5), mesothelioma (n=31), and metastatic cancer (n=26)] with malignant pleural effusion at Fukujuji Hospital from January 2012 to October 2022. Pleural amylase levels were compared. Results Pleural amylase levels were significantly higher in patients with lung adenocarcinoma [median 58.6 IU/L (interquartile range (IQR) 33.8-139.3)] than in those with small-cell lung carcinoma [median 37.2 IU/L (IQR 26.3-63.7), p=0.012]. The median pleural amylase level was higher in patients with lung adenocarcinoma than in those with other cancer or histologic types, although the difference was not significant. Pleural amylase levels were higher in epidermal growth factor receptor (EGFR) mutation-positive patients than in EGFR mutation-negative patients [median 95.8 IU/L (IQR 52.7-246.5) vs. median 51.2 IU/L (IQR 27.8-96.9), p<0.001]. The Kaplan-Meier survival curves of pleural amylase ≥75 IU/L were higher than those of pleural amylase <75 IU/L [log-rank test p<0.001, hazard ratio 0.54 (95% confidence interval: 0.41-0.71)]. Conclusion This study demonstrates that pleural amylase levels were elevated in patients with lung adenocarcinoma and EGFR mutations. Furthermore, a high pleural amylase level was associated with a good prognosis.

• Ultra-magnifying Imaging of Thoracoscopic Biopsy Specimens Using Ex vivo Endocytoscopy in Three Patients with Mesothelioma. Y. Shiratsuki, N. Kurimoto, Y. Amano, et al. 2022;61(21):3251-3257. PubMed · Publisher · Free full text

  Abstract

  We performed endocytoscopy (ECS) for the ex vivo evaluation of mesothelioma in specimens biopsied during medical thoracoscopy in three patients. We evaluated 19 biopsy specimens based on the density of nuclei and irregularity in the nuclei shape using ECS and compared them with the histopathological findings. All 10 specimens considered malignant based on ECS were diagnosed as malignant based on histopathology. The nine specimens evaluated as non-malignant based on ECS consisted of six specimens diagnosed as malignant based on histopathology and three diagnosed as non-malignant based on histopathology. ECS was feasible and had some utility for ex vivo ultra-magnifying imaging of thoracoscopic biopsy specimens from patients with mesothelioma.

• Malignant Peritoneal Mesothelioma with Latent Tuberculosis Infection. N. Inoue, K. Takumi, D. Sone, et al. 2021;60(21):3409-3412. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant peritoneal mesothelioma (MPM) is a rare malignant tumor with peritoneal thickening. Tuberculous peritonitis also shows peritoneal thickening, so differentiating between the two is important but difficult if latent tuberculosis infection (LTBI) is present. We herein report a patient with MPM and LTBI. A 79-year-old man was diagnosed with peritoneal thickening on computed tomography. Interferon gamma release assay (IGRA) results were positive, suggesting tuberculous peritonitis. He underwent a laparoscopic omental biopsy and was diagnosed with MPM, which can occur together with LTBI. If peritoneal thickening is observed, an IGRA should be performed early, and the possibility of LTBI should be considered.

• Malignant Pleural Mesothelioma in Patients Who Previously Received Radiotherapy for Their First Malignant Tumor. I. Sekine, Y. Yamamoto, T. Suzuki, et al. 2021;60(5):663-665. PubMed · Publisher · Free full text

• The Association between Malignant Pleural Mesothelioma and Thoracic Radiation Therapy for Hodgkin's Lymphoma: The First Case Report in Japan. K. Nakashima, Y. Demura, M. Oi, et al. 2021;60(5):771-775. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is mostly observed in patients with a history of asbestos exposure. Although other causes are rare, there are several reports of MPM induced by therapeutic radiation, mainly in Europe and North America. However, no such case has been reported in Japan. We herein report a 50-year-old Japanese woman who developed MPM 25 years after thoracic radiation therapy for Hodgkin's lymphoma. The patient had no history of exposure to asbestos; therefore, her history of radiation therapy was considered to be the cause of MPM. Clinicians should consider secondary MPM in patients with a history of thoracic radiation therapy.

• Malignant Peritoneal Mesothelioma Presenting with Polymyalgia Rheumatica-like Syndrome. Y. Ide, T. Yuki, Y. Taooka, et al. 2020;59(20):2629-2632. Case report PubMed · Publisher · Free full text

  Abstract

  A 30-year-old man was admitted to our hospital because of pain in his proximal extremities. The pain mimicked polymyalgia rheumatica (PMR) and it temporarily improved by a low dose of glucocorticoids, but his symptoms relapsed many times. After six years of glucocorticoid treatment, he developed abdominal pain and ascites, for which he was diagnosed with malignant peritoneal mesothelioma (MPM). His PMR-like symptoms improved with cytoreductive surgery and chemotherapy for MPM. Finally, we diagnosed this PMR-like syndrome to be paraneoplastic syndrome with MPM. Although cases of MPM complicated by PMR-like syndrome are rare, MPM should be taken into account in the differential diagnosis.

2010s

• Amelanotic Malignant Melanoma with Dense Pleural Thickening Mimicking Malignant Mesothelioma. T. Saraya, M. Fujiwara, K. Morita, et al. 2019;58(7):969-972. Case report PubMed · Publisher · Free full text

  Abstract

  A 51-year-old man was diagnosed with stage IIC nodular malignant melanoma (T4bN0M0) of the right upper arm. The tumor was treatment-refractory, and left-sided pleural effusion emerged 1.5 years later. Aspiration of pleural fluid revealed abundant amelanotic, atypical cells that resembled epithelial malignant mesothelioma or lung adenocarcinoma cells; these cells were positive for melanoma-associated antigen recognized by T cells (MART-1)/Melan-A, HMB-45, and S-100 on immunocytochemistry. Thoracic computed tomography (CT) revealed marked diffuse pleural thickening in the left hemithorax that mimicked malignant mesothelioma; thus, the present report describes the unique cytological and radiological findings of this case.

• Malignant Pleural Mesothelioma with Bone Marrow Metastases. H. Ihara, N. Harada, N. Shimada, et al. 2018;57(17):2541-2545. Case report PubMed · Publisher · Free full text

  Abstract

  A 64-year-old man with the bone marrow metastasis due to malignant pleural mesothelioma (MPM) was diagnosed with anemia, leukoerythroblastosis, thrombocytopenia, and lower back pain. A bone marrow biopsy demonstrated infiltrative malignant mesothelioma lesions in the bone marrow. The patient died within 15 days of the detection of the bone marrow involvement. Physicians should consider performing a bone marrow biopsy to diagnose bone marrow metastasis and treat patients with palliative chemotherapy at an earlier phase of the disease. To our knowledge, this is the first report of an MPM patient having bone marrow metastasis with anemia, leukoerythroblastosis, and thrombocytopenia.

• The Antemortem Diagnosis of Primary Malignant Pericardial Mesothelioma: A Multidisciplinary Evaluation. K. Shikano, S. Hirano, T. Hiroishi, et al. 2018;57(17):2559-2562. Case report PubMed · Publisher · Free full text

  Abstract

  A 64-year-old woman complaining of progressive dyspnea was admitted with recurrence of massive pericardial effusion. The patient had been diagnosed with radiation pericarditis based on a previous case of pericardiocentesis. To make a diagnosis and improve her symptoms, imaging examinations and pericardial fenestration were performed. Because of difficulty making a diagnosis, after some months, pericardiotomy and incision of the epicardium were performed. The patient was ultimately diagnosed with primary malignant pericardial mesothelioma of the epithelioid type. Primary malignant pericardial mesothelioma is a rare tumor that is difficult to diagnose. An antemortem diagnosis can be made by a multidisciplinary evaluation.

• A Rare Case of Biphasic Malignant Peritoneal Mesothelioma with Refractory Ascites. T. Komaki, H. Urata, K. Mori, et al. 2017;56(7):861-864. Case report PubMed · Publisher · Free full text

  Abstract

  An 81-year-old man was admitted to our hospital with abdominal distension due to refractory ascites of unknown origin. He subsequently died of aspiration pneumonia. Autopsy revealed a diagnosis of biphasic malignant peritoneal mesothelioma (MPM) containing both epithelioid and sarcomatous components. The diagnosis of MPM is often difficult because serum tumor markers, imaging studies, and the cytology of ascites may not provide enough information. Accordingly, peritoneal biopsy is necessary in order to diagnose MPM based on the histological and immunohistochemical findings.

• Sarcomatoid Carcinoma Mimicking Malignant Mesothelioma. J. Takiguchi, H. Sakamoto, N. Inoue. 2017;56(8):987-988. PubMed · Publisher · Free full text

• Brain Metastasis of Pleural Mesothelioma after a Subarachnoid Hemorrhage. A. Hirooka, A. Tamiya, M. Kanazu, et al. 2016;55(7):779-81. Case report PubMed · Publisher

  Abstract

  Malignant pleural mesothelioma (MPM) is an uncommon, fatal neoplasm induced by asbestos exposure. Brain metastases from MPM are extremely rare, with most such cases diagnosed only at the time of autopsy. This report describes what we believe to be the first case of MPM metastasizing to the brain after a subarachnoid hemorrhage, as well as the subsequent surgical removal of the brain metastasis.

• Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade. C. Saisho, H. Ishii, N. Edakuni, et al. 2016;55(21):3161-3164. Case report PubMed · Publisher · Free full text

  Abstract

  Primary pericardial malignant mesothelioma is a very rare clinical entity and its prognosis is very poor. We herein report a 67-year-old man who presented with pericardial mesothelioma that was diagnosed 21 months after the onset of cardiac tamponade as the initial manifestation. Despite undergoing pericardiocentesis and surgical pericardial fenestration at the onset of cardiac tamponade, we were unable to make a conclusive diagnosis of mesothelioma based on the cytological and histological findings. This unusual case had a relatively long progression-free period without treatment before the appearance of pleural tumors that showed the histological features of malignant sarcomatoid mesothelioma.

• An Autopsy Case Report of Malignant Pleural Mesothelioma with Deciduoid Features. R. Ushio, M. Yamamoto, Y. Shibata, et al. 2015;54(22):2915-7. Case report PubMed · Publisher

  Abstract

  Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma. We experienced the case of a 73-year-old man with asbestos exposure who was diagnosed with malignant pleural mesothelioma with deciduoid features. He received chemotherapy containing six cycles of cisplatin and pemetrexed and survived for twenty-five months after the diagnosis. At autopsy, the final diagnosis was biphasic pleural mesothelioma. Cells with deciduoid features had mostly disappeared, and spindle cells markedly proliferated. To the best of our knowledge, this is the first autopsy case of malignant pleural mesothelioma with deciduoid features that exhibited a response to chemotherapy.

• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma. H. Ashinuma, M. Shingyoji, Y. Yoshida, et al. 2015;54(1):43-8. Case report PubMed · Publisher

  Abstract

  Pericardial mesothelioma is a very rare pericardial tumor. Diagnosing pericardial disease can be challenging, and obtaining an antemortem diagnosis of pericardial mesothelioma is particularly difficult. We herein report the case of a 60-year-old man with pericardial mesothelioma diagnosed on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Chest computed tomography showed a mass surrounding the pericardium, and EBUS-TBNA of the right inferior paratracheal and subcarinal stations was consequently performed. No uptake was noted on (18)F-fluorodeoxy glucose positron emission tomography, other than in the pericardial mass. The results of histological and immunohistochemical examinations indicated the features of malignant mesothelioma. We therefore diagnosed the patient with pericardial mesothelioma, which was subsequently confirmed at autopsy.

• "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA). F. Lococo, G. Rossi, L. Agostini, et al. 2014;53(5):467-9. Case report PubMed · Publisher

  Abstract

  The acquisition of histologic material is obligatory in order to establish the diagnosis of malignant pleural mesothelioma (MPM). In particular, tissue acquisition in cases of "dry" MPM (focal pleural thickening without pleural effusion or mediastinal lymph node involvement) is usually performed via a thoracoscopic pleural biopsy. In contrast, the techniques for performing echoendoscopic (transbronchial or transesophageal) needle aspiration of pleural lesions have only rarely been reported due to the theoretical limitations of tissue acquisition in such cases. We herein report the first case of "dry" MPM successfully diagnosed via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a 73-year-old man presenting with a pleural mass in the right costovertebral recess, adjacent to the carina. The patient underwent radical resection, and a definitive pathological examination confirmed the diagnosis of epithelioid MPM.

• An autopsy case of malignant pleural mesothelioma associated with nephrotic syndrome. S. Suzuki, M. Toyoshima, F. Nihashi, et al. 2014;53(3):243-6. Case report · Review PubMed · Publisher

  Abstract

  A 64-year-old man who had been exposed to asbestos was referred to our hospital for a detailed examination of left pleural effusion. A laboratory examination of the urine and blood revealed nephrotic syndrome. A thoracoscopic examination did not yield a definitive diagnosis. Twenty months later, a left pleural tumor became apparent, and the patient died of respiratory failure and cachexia. An autopsy revealed epithelioid malignant pleural mesothelioma. The glomeruli appeared normal under light microscopy. A review of the English literature revealed only three reports of malignant mesothelioma associated with minimal-change nephrotic syndrome. The natural course of malignant mesothelioma with nephrotic syndrome has not been previously reported.

• Long progression-free survival by pemetrexed continuation maintenance therapy following cisplatin-based chemotherapy in malignant pleural mesothelioma. T. Takeda, H. Itano, S. Fukita, et al. 2014;53(20):2347-51. Case report PubMed · Publisher

  Abstract

  Malignant pleural mesothelioma (MPM) is associated with a poor prognosis. The combination of cisplatin and pemetrexed has been established as a standard chemotherapy that confers a survival benefit. Because the regimen is sometimes hampered by the renal toxicity of cisplatin and no second-line chemotherapy has yet been established, the strategy of administering a higher total dose of pemetrexed to optimize the regimen could be promising. We herein describe the case of a 69-year-old man with MPM who underwent five cycles of cisplatin plus pemetrexed and exhibited a partial response. Because his serum creatinine increased, pemetrexed maintenance therapy (PMT) was adopted, and 18 cycles were successfully delivered and the patient achieved a complete response. This case suggests that PMT could thus be useful for treating MPM.

• Non-asbestos-related malignant pleural mesothelioma. A. Kanbay, Z. Ozer Simsek, N. Tutar, et al. 2014;53(17):1977-9. PubMed · Publisher

  Abstract

  Malignant pleural mesothelioma (MPM) is an uncommon tumor derived from mesothelial lining cells. MPM has been described as an insidious neoplasm because of its long latency period. The tumor is typically found in patients several decades after asbestos exposure. We herein describe a 26-year-old patient with MPM who presented with pleural effusion. The patient had not been exposed to asbestos or erionite. There are few case reports of non-asbestos-related MPM in young patients. We report this case to remind physicians to consider MPM in the differential diagnosis of pleural effusion in young patients without exposure to asbestos or erionitis.

• Pleural metastases from papillary thyroid carcinoma mimicking mesothelioma. J. Takeshita, N. Katakami, S. Fujita, et al. 2014;53(2):163-4. Case report PubMed · Publisher

• Pseudomesotheliomatous carcinoma due to pleural metastasis from renal pelvic cancer. Y. Katsuya, M. Fukusumi, S. Morita, et al. 2014;53(8):871-4. PubMed · Publisher

  Abstract

  A 78-year-old man was referred to our department with a one-week history of dyspnea and coughing. A chest X-ray showed massive left pleural effusion. Computed tomography revealed diffuse irregular thickening of the left pleura similar to malignant mesothelioma and multiple nodules in both lungs. The patient died of respiratory failure nine days after hospitalization. An autopsy revealed metastasis to the pleura and lungs from urothelial carcinoma of the left kidney.

• Small cell carcinoma presenting with massive pleural spread mimicking malignant pleural mesothelioma. T. Takeda, M. Saitoh, S. Fukita, et al. 2014;53(6):613-6. Case report PubMed · Publisher

  Abstract

  Small cell carcinoma (SCC) predominantly spreading over the pleura is exceedingly rare and difficult to diagnose without proof of malignant effusion. A 65-year-old man presented with right pleural thickening and effusion and was diagnosed with SCC based on a thoracoscopic pleural biopsy. He received combined chemotherapy consisting of cisplatin and irinotecan hydrochloride, which resulted in a complete response. Seven months later, local relapse was observed. Thereafter, he received second-, third- and fourth-line chemotherapies and died of tumor progression 21 months after the diagnosis. Considering the possibility of SCC with pleural spread, performing early invasive procedures is important for diagnosing pleural malignancies.

• Mesothelioma-mimicking multiple myeloma with dumbbell-type progression. T. Sekiguchi, Y. Nishida, A. Inaba, et al. 2013;52(11):1287-8. Case report PubMed · Publisher

• Primary malignant sarcomatoid mesothelioma in the pericardium. K. Tateishi, M. Ikeda, T. Yokoyama, et al. 2013;52(2):249-53. Case report PubMed · Publisher

  Abstract

  Primary malignant pericardial mesothelioma is an exceptionally rare tumor, and making an antemortem diagnosis of this disease is notoriously difficult. We herein report the case of a 61-year-old woman with pericardial mesothelioma who presented with shortness of breath and peripheral edema of the lower limbs. Chest computed tomography (CT) showed an anterior mass and thickened pericardium with multiple pericardial nodules. A biopsy of the mediastinal mass was performed using right thoracotomy, and the histological findings indicated a sarcomatoid tumor. The patient was treated with chemotherapy; however, she but died three months after diagnosis. An autopsy confirmed a final diagnosis of sarcomatoid type primary malignant pericardial mesothelioma following extensive immunohistopathological examinations.

• Primary sarcomatoid malignant pericardial mesothelioma. D. Jiang, M. Kong, J. Li, et al. 2013;52(1):157-8. Case report PubMed · Publisher

  Summary

  This illustrated case report described a 39-year-old man in China with primary sarcomatoid malignant mesothelioma of the pericardium. He was admitted with a 10-month history of shortness of breath and chest distress on exertion. Echocardiography showed a pericardial mass and effusion. Computed tomography showed a thickened pericardium, effusion, and a large pericardial mass encompassing the left pulmonary artery and compressing the left and right pulmonary arteries. A positron emission tomography scan was positive along the pericardium. A pericardial biopsy obtained by video-assisted thoracic surgery confirmed sarcomatoid malignant mesothelioma. Immunohistochemical staining was positive for calretinin, vimentin and CD34 and negative for EMA, SMA, desmin and S100 protein. Because of the tumor's sensitive location and poor prognosis, the patient received no radiation treatment or chemotherapy. His cough and shortness of breath worsened, and repeat CT showed tumor progression. He died of cardiac failure 11 months after diagnosis. The authors noted that primary malignant pericardial mesothelioma is extremely rare, with an incidence of 0.0022% in an autopsy series of 500,000 cases, and that the sarcomatoid type is very rare. They also noted that diagnosis is difficult and that most patients die within one year of diagnosis. The report did not mention asbestos exposure or the patient's occupational history.

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

• Primary malignant mesothelioma of the appendix. K. Hayashi, M. Takamura, Y. Sato, et al. 2012;51(9):1027-30. Case report PubMed · Publisher

  Abstract

  We report a case of primary malignant mesothelioma of the appendix. A 35-year-old man without any history of asbestos exposure was admitted to our hospital for further examination following the discovery of multiple liver tumors, an ileocecal tumor, and abdominal lymph node swelling. An ultrasound-guided liver tumor biopsy revealed malignant mesothelioma. Despite receiving systemic chemotherapy, he died 3 months after the initial diagnosis. At autopsy, a diagnosis of multiple organ metastases from a malignant biphasic mesothelioma of the appendix was made. To our knowledge, this is only the second reported case of primary malignant mesothelioma of the appendix.

• Prognostic factors in malignant pleural mesothelioma: a retrospective study. H. Suzuki, T. Hirashima, M. Kobayashi, et al. 2012;51(7):707-10. PubMed · Publisher

  Abstract

  Objective: The incidence of malignant pleural mesothelioma (MPM) in Japan is predicted to increase over the next few decades. Prognostic factors remain unclear although several studies have reported this disease. In this study, we examined the prognostic factors of MPM from single institution practice data and tested the scoring systems of past reports.

  Methods: We retrospectively obtained clinical data from the medical records of patients who were diagnosed with MPM from 1991 to 2010. The European Organization for Research and Treatment of Cancer prognostic score (EPS) was calculated.

  Results: We surveyed the records of 68 patients. Univariate analysis showed that significant prognostic factors were histological type, stage, performance status (PS), chemotherapy, and lactate dehydrogenase (LD). Multivariate analysis identified stage, PS and LD as independent prognostic factors. Low-risk group (EPS ≤1.27) survival was significantly better than that of the high-risk group (EPS >1.27) (17.0 months vs. 8.0 months; p=0.002).

  Conclusion: Stage, PS and LD were demonstrated to be independent prognostic factors. An EPS >1.27 was still considered a poor prognosis indicator in the practice data of MPM.

• Sarcomatoid peritoneal malignant mesothelioma. M. Nakamura, K. Kobashikawa, N. Uchima, et al. 2011;50(18):2045. Case report PubMed · Publisher

• Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma. J. Hamamoto, D. Notsute, K. Tokunaga, et al. 2010;49(5):423-6. Case report PubMed · Publisher

  Abstract

  A 74-year old man was admitted to our hospital with right diffuse pleural thickening and effusion and with subcarinal lymph node swelling. The effusion obtained by thoracentesis showed no malignant cells, although positron emission tomography showed abnormal uptake in the right pleural thickening and subcarinal lymph node. Histopathological examination of the lymph node specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration showed a sheet of epithelioid-like large atypical cells. The tumor cells were immunohistochemically positive for calretinin and cytokeratin 5/6, and negative for CEA and TTF-1. Therefore, malignant pleural mesothelioma of epithelioid type was diagnosed.

• IgG4-related lung disease in a worker occupationally exposed to asbestos. M. Toyoshima, K. Chida, M. Kono, et al. 2010;49(12):1175-8. Case report PubMed · Publisher

  Abstract

  A case of IgG4-related lung disease in a worker who had been exposed to asbestos is described. The patient had nocturnal cough and wheeze that responded to inhaled corticosteroid, and the radioallergosorbent test was positive against common allergens, suggesting an association with atopic asthma. IgE elevation is reported in asbestos-exposed workers, and asbestos exposure may cause atopic conditions. Predominance of Th2 cytokines and up-regulation of regulatory T lymphocytes have been reported in IgG4-related disease. IgG4-related disease may occur from hypersensitivity of the regulatory immune system to atopic conditions. Asbestos exposure may be a causal factor of IgG4-related disease.

• Localized malignant pleural mesothelioma showing a thoracic mass and metastasizing to the stomach. H. Hayashi, K. Notohara, H. Yoshioka, et al. 2010;49(7):671-5. Case report PubMed · Publisher

  Abstract

  Malignant mesothelioma typically shows either diffuse tumors or multiple pleura-based nodules. Localized malignant mesothelioma is rare. In this case report, a 70-year-old man with left chest wall tumor underwent tumor resection, and the lesion was pathologically diagnosed as biphasic malignant mesothelioma. Tumor recurrence was detected in the stomach due to vomiting of blood, and also spread to the mediastinal lymph node, and bone 3 months postoperatively. Total gastrectomy was performed and the histopathological diagnosis of metastasis of mesothelioma was made. In the previously reported cases, all of the localized malignant mesothelioma arose in the pleural space and there was no metastasis of localized malignant mesothelioma to the stomach. In the present case, gross and histological examinations were performed for both the primary lesion and gastric metastatic tumor. Though it was very difficult to distinguish mesothelioma from sarcoma and other chest wall tumors, immunochemical staining was able to facilitate making the diagnosis. This case suggests that localized malignant mesothelioma is capable of showing multiple forms and a variety of clinical courses. Localized malignant mesothelioma can arise primarily from the chest wall.

• Malignant pleural mesothelioma presenting as an acute surgical abdomen due to metastatic jejunal perforation. K. Gocho, K. Isobe, K. Kaburaki, et al. 2010;49(6):597-601. Case report · Review PubMed · Publisher

  Abstract

  A 52-year-old man was admitted to our hospital in June 2008 presenting abnormal tumor lesions along the left pleura on chest X-ray. The needle-biopsied specimen of the left pleura proved the biphasic type of malignant mesothelioma. However, he complained of acute abdominal pain 7 days after the diagnosis. Chest X-ray revealed free air below the right diaphragm. Emergency surgery revealed a 4-cm perforating jejunal tumor with peritonitis. Histopathology of the resected jejunum demonstrated a metastatic tumor of malignant pleural mesothelioma. This is the first reported case of malignant pleural mesothelioma presenting as an acute surgical abdomen due to jejunal metastasis with perforation.

2000s

• Silico-asbestosis that responded to steroid therapy. S. Hoshi, Y. Tamai, A. Tamura, et al. 2006;45(15):917-21. Case report PubMed · Publisher

  Abstract

  A 73-year-old man with silico-asbestosis responded to steroid therapy. Chest CT scans showed diffuse micronodular opacities and ground glass opacities bilaterally throughout the entire lung fields, as well as progressive massive fibrosis in the bilateral upper lung fields. Diagnostic thoracoscopic biopsy revealed mixed dust pneumoconiosis with silicotic nodules, as well as fibrosis similar to that of Usual Interstitial Pneumonia (UIP) with many fibroblastic foci and alveolitis. Many asbestos bodies were also detected by iron staining.

• Rounded atelectasis associated with pulmonary lymphangioleiomyomatosis. K. Kishi, S. Homma, A. Miyamoto, et al. 2005;44(6):625-7. Case report PubMed · Publisher

  Abstract

  Rounded atelectasis is an unusual form of lung collapse that develops as a consequence of pleural diseases. Among a variety of conditions, asbestos inhalation has been attributed in most cases, but many other causes have also been implicated. Here, we describe the first case of rounded atelectasis and pneumothorax associated with pulmonary lymphagioleiomyomatosis.

• Malignant peritoneal mesothelioma associated with deep vein thrombosis following radiotherapy for seminoma of the testis. F. Sato, H. Yamazaki, K. Ataka, et al. 2000;39(11):920-4. Case report PubMed · Publisher

  Abstract

  A 52-year-old man developed malignant peritoneal mesothelioma 17 years after radiotherapy for seminoma of the testis. Although asbestos exposure is considered to be the major risk factor for the development of malignant mesothelioma, prior therapeutic radiation has also been postulated as a causative factor. The unexplained appearance of ascites or pleural effusion within a previously irradiated area should be considered suggestive of malignant mesothelioma in any long-term survivor of cancer. In addition, the patient suffered a deep vein thrombosis four years before the diagnosis of mesothelioma. Deep vein thrombosis is a common complication of malignant disease, and is often the first clue to occult malignancy.

1990s

• A clinicopathological study of lung cancer patients with occupational exposure to chrysotile asbestos fibers. K. Hamada, T. Tokuyama, Y. Okamoto, et al. 1999;38(10):780-4. PubMed · Publisher

  Abstract

  Objective: To summarize the features of asbestos-related lung cancer.

  Patients: Thirty-one lung cancer patients with occupational exposure to chrysotile asbestos fibers. They worked or had worked in one asbestos factory or its subcontracters.

  Result: All patients were male with mean age of 60.6 when diagnosed, and all except one were current or ex-'heavy' smokers. Histological types were fairly evenly divided into adeno-, squamous and small cell carcinoma and 24 (78%) of patients showed 'peripheral type' lung cancers. Regarding clinical stages, 20 patients (65%) were classified as III or IV (advanced stage). Tumor shadow(s) was detected on chest X-ray in 22 patients (71%), and in 5 patients with 'negative' chest X-ray, chest CT was necessary to recognize a primary tumor. Seventeen patients (55%) did not undergo periodical check-ups.

  Conclusion: Occupational asbestos exposure is interpreted as one of the important risks for lung cancer and frequent and accurate observation is necessary.

• Benign asbestos pleural effusion associated with pulmonary aspergilloma. J. Hiyama, M. Marukawa, Y. Shiota, et al. 1998;37(11):965-8. Case report PubMed · Publisher

  Abstract

  A rare case of benign asbestos pleural effusion associated with aspergilloma is reported. A chest radiograph of a 75-year-old Japanese man who was admitted with right chest pain showed a right pleural effusion and nodular shadows in the right apex and left middle lung field. Thoracocentesis revealed an exudate with atypical mesothelial cells. An open lung biopsy showed aspergilloma in the right S2 area and no evidence of malignancy. Many reactive mesothelial cells were found in the pleura. A quantitative asbestos digestion study of the lung tissue biopsy showed high-grade asbestos exposure.

• Two familial mesothelioma cases with high concentrations of soluble cytokeratin 19 fragment in pleural fluid. J. Hiyama, M. Marukawa, Y. Shiota, et al. 1998;37(4):407-10. Case report PubMed · Publisher

  Abstract

  We report two cases of diffuse malignant pleural mesothelioma occurring almost simultaneously in one family. Patient 1 was a 42-year-old Japanese man who had worked as an electrical engineer for 25 years. Patient 2, his mother, was 69 years old. She lived for 10 years with patient 1 after he started his work, and also worked at a shipyard herself for 6 years. The concentrations of cytokeratin subunit 19 fragment (CYFRA 21-1) in pleural fluid of the two patients were 1,500 ng/ml, and 1,200 ng/ml, respectively. Measurement of CYFRA 21-1 concentration in the pleural fluid may be a useful tool for a diagnosis of malignant mesothelioma.

• Brain metastasis in malignant pleural mesothelioma. A. Kawai, Y. Nagasaka, M. Muraki, et al. 1997;36(8):591-4. Case report · Review PubMed · Publisher

  Abstract

  A 55-year-old male who had a remote history of occupational asbestos exposure consulted us because of chest pain. Chest X-ray revealed diffuse pleural thickening and pleural effusion on the right. A diagnosis of malignant mesothelioma, biphasic type was made by needle pleural biopsy. Fourteen months later, the patient died of brain metastasis. At autopsy, malignant mesothelioma of the pleura with metastasis to the brain and bilateral adrenal glands was observed. Brain metastases proven by autopsy are rare in cases of malignant mesothelioma. The ferruginous body count in the lung tissue was 16 per gram of wet weight.

• Malignant lymphoma involving the penis following malignant pleural mesothelioma. K. Takabe, Y. Tsukada, T. Shimizu, et al. 1997;36(10):712-5. Case report PubMed · Publisher

  Abstract

  A 74-year-old man who had been diagnosed with malignant mesothelioma developed malignant lymphoma of B-cell origin involving the penis. He had a history of occupational exposure to asbestos as a construction worker. The association of malignant mesothelioma with lymphoma is rare, and the possibility of asbestos exposure as a common etiology is discussed. The intense stimulation of B lymphocytes and decreased T lymphocyte activity in asbestos-exposed populations may result in development of B-cell malignancies. Though the relationship between asbestos exposure and malignant mesothelioma is firmly established, the relationship between asbestos exposure and lymphoma remains to be investigated.

• Non-ischemic myocardial fibrosis after long-term asbestos exposure. A. Kohama, T. Masuyama, M. Hori, et al. 1996;35(8):605-10. PubMed · Publisher

  Abstract

  To determine whether or not myocardial fibrosis in the left ventricle increases after exposure to asbestos fiber, we studied myocardial fibrosis in 42 autopsied hearts; 17 of asbestosis (AS) and 18 of chronic pulmonary disease (CP) without pneumoconiosis. Seven patients with extracardiopulmonary disease were used as a control group (CONT). The extent of myocardial fibrosis in the left ventricle was significantly greater in the AS group compared to the other groups (AS 3.6 +/- 1.3% vs. CP 2.4 +/- 1.0% vs. CONT 1.6 +/- 0.8%). There was a significant difference in the appearance ratio of focal fibrosis between the asbestosis group and the other groups. Focal fibrosis was observed in none of 7 control patients, in 3 of 18 patients with chronic pulmonary disease and in 9 of 17 patients with asbestosis. We concluded that characteristic myocardial fibrosis was observed in humans after long-term asbestos exposure.

  In plain English

  This Japanese autopsy study compared heart muscle scarring (fibrosis) in 42 hearts: 17 from people with asbestosis, 18 with other chronic lung diseases but no pneumoconiosis, and 7 controls who died of diseases outside the heart and lungs. Most asbestosis patients had worked in asbestos spinning, for 10 to 34 years. Average left-ventricle fibrosis was 3.6% of tissue area in the asbestosis group, 2.4% in the lung disease group and 1.6% in controls. The asbestosis figure was significantly higher than both others. Scattered (focal) fibrosis appeared in 10 of 17 asbestosis patients, 3 of 18 lung disease patients and 0 of 7 controls. No asbestos bodies were found in the asbestosis group's hearts, which the authors said does not rule out asbestos fibers. The authors concluded that left-ventricle fibrosis changes in pattern and amount after long-term asbestos exposure and accompanying respiratory failure, without coronary sclerosis. They suggested asbestos fiber may be one cause. Their stated limitations included no established way to measure percent fibrosis in autopsied hearts, cancer-related wasting in most controls, and studying only asbestosis patients who died of respiratory failure or chronic cor pulmonale.

  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.

• Dyskeratosis congenita showing usual interstitial pneumonia. S. Imokawa, A. Sato, M. Toyoshima, et al. 1994;33(4):226-30. Case report PubMed · Publisher

  Abstract

  A 46-year-old man was admitted to our hospital with cough and dyspnea on exertion. A chest X-ray film showed diffuse interstitial shadows. He had hyperpigmentation forming a network pattern around his neck and dystrophy of the fingernails and toenails, and was diagnosed as having dyskeratosis congenita. Histological examination of the lung specimen obtained from the left S4b by open lung biopsy revealed usual interstitial pneumonia pattern with neither asbestos bodies nor silicotic nodules. Taken together with previously published findings, pulmonary involvement is considered to be an important complication of dyskeratosis congenita.

• Malignant pleural mesothelioma presenting as achalasia. H. Seki, K. Matsumoto, K. Ohmura, et al. 1994;33(10):624-7. Case report PubMed · Publisher

  Abstract

  A 65-year-old man with an occupational history of asbestos exposure developed dysphagia and vomiting. Clinical examinations at onset revealed a dilated esophagus with smooth narrowing at the gastroesophageal junction and no apparent tumor in and around the esophagus. Achalasia was suspected. Dysphagia progressed gradually and examinations performed three months after the onset disclosed a tumor in the pleural and the peritoneal cavities. At laparotomy, the tumor extended from the pleural cavity into the peritoneal cavity. Histological examination of the biopsied specimen demonstrated malignant mesothelioma. We report the first case of malignant pleural mesothelioma presenting as achalasia.

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