Respirology Case Reports

Our medical research library holds 46 studies published in Respirology Case Reports (2014–2026). 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. 44 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: John Wiley & Sons, Inc
• Published: 2013 to the present, United States
• Language: English
• ISSN: 2051-3380 (electronic)
• Its record in the NLM Catalog

2020s

• Environmental Asbestos Exposure as a Possible Pathway to Early-Onset Pleural Mesothelioma: A Case From Afghanistan and Pakistan to London. S. Mounouchos, A. Aggarwal, A.A. Nafees, et al. 2026;14(10):e70774. PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is strongly associated with occupational asbestos exposure and typically presents decades after exposure, in older men. The association of MPM with environmental exposure and genetic susceptibility is less recognised. We report a case of a 40-year-old man presenting in London with dyspnoea, weight loss and a persistent right-sided pleural effusion following hospitalisation for pneumonia. Imaging showed circumferential nodular thickening of the right pleura with lymph node involvement, and histopathology was in keeping with epithelioid-type MPM. With no known occupational exposure, childhood residences in Kabul, Afghanistan and Peshawar, Pakistan, where high levels of environmental asbestos are documented, represent plausible sources of environmental exposure. As a result of migration from regions with high environmental asbestos exposure, clinicians in high-income countries may encounter increasing numbers of patients with MPM due to non-occupational asbestos exposure.

  © 2026 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Immune-Related Encephalitis in a Patient With Pleural Mesothelioma: Case Report. F. Onishi, N. Hara, M. Ota, et al. 2026;14(9):e70748. PubMed · Publisher · Free full text

  Abstract

  A 69-year-old man who was a former plumber with a history of occupational asbestos exposure was diagnosed with unresectable pleural mesothelioma. Six months after initiation of combination therapy with ipilimumab and nivolumab, he presented with an altered level of consciousness and extrapyramidal symptoms and was diagnosed with immune-related encephalitis. Although high-dose corticosteroid therapy and intravenous immunoglobulin led to partial improvement in his level of consciousness, the response was limited. Immune-related encephalitis is rare, especially in association with pleural mesothelioma. Optimal management of the condition needs to be established.

  © 2026 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Sarcomatoid Mesothelioma Revealed After Treatment for Tuberculous Pleurisy: A Case Report. D. Nagayama, K. Yokoo, Y. Yabushita, et al. 2026;14(9):e70734. PubMed · Publisher · Free full text

  Abstract

  Differentiating tuberculous (TB) pleurisy from malignant pleural mesothelioma is challenging due to similar clinical presentations. We report an 83-year-old man with sarcomatoid mesothelioma initially treated for TB pleurisy. He presented with lymphocyte-predominant exudative pleural effusion and a positive Interferon-Gamma Release Assay. Thoracoscopy revealed purulent effusion, but biopsies were non-diagnostic. Despite empiric anti-tuberculosis therapy, the effusion persisted. A subsequent surgical biopsy showed fibrosis and scattered spindle cells. However, 2 months later, a rapidly growing chest wall mass with bone invasion appeared. A CT-guided percutaneous biopsy showed proliferation of atypical spindle cells and fluorescence in situ hybridization (FISH) analysis allowed for the diagnosis of sarcomatoid mesothelioma. This case highlights the aggressive nature of sarcomatoid mesothelioma and its diagnostic difficulty. For treatment-refractory pleurisy, clinicians must maintain high suspicion, ensuring vigilant follow-up and prompt repeat biopsies despite negative initial results, while consulting pathologists to consider additional FISH testing.

  © 2026 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Successful Diagnostic Confirmation of Malignant Pleural Mesothelioma With Extensive Pleural Adhesions Using Pleural Cryobiopsy Under Local Anaesthesia. S. Otaki, M. Suzuki, K. Yano, et al. 2026;14(8):e70704. PubMed · Publisher · Free full text

  Abstract

  Local anaesthesia thoracoscopy using flex-rigid thoracoscope is useful for diagnosing pleural lesions, but it is generally not indicated in cases with extensive pleural adhesions. We report a case of malignant pleural mesothelioma (MPM) with extensive pleural adhesions that was safely diagnosed using pleural cryobiopsy under local anaesthesia. A 65-year-old man with a history of asbestos exposure presented with chest pain and significant weight loss. A very small amount of pleural effusion, narrowing of the left lower intercostal spaces on chest computed tomography (CT) and negative lung sliding sign on transthoracic echocardiography (TTE) indicated significant pleural adhesions. Considering the high risk of general anaesthesia, biopsy under minimally invasive local anaesthesia was chosen. Precise localization of the lesions using positron emission tomography-CT and TTE enables making the incision over the tumour. After minimal adhesion dissection, pleural cryobiopsy was performed and a definitive diagnosis of epithelial MPM was made.

  © 2026 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Thoracic Actinomycosis: A Rare Cause of Pleural Thickening. E. Shum, J. Muhandiramge, J. Finn, et al. 2026;14(4):e70451. PubMed · Publisher · Free full text

  Abstract

  A middle-aged man presented with an indolent growth on his chest wall, features of sepsis, and constitutional symptoms. He was subsequently found to have raised inflammatory markers and pleural thickening on imaging which, coupled with a history of asbestos exposure, was concerning for malignancy. While there was clinical improvement with empirical intravenous penicillin antibiotics, the diagnosis was not certain until an excisional biopsy of the mass was performed, with histopathology showing Splendore Hoeppli material ('sulfur granules') leading to the diagnosis of an Actinomyces infection. The diagnosis allowed for appropriate management with a prolonged course of antibiotics, resulting in complete resolution of symptoms. This case highlights the importance of investigation for atypical infection in patients with pleural thickening, particularly in those with risk factors such as drug use.

  © 2026 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Asbestosis Requiring Lung Transplantation in a Retired Hairdresser: An Occupational Exposure to Comb Through. R. Bu, L. Puttagunta, K. Halloran, et al. 2025;13(7):e70283. PubMed · Publisher · Free full text

  Abstract

  Asbestosis is a form of fibrotic interstitial lung disease caused by the inhalation of excessive asbestos fibres. We describe a patient who developed asbestosis due to occupational exposures while working as a hairdresser in the 1970s and 1980s. Not appreciating this profession as a risk factor for developing asbestosis led to several treatment strategies that were ineffective and eventually led to the need for lung transplantation. More recent changes to governmental policy have effectively reduced the incidence of such an exposure risk; however, given the long latency of the disease, we emphasise that a broad occupational history including potential historic exposures remains an important component of the assessment of interstitial lung disease. We also outline many reasons for a second wave of asbestosis-related lung disease that is only now emerging and encourage clinicians to continue to maintain asbestosis on the differential for working up undifferentiated fibrotic lung disease.

  © 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Aspirated Soybean Mimicking Endobronchial Tumour Removed With a Cryoprobe. S. Matsumoto, Y. Takigawa, K. Sato, et al. 2025;13(10):e70366. PubMed · Publisher · Free full text

  Abstract

  Adult airway foreign bodies are misdiagnosed as endobronchial tumours on imaging. A 77-year-old man with asbestosis presented with a worsening cough. Computed tomography (CT) showed a 12-mm low-attenuation right upper-lobe bronchial lesion with distal bronchiectasis and infiltrates. Magnetic resonance imaging (MRI) suggested a fat-containing tumour (lipoma or hamartoma). Flexible bronchoscopy revealed a yellowish polypoid mass; poor sedation tolerance necessitated rigid bronchoscopy under general anaesthesia. Using a 1.7-mm cryoprobe, the lesion was cryoactivated for 10 s and removed en bloc. It proved to be a foreign body resembling a legume and was later confirmed to be an aspirated soybean from 1 month earlier. The fat and water content of soybeans can yield MRI appearances similar to fatty tumours. Distinguishing tumours from foreign bodies by imaging or bronchoscopy alone is challenging. Cryoprobe extraction is effective for hydrated foreign bodies, and aspiration should be considered in the differential diagnosis of endobronchial tumours.

  © 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Dual Immunotherapy for Pericardial Mesothelioma That Developed After a Decade-Long Idiopathic Pericarditis: A Case Report. B.G. Mirete, P.R. Paya, M.M. Marin, et al. 2025;13(5):e70190. PubMed · Publisher · Free full text

  Abstract

  Malignant pericardial mesothelioma (MPeM) is exceptionally rare, and its association with long-standing idiopathic pericarditis remains unreported. We present a 46-year-old woman with a decade-long history of recurrent idiopathic pericarditis who developed multiple pericardial nodules, mediastinal lymphadenopathy, and metastatic liver and bone lesions. A core needle biopsy confirmed biphasic MPeM. Due to her pericardial condition, she initially received platinum-based chemotherapy instead of immunotherapy, but the disease progressed. She then underwent dual immune checkpoint inhibition (ICI) and achieved a significant clinical and radiological response. This case raises the possibility of chronic inflammation contributing to pericardial malignancy and underscores the potential role of dual ICI in this rare and challenging disease.

  © 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Letter to the Editor: 'Asbestosis Requiring Lung Transplantation in a Retired Hairdresser: An Occupational Exposure to Comb Through'. E. Anderson, S. Meyler, A. Gallagher, et al. 2025;13(10):e70368. Letter PubMed · Publisher · Free full text

• Miliary Mesothelioma. D. Jayabalan, M. Donaghy, C. Charlesworth, et al. 2025;13(3):e70141. PubMed · Publisher · Free full text

  Abstract

  Miliary spread of mesothelioma is a rare but important manifestation of late-stage disease, likely due to hematogenous dissemination. This case highlights characteristic CT imaging findings, emphasizing the need for awareness among clinicians and radiologists. Recognizing this pattern can aid in diagnosis, prognostication, and appropriate referral for palliative management.

  © 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Partial Response to Nivolumab and Ipilimumab in a Patient With Malignant Pleural Mesothelioma and Pre-Existing Myasthenia Gravis Without Severe Flares or Immune-Related Adverse Events: A Case Report. M. Higa, T. Kuda, Y. Ohya, et al. 2025;13(8):e70297. PubMed · Publisher · Free full text

  Abstract

  Detailed clinical data on the combination immune checkpoint inhibitor (ICI) therapy in patients with myasthenia gravis (MG) remain limited. We report a case of malignant pleural mesothelioma with previously undiagnosed ocular MG. Owing to hepatic dysfunction, reduced doses of nivolumab and ipilimumab were administered before confirmation of anti-acetylcholine receptor (AChR) antibody positivity. MG was diagnosed based on subtle ocular symptoms and serological tests. Prophylactic intravenous immunoglobulin and an acetylcholinesterase inhibitor were administered; combination therapy was discontinued owing to the risk of MG flare, but a partial tumour response was achieved. With disease progression, nivolumab monotherapy was reintroduced, and early steroid pulse therapy was administered owing to elevated creatine kinase, again inducing a partial response. Serological screening for anti-AChR antibodies may help prevent severe MG flares and immune-related adverse events. With caution, dose-reduced and limited-exposure ICI combination therapy may be feasible in selected patients with MG under appropriate prophylactic management.

  © 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Radiotherapy-Induced Pleural Mesothelioma in a Childhood Leukaemia Survivor: A Case Report. S. Saeki, R. Kurosawa, A. Yamada, et al. 2025;13(9):e70342. PubMed · Publisher · Free full text

  Abstract

  We report the case of a 41-year-old woman who developed an epithelioid-type pleural mesothelioma (PM) decades after treatment for childhood acute myeloid leukaemia (AML), who was treated with chemotherapy and total body irradiation (TBI). The diagnosis was confirmed by thoracoscopic pleural biopsy and immunohistochemical staining. Although PM is classically associated with asbestos exposure, the patient had no known history of exposure. This case report highlights the fact that PM can occur as a late-onset secondary malignancy following radiation therapy in childhood cancer survivors. Although radiation-induced PM has been reported primarily in survivors of Hodgkin lymphoma or breast cancer, incidences following treatment for leukaemia are exceptionally rare. This case report highlights the importance of considering prior therapeutic irradiation, including total-body irradiation, as a potential etiological factor for non-asbestos-related PM. It also emphasises the need for the long-term surveillance and monitoring of childhood cancer survivors, particularly those who have received radiation therapy.

  © 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Reply to 'Letter to the Editor: "Asbestosis Requiring Lung Transplantation in a Retired Hairdresser: An Occupational Exposure to Comb Through"'. R. Bu, L. Puttagunta, A. Hirji. 2025;13(10):e70370. Letter · Comment PubMed · Publisher · Free full text

• A case of attempted transbronchial spigot insertion for fistulous pyothorax in the residual pleural airspace after pleurectomy/decortication for malignant pleural mesothelioma. R. Miyata, S. Morizono, T. Umehara, et al. 2024;12(1):e01286. Case report PubMed · Publisher · Free full text

  Abstract

  Pleurectomy/decortication for malignant pleural mesothelioma is a relatively recent surgical approach for which there is a dearth of information on complications, especially in the late postoperative period. A 70-year-old man was diagnosed with right epithelioid malignant pleural mesothelioma and underwent pleurectomy/decortication. Computed tomography at 6 months after surgery revealed nodules on the surface of the right lung. These nodules gradually increased in size and were diagnosed as recurrent disease. Immunotherapy was started, but treatment was discontinued a few days after the first course due to pneumonitis. Subsequent oral prednisolone therapy for about 2 months ameliorated pneumonitis, but fistulous pyothorax developed. During attempted transbronchial occlusion of the responsible bronchus, some spigots penetrated the empyema cavity. Open window thoracotomy was performed on the following day. This case suggests that if there is no change in diameter between the proximal and distal parts of the responsible bronchus, transbronchial occlusion should not be chosen.

  © 2024 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• A rare case of a huge malignant pleural mesothelioma presenting in the posterior mediastinum. Y. Mori, C. Kato, H. Yamakawa, et al. 2024;12(7):e01429. Case report PubMed · Publisher · Free full text

  Abstract

  We report a case of a 69-year-old woman with pleural mesothelioma presenting in the posterior mediastinum with a maximum diameter of 25 cm. She had a chronic cough and a pleural effusion was noted on chest X-ray. The examination of the effusion showed high hyaluronic acid levels, and mesothelioma was suspected. A chest computed tomography scan showed a huge mediastinal mass, which caused rapid progression of respiratory failure and compression of the heart. Sufficient tissue samples could not be obtained before death. The patient died approximately 1 month after the initial visit, and a pathological autopsy was performed. The diagnosis of malignant pleural mesothelioma was made. Malignant pleural mesothelioma with a huge posterior mediastinal mass such as in this case is considerably rare; however, it is a rapidly progressing form of the disease and is reported here as an important differential diagnosis for mediastinal tumours.

  © 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Calcifying fibrous tumour of the pleura without gross calcification. H.J. Lee, J.S. Jeong, Y.C. Lee. 2024;12(5):e01365. Case report PubMed · Publisher · Free full text

  Abstract

  Calcifying fibrous tumours of the pleura (CFTP) typically appear as calcified, non-enhancing lesions on chest CT scans. However, enhancing pleural lesions can mimic malignancy like mesothelioma. We report a rare case that enhancing pleural thickening, confirmed as CFTP through pathological examination, despite the absence of visible calcification on radiological imaging.

  © 2024 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Pleuroparenchymal sarcoidosis: A rare manifestation mimicking metastatic lung cancer. E. Gan, C.K. Tay. 2024;12(8):e01438. Case report PubMed · Publisher · Free full text

  Abstract

  A 66-year-old male from Myanmar presented with 3 months of cough and constitutional symptoms. He was an ex-tobacco user with no significant medical or exposure history. Chest x-ray showed ill-defined bilateral opacities and a left pleural effusion. Chest CT revealed two right lower lobe masses, and a moderate-sized left pleural effusion. PET-CT demonstrated hypermetabolic uptake in the thickened nodular pleura, pericardium, and hilar/mediastinal lymph nodes. EBUS-TBNA of the right lower paratracheal node and TBLB of the right lower lobe mass yielded epithelioid granulomas comprising multinucleated giant cells, epithelioid histiocytes and lymphoplasmacytic cells. Thoracoscopy revealed hard, whitish mass-like parietal pleural plaques, and pleural biopsy revealed identical histopathologic results. His symptoms resolved quickly after commencing prednisolone 25 mg daily. Chest CT at 6 months demonstrated near complete resolution of the parenchymal masses and pleural effusion. We highlight this unique case of pleuroparenchymal sarcoidosis mimicking metastatic lung cancer in a tuberculosis-endemic region.

  © 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Unveiling a rare haemorrhagic malignant pleural effusion: The role of medical thoracoscopy in diagnosing primary pleural angiosarcoma. A.R. Chong, K.L. Ng, N.C. Huan, et al. 2024;12(11):e70068. PubMed · Publisher · Free full text

  Abstract

  Primary pleural angiosarcoma (PPA) is a rare and challenging tumour to diagnose, often mistaken for other malignancies such as mesothelioma and lung cancer due to overlapping clinical and imaging features. We report a 52-year-old woman who presented with progressive shortness of breath and pleuritic chest pain. Imaging studies and thoracentesis revealed a large haemorrhagic left pleural effusion. Medical thoracoscopy (MT) showed a thickened and lobulated parietal pleura with multiple nodular lesions. Histopathological examination confirmed a diagnosis of angiosarcoma, characterized by pleomorphic tumour cells, a high Ki67 proliferation index and positive immunohistochemical markers, including CD31, D2-40, Vimentin, and Factor VIII. Tragically, the patient developed a hospital-acquired infection and passed away before any definitive treatment for the angiosarcoma could be initiated. This case underscores the diagnostic complexities of PPA and highlights the utility of MT in identifying this rare malignancy.

  © 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Malignant pleural mesothelioma with resolution of pleural effusion. S. Nishida, K. Toriyama, M. Yomota, et al. 2023;11(11):e01234. PubMed · Publisher · Free full text

  Abstract

  In malignant pleural mesothelioma patients, pleural effusion may improve during the course of the disease. Pleural effusion with nodular shadows bordering the pleura should be followed up even if the pleural effusion improves.

  © 2023 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• A case of simultaneous diagnosis of tunica vaginalis testis and pleural mesothelioma. R. Matsuki, S. Ishii, T. Suzuki, et al. 2022;10(4):e0937. Case report PubMed · Publisher · Free full text

  Abstract

  A 37-year-old man was admitted to our hospital with chest pain and fever. Computed tomography showed pleural effusion and irregularly marginated, elevated lesions inside diffuse pleural thickening. Detailed medical examination showed swelling of the left testicle. 18F-fluorodeoxyglucose positron emission tomography showed uptakes at the thickened pleura and left testis. Pelvic magnetic resonance imaging showed a mass in the left testis with a heterogeneous and partially calcified tumour present interiorly. Thoracoscopy was performed under local anaesthesia, enabling the observation of masses at the pleura and biopsy of the mass, which was diagnosed as malignant pleural mesothelioma. The affected testicle was resected and diagnosed as tunica vaginalis testis mesothelioma. Thus, simultaneous tunica vaginalis testis and pleural mesothelioma were diagnosed. It is necessary to closely examine parts of the body other than the chest.

  © 2022 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• A case of slowly progressive malignant pericardial mesothelioma suggesting the involvement of BAP1 loss. N. Fukasawa, Y. Agemi, A. Shiba, et al. 2022;10(9):e01004. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pericardial mesothelioma (MPM) is a rare tumour that arises from the mesothelial cells of the pericardium. No standard treatment has been established owing to a poor treatment response; therefore, MPM has a poor prognosis. We herein report a rare case of MPM in a 70-year-old man that was diagnosed immunohistopathologically using cell block sections of pericardial fluid and in which long-term survival for more than 3 years was achieved with only periodic pericardial drainage. Immunohistopathological staining investigations, especially BRCA1-associated protein 1 (BAP1) immunostaining using cell block sections of pericardial effusion, are effective in making a diagnosis of MPM. Well-differentiated papillary mesothelioma (WDPM) with BAP1 loss progresses to MPM in the long term, showing that BAP1 loss may induce phenotypical evolution of WDPM. BAP1 loss may also progress to malignant mesothelioma in situ and then to invasive mesothelioma. BAP1 immunohistochemistry should be considered for the early diagnosis of MPM.

  © 2022 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• An unusual isolated anterior mediastinal lesion. N. Quigley, L. Lang-Lazdunski, C. Boily-Daoust, et al. 2022;10(11):e01059. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is an infrequent tumour of poor prognosis with a strong association with asbestos exposure. Pleural effusion or thickening is the most common radiological finding. Thoracoscopic biopsy is the diagnostic modality of choice. In our report, we present the case of a career welder who consulted with vocal cord palsy and an atypical anterior mediastinal lesion. An EBUS-TBNA-guided biopsy and a thorough cytological assessment led to an unexpected diagnosis of epithelioid MPM. A localized anterior mediastinal lesion is an extremely infrequent presentation of MPM that deserves clinical recognition.

  © 2022 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Antibiotic administration via indwelling peritoneal catheter to treat infected malignant ascites. T. Jayawardena, S. Vekaria, S. Krivinskas, et al. 2022;10(11):e01055. Case report PubMed · Publisher · Free full text

  Abstract

  Indwelling pleural catheter is an established management for malignant pleural effusions. Extending its use to patients with malignant ascites by insertion of a catheter intraperitoneally enables regular outpatient drainage and improves quality-of-life. However, indwelling pleural/peritoneal catheter (IPC/IPeC) is associated with catheter-related infections, traditionally managed with systemic antibiotics and occasionally requires catheter removal. Direct administration of antibiotics intra-abdominally via peritoneal dialysis (PD) catheters is a well-established, efficacious practice in PD-related peritonitis and minimizes systemic adverse effects. We applied the same principles to a patient with peritoneal mesothelioma who developed peritonitis 3 weeks after insertion of IPeC. Intraperitoneal vancomycin was administered via, and compatible with, the IPeC. The patient tolerated the treatment without adverse effects and made a full recovery without requiring catheter removal.

  © 2022 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• A case of diffuse large B-cell lymphoma originating from chest wall complicated by benign asbestos pleural effusion. N. Kondo, Y. Inoue, H. Takeyama, et al. 2021;9(3):e00714. Case report PubMed · Publisher · Free full text

  Abstract

  A 78-year-old man with exposure to asbestos was admitted to our hospital for back pain. A chest computed tomography showed right pleural effusion and a significant increase in the size of masses in the right chest wall over an interval of six months. He did not undergo further examinations and expired one month later. Autopsy revealed the presence of diffuse large B-cell lymphoma (DLBCL) and complicated by benign asbestos pleural effusion. We considered that this tumour had originated from the soft tissue in the chest wall based on the radiological and autopsy findings. The present report highlights that primary DLBCL of chest wall might be associated with chronic inflammation due to asbestos-related pleural diseases.

  © 2021 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Hyaluronic acid in viscous malignant mesothelioma pleural effusion. H.M. Cheah, D. Fitzgerald, A. Louw, et al. 2021;9(1):e00694. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural effusion (MPE) is common with mesothelioma. We report two cases of extraordinarily viscous MPEs associated with mesothelioma. The viscosity prohibited spontaneous gravity-dependent drainage via indwelling pleural catheters. Our ex vivo experiments found very high hyaluronic acid (HA) content within the fluid. Treatment of the fluid with hyaluronidase, but not with deoxyribonucleases, significantly reduced fluid viscosity. The results provide proof that HA can contribute to high viscosity of pleural fluid in mesothelioma. Research into strategies of counteracting HA properties in the management of MPEs may provide further insight.

  © 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• A challenging diagnosis of malignant mesothelioma with osteosarcomatous differentiation metastasizing to bone. M. Brown, H. Jersmann, T. Crowhurst, et al. 2020;8(8):e00664. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is an insidious primary neoplasm of the pleura that can be challenging to diagnose and is commonly considered to be only locally invasive. We present the case of a 74-year-old male who presented with clinical features of MPM but from whom pleural fluid and biopsies initially suggested benign pathology. He later developed diffuse bony metastases and re-examination of pleural biopsies using modern immunohistochemistry and molecular testing revealed a diagnosis of sarcomatoid and desmoplastic MPM with heterologous osteosarcomatous differentiation. This case not only demonstrates the rare potential of skeletal metastasis of MPM, but also highlights the importance of recognizing the utility of modern diagnostic tests and their potential to prevent the need for unnecessary invasive procedures. To our knowledge this is the first description of this rare histological sub-type presenting with skeletal metastases.

  © 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Endoscopic ultrasound-guided pleural biopsy in the hands of the pulmonologist. R. Bibi, U. Bodtger, R. Nessar, et al. 2020;8(2):e00517. Case report PubMed · Publisher · Free full text

  Abstract

  The use of the endobronchial ultrasound (EBUS) endoscope in the oesophagus, the so-called EUS-B procedure, for the diagnosis and staging of thoracic malignancy is quickly gaining ground. Pleural lesions located close to the oesophagus can be inaccessible to transthoracic biopsy and endoscopic procedures can be the only option. We here present two cases demonstrating that EUS-B-guided fine needle aspiration (EUS-B-FNA) of pleural lesions is possible. The first case demonstrates a EUS-B-FNA with malignant mesothelioma of a pleural lesion in a 70-year-old patient. In the second case, EUS-B-FNA diagnosed a pleural metastasis from adenoid cystic adenocarcinoma in a 75-year-old-patient. In conclusion, we hereby demonstrate that EUS-B-FNA from pleural lesions is feasible and appears to be safe.

  © 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Intrapleural urokinase directly under medical thoracoscopy for the diagnosis of tuberculous pleurisy. S. Terashita, H. Kawachi, T. Tajiri, et al. 2020;8(1):e00498. Case report PubMed · Publisher · Free full text

  Abstract

  Medical thoracoscopy, also called "local anesthetic thoracoscopy" and "pleuroscopy," is a minimally invasive single-port endoscopic technique that provides direct visualization of the pleural surfaces and channels to conduct diagnostic and therapeutic procedures. However, this technique is not helpful when substantial fibrous adhesions exist. We reported the first case of intrapleural urokinase directly under medical thoracoscopy for the diagnosis of malignant pleural mesothelioma with severe multiloculated pleural effusions in 2019. This is the second report regarding the efficacy of intrapleural urokinase directly under medical thoracoscopy for the diagnosis of multiloculated pleural effusions. Urokinase-induced intrapleural fibrinolysis, which removed the fibrous septa, consequently improved the field of view under endoscopy within only 10 min. Fibrinolytic effect appeared very rapidly. This technique is available for tuberculous pleurisy with severe multiloculated pleural effusion.

  © 2019 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Mediastinal malignant mesothelioma discovered in a patient with dysphagia. D. Amore, S. Massa, U. Caterino, et al. 2020;8(6):e00592. PubMed · Publisher · Free full text

  Abstract

  A mediastinal mass in patients with a history of asbestos exposure should raise the suspicion of malignant mesothelioma.

  © 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Primary squamous cell carcinoma of the pleura treated with nivolumab. I. Sigala, N. Alevizopoulos, K. Elefteriou, et al. 2020;8(2):e00516. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural effusions usually manifest in the course of metastatic cancer disease. Primary pleural tumours are rare with mesothelioma being by far the most common. Primary squamous cell carcinoma of the pleura (PSCCP) is extremely rare. It is usually asymptomatic, until it invades the pleura presenting pain as the first symptom. Our knowledge about its treatment or prognosis is limited due to its rarity. We present the case of a 48-year-old man who presented with persistent right-sided thoracic pain with chest computed tomography (CT) scan demonstrating a right-sided pleural effusion and pleural mass invading the ribs. Ultrasound-guided biopsy revealed a PSCCP. Positron emission tomography staging demonstrated metastatic lung and lymph node involvement precluding surgical therapy. We provide information about treatment, including immunotherapy as well as extended follow-up course. Immunotherapy with nivolumab resulted in prolongation of survival with good quality of life.

  © 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Radiographic change over 11 years in a patient with asbestos-related pleural disease. R. Hara, Y. Yano, F. Okabe, et al. 2020;8(7):e00642. Case report PubMed · Publisher · Free full text

  Abstract

  Asbestos-related pulmonary conditions such as benign asbestos pleural effusion (BAPE) and diffuse pleural thickening (DPT) can develop after many years of asbestos exposure. These conditions cause progressing constrictive deficit in pulmonary function which may lead to respiratory failure and death. We report the case of a 72-year-old man with asbestos-related BAPE and DPT which developed approximately 40 years after occupational asbestos exposure, leading to chronic respiratory failure and death. We were able to observe his clinical course including computed tomography (CT) scan evaluation over 11 years. In addition to this observation, moderate asbestos body concentration was confirmed in autopsy-derived lung tissue. There are few case reports that showed radiographic course of asbestos-related pulmonary disorder initiated as BAPE, followed by unilateral DPT and later bilateral DPT that was histologically proven with asbestos body. We consider his clinical course is important in managing this disease, especially in early phase.

  © 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Remarkable response to nivolumab in sarcomatoid malignant pleural mesothelioma with high PD-L1. K. Tsubouchi, S. Inoue, R. Ibusuki, et al. 2020;8(3):e00536. Case report PubMed · Publisher · Free full text

  Abstract

  We report herein a case of sarcomatoid malignant pleural mesothelioma (MPM) with high PD-L1 expression who was refractory to standard chemotherapy but had a remarkable and sustained response to nivolumab. A 78-year-old man presented with right chest pain. Computed tomography (CT) showed a solid mass extending to the right pleura. Histopathological examination revealed the proliferation of spindle to pleomorphic ovoid shaped tumour cells, which are positive for calretinin and podoplanin. The patient was diagnosed with sarcomatoid MPM. Despite treatment with carboplatin and pemetrexed, the primary lesion rapidly progressed and new multiple pleural metastases were observed. Although his performance status decreased with advancing of symptoms and adverse events, nivolumab was administered. After the nivolumab treatment, CT showed a significant reduction in pleural tumours with a marked improvement in symptoms. In the primary specimens, TPS of PD-L1 was 80%. The patient has continued this treatment with sustained and remarkable effectiveness with good quality of life (QOL).

  © 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

• Widespread pulmonary invasion by malignant pleural mesothelioma: an important diagnostic consideration. M. MacMillan, B. Roy, S. McLaren, et al. 2020;8(9):e00675. Case report PubMed · Publisher · Free full text

  Abstract

  We report a rare case of early and extensive pulmonary invasion of malignant pleural mesothelioma (MPM) in a 70-year-old woman. She first presented with a hydropneumothorax and subsequent workup, including video-assisted thoracoscopy (VAT), confirmed MPM. After VAT, she developed dyspnoea, cough, and widespread pulmonary infiltrates of uncertain aetiology. These infiltrates progressed over the following months, failed to respond to antibiotics, and were strongly fluorodeoxyglucose (FDG)-avid on positron emission tomography (PET). Bronchoalveolar lavage (BAL) yielded extremely viscous fluid containing mesothelioma cells. These cells were also found in the sputum when nebulized deoxyribonuclease (DNase) was trialled to enhance clearance of the pulmonary fluid. The patient deteriorated rapidly with progressive mediastinal and contralateral MPM involvement and died one month later. This case highlights the importance of including tumour invasion as a differential diagnosis of non-resolving pulmonary infiltrates in patients with MPM.

  © 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

2010s

• The significance of non-occupational asbestos exposure in women with mesothelioma. N. Tlotleng, K. Sidwell Wilson, N. Naicker, et al. 2019;7(1):e00386. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant mesothelioma is a rare and aggressive pleural or peritoneal tumour almost always caused by exposure to asbestos fibres. Exposure to asbestos can cause malignant mesothelioma 30-40 years after exposure. A description of sources of exposure is important for prevention and possible financial compensation. Three women with cases of histologically confirmed malignant mesothelioma diagnosed from non-occupational asbestos exposure are described. Patients were contacted for an interview to assess their exposure history to asbestos. All three cases had mixed exposure histories related to secondary, environmental contamination, and domestic exposure. This case series highlight how ubiquitous asbestos is in the environment and how diverse the exposures may be. It is anticipated that a significant number of cases of non-occupational mesothelioma will be seen in many countries for several decades given the extent of asbestos containing materials.

• Transbronchial lung cryobiopsy: a novel confirmatory tool to diagnose asbestos-related pulmonary fibrosis. M. Zajaczkowska, A. Johnson, L. Gallur, et al. 2019;7(1):e00380. Case report PubMed · Publisher · Free full text

  Abstract

  Asbestosis is diagnosed with a combination of historical, clinical and radiological findings in the absence of another cause. Histology is required when uncertainty exists, with lung biopsy via VATs being gold standard. Transbronchial cryobiopsy is becoming increasingly popular for diagnosing interstitial lung disease and may provide sufficient lung sample to demonstrate asbestosis. A 73 year old man presented with dyspnoea on a background of rheumatoid arthritis, previous methotrexate use and asbestos exposure. Examination revealed fine crackles in the mid and lower zones bilaterally without signs of pulmonary hypertension. The presence of pleural plaques and basal interstitial reticulation on HRCT was suggestive of asbestosis but histology was required to differentiate this from rheumatoid or methotrexate associated ILD. Samples of lung tissue were obtained via transbronchial cryobiopsy, demonstrating fibrosis and asbestos fibres consistent with asbestosis. Transbronchial cryobiopsy appears effective in obtaining sufficient parenchymal lung samples to diagnose asbestosis when clinical uncertainty exists.

• Malignant pleural mesothelioma presenting with remitting-relapsing pleural effusions: report of two cases. S. Muruganandan, D.B. Fitzgerald, Y.C.G. Lee. 2018;6(3):e00306. Case report PubMed · Publisher · Free full text

  Abstract

  Pleural effusions are common and are associated with malignancy in one sixth of cases. Malignant pleural effusion (MPE) is typically persistent and progressive, prompting further investigations if the initial tests are not diagnostic. A spontaneously remitting effusion is commonly presumed to be benign, and further investigations may not be performed. We present two cases in which the presenting pleural effusion spontaneously resolved but recurred (in one case, multiple times), leading to further investigations that revealed an underlying malignant pleural epithelioid mesothelioma. These cases demonstrate the need for clinicians to be aware that remitting effusions can occur in the context of pleural malignancy and should be kept under observation, with a low threshold for further investigation if relapse occurs.

• Rapid diffuse pleural thickening due to metastatic meningioma. F. Kobayashi, T. Saraya, K. Ohkuma, et al. 2018;6(4):e00313. Case report PubMed · Publisher · Free full text

  Abstract

  A 64-year-old man was referred to our hospital because of persistent dyspnoea for the past 1 month. He had recurrent brain anaplastic meningioma after two operations and irradiation. He suffered from right pleural effusion in the previous few months and was diagnosed with malignant mesothelioma via pleural biopsy 1 month prior to coming to our hospital. At his first visit to our hospital, thoracic computed tomography demonstrated rapidly developed large inhomogeneously enhancing pleural thickening up to 3 cm, which surrounded the right hemithorax, together with left-sided pleural effusion. After re-evaluation of the pathological specimens retrieved from the local hospital, he was finally diagnosed with pleural metastasis secondary to anaplastic meningioma (WHO classification, grade 3). Generally, brain meningiomas are believed to be benign and seldom metastasize to other organs. However, the present case clearly demonstrated the unique clinical presentation of anaplastic meningioma, also known as malignant meningioma, which mimicked the pathological and radiological findings of a malignant mesothelioma.

• Chest pain and recurrent chylothorax: an unusual presentation of malignant pleural mesothelioma. D.R. Darley, E. Granger, A.R. Glanville. 2017;5(5):e00250. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant mesothelioma presenting with recurrent chylous effusion is rare. We describe the case of a 34-year-old female Macedonian immigrant who presented with central chest pain and subsequently a left-sided chylous pleural effusion. The diagnosis was made on pleural biopsy via video-assisted thoracoscopic surgery (VATS). Our case demonstrates the utility of thoracic magnetic resonance imaging (MRI) and the difficulties associated with pleural cytology and cervical lymph node biopsy in the establishment of a diagnosis of mesothelioma. It is a reminder that mesothelioma can metastasize to mediastinal and cervical lymph nodes, can occur in young people, and may present as a chylothorax.

• Alveolar-filling growth pattern of sarcomatoid malignant pleural mesothelioma. T. Hayakawa, S. Tajima, Y. Takanashi, et al. 2016;4(5):e00175. Case report PubMed · Publisher · Free full text

  Abstract

  A case of sarcomatoid malignant pleural mesothelioma showing extremely rare growth pattern is described. A 63-year-old man presented to our hospital with left pleural effusion. A computed tomography (CT) scan of the chest showed diffusely thickened left visceral and parietal pleura associated with intermingled pulmonary infiltrative shadowing. Biopsy of the pleura under general anaesthesia confirmed the diagnosis of sarcomatoid malignant pleural mesothelioma. The patient underwent left extra-pleural pneumonectomy. Histopathologically, the sarcomatoid spindle tumour cells changed their morphology to polygonal cells in the pulmonary parenchyma and grew upwards, filling the alveolar space without the destruction of its septa, showing an alveolar-filling growth pattern. The current report indicates a case of sarcomatoid pleural mesothelioma that shows an alveolar-filling growth pattern, despite having not been thoroughly categorized in the World Health Organization (WHO) classification.

• IgG4-related disease in asbestos-related pleural disease. Y. Onishi, Y. Nakahara, K. Hirano, et al. 2016;4(1):22-4. Case report PubMed · Publisher · Free full text

  Abstract

  A 67-year-old man with a history of asbestos exposure and rounded atelectasis complained of cough and swelling in the left submandibular region. Computed tomography showed an increase in size of the right lower lung lobe lesion, which was recognized as the pre-existing rounded atelectasis, as well as swelling of the pancreas and submandibular glands. Biopsy from a submandibular gland and the pulmonary lesion led to a diagnosis of immunoglobulin G4-related disease (IgG4-RD). IgG4-RD is a recently recognized disease that was first reported as an autoimmune disease; however, some reports have indicated another pathogenesis of an allergic nature that is characterized by type 2 helper T cell (Th2) inflammation. Additionally, it is recognized that long-term exposure to asbestos can cause immune dysregulation. Here we present a case of IgG4-RD associated with asbestos-related pleural disease. Asbestos-induced immune dysregulation may be one etiology of IgG4-RD.

• Pemetrexed for epithelioid haemangioendothelioma of the pleura. S. Kanemura, K. Kuribayashi, Y. Moriya, et al. 2016;4(6):e00191. Case report PubMed · Publisher · Free full text

  Abstract

  A 31-year-old woman presented with a 2-month history of dull left back pain. Chest roentgenography revealed pleural thickening in the left lung apex, whereas chest computed tomography showed a left pleural effusion with diffuse pleural thickening. Based on these findings, malignant mesothelioma was suspected. Video-assisted thoracoscopic pleural biopsy was performed, and subsequent staining of the specimen revealed negative results for anti-cytokeratin antibodies and positive results for vascular endothelial immunohistochemical markers. Therefore, a diagnosis of epithelioid hemangioendothelioma (EHE) was made, and chemotherapy with carboplatin, pemetrexed, and bevacizumab was initiated. After the fourth course of treatment, the disease was well controlled with a 90% reduction of the left pleural effusion. This case is very rare in that the EHE originated from the pleura. Additionally, there has been no report of pemetrexed for treatment of EHE.

• Repetitive responses to nanoparticle albumin-bound paclitaxel and carboplatin in malignant pleural mesothelioma. O. Kanai, K. Fujita, K. Nakatani, et al. 2016;4(1):28-31. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is a rare tumor with a poor prognosis. Although cisplatin plus pemetrexed is the standard chemotherapy for patients with unresectable MPM, few agents are available for MPM patients who do not tolerate pemetrexed. Here, we report the first case of an MPM patient for whom the combination of nanoparticle albumin-bound paclitaxel and carboplatin (nabPC) repetitively achieved tumor regression. A 76-year-old man was diagnosed with epithelioid MPM. One cycle of carboplatin plus pemetrexed and two cycles of gemcitabine were administered but failed to inhibit tumor progression. By contrast, four cycles of nabPC resulted in a good response. Upon disease progression, four cycles of nabPC were performed again and resulted in a modest response. In conclusion, based on the present case, nabPC is a potential alternative chemotherapeutic agent for MPM, especially for MPM patients who do not tolerate pemetrexed.

• Malignant pleural mesothelioma presenting as a spontaneous pneumothorax. A. Mitsui, H. Saji, T. Shimmyo, et al. 2015;3(1):9-12. Case report PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is thought to arise from the mesothelial cells that line the pleural cavities. Most patients initially experience the insidious onset of chest pain or shortness of breath and have a history of asbestos exposure. MPM rarely presents as spontaneous pneumothorax. We report two male patients who presented with a spontaneous hydropneumothorax. One was exposed to asbestos and the other was not. Computed tomography showed tiny nodules with pleural thickness. They both underwent pleural effusion cytology and/or pleural biopsy. Therefore, the pathological diagnosis of MPM was obtained in both cases. We also reviewed 16 Japanese MPM cases with pneumothorax including our two patients. More than half of the patients suffered from pneumothorax repeatedly. We emphasize the need to obtain a pathological diagnosis of pleural effusion cytology and/or pleural biopsy in older patients presenting with a spontaneous hydropneumothorax.

• Pleural vasculitides of microscopic polyangiitis with asbestos-related plaques. A. Hara, Y. Kinoshita, K. Hosoi, et al. 2015;3(4):148-50. Case report PubMed · Publisher · Free full text

  Abstract

  A 69-year-old man who had been exposed to asbestos for approximately 40 years presented with the complaint of fever and pleuritic chest pain on the right side on deep inspiration. Chest X-ray films showed pleural effusion in the right side. Initial antibiotic treatment was ineffective. The hyaluronic acid level was high in the pleural effusion but no malignant mesotheliomal cells were seen with blind pleural biopsy. Blood chemistry showed a remarkable high titer of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) and open renal biopsy suggested crescentic glomerulonephritis. The precise pathological examination on the pleura obtained by the open pleural biopsy showed vasculitides and plaque leading to diagnosis of microscopic polyangiitis (MPA). This is a rare case of MPA seen in the pleural arteries.

• Primary pleural epithelioid hemangioendothelioma mimicking as a posterior mediastinal tumor. J. Wethasinghe, J. Sood, R. Walmsley, et al. 2015;3(2):75-7. Case report PubMed · Publisher · Free full text

  Abstract

  A 41-year-old man with no previous asbestos exposure presented with 6 months of dull right lower chest pain and weight loss. The initial computed tomography (CT) scan was reported as showing a soft tissue thickening in the posterior mediastinum with non-specific nodules in the horizontal and oblique fissures. An endoscopic ultrasound-guided fine needle aspiration from the 12 × 25 mm heterogeneous posterior mediastinal mass was suspicious for a ganglioneuroma. The procedure was complicated by a large hemothorax requiring drainage. A subsequent positron emission tomographic CT revealed a moderately fluorodeoxyglucose avid area of pleural thickening extending from the sixth to ninth thoracic vertebral body in the paraspinal region along with nodules along the right horizontal and oblique fissures. A thoracoscopic biopsy of the pleural lesion confirmed a pleural epithelioid hemangioendothelioma. There was a 5-mm reduction in tumor thickness and improvement in his pain following 54 Gy of radiotherapy.

• Henoch-Schonlein purpura in mesothelioma. S. Joshi, S. Pillai, A. Chakera, et al. 2014;2(4):138-40. PubMed · Publisher · Free full text

  Abstract

  Henoch-Schonlein purpura (HSP) is primarily a childhood immunoglobulin A (IgA)-mediated illness. When adults are affected, malignancy can be associated. We present a rare case of HSP in a 75-year-old man with malignant pleural mesothelioma. He presented with episodes of dizziness and subsequently developed non-palpable purpura across his legs, arthralgia, hematuria, proteinuria, and acute renal impairment. HSP was diagnosed based on clinical and histological findings on biopsy specimens from the skin and kidney that showed a leukocytoclastic vasculitis and mesangioproliferative glomerulonephritis with IgA deposits, respectively. He was treated with high-dose oral steroids with resolution of the skin and renal manifestations of the disease. HSP is rare in adults but has been linked to cancers. This is the first report of HSP in a patient with known malignant pleural mesothelioma.

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