The American Journal of Case Reports

Our medical research library holds 21 studies published in The American Journal of Case Reports (2012–2026). 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. 21 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: International Scientific Information, Inc
• Published: 2008 to the present, United States
• Language: English
• ISSN: 1941-5923 (electronic)
• Continues: Case Reports & Clinical Practice Review
• Its record in the NLM Catalog

2020s

• Neoadjuvant Pressurized Intraperitoneal Aerosol Chemotherapy for Conversion to Cytoreductive Surgery in Unresectable Malignant Peritoneal Mesothelioma: A Report of 2 Cases. A. Urbano-Ruiz, B. Latronico Palma, R.E. Carnut Rego, et al. 2026;27:e950407. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Peritoneal mesothelioma (PM) is the second most common presentation site of malignant mesothelioma. The standard of care for PM is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Because of its insidious manifestations, PM is often diagnosed at advanced, unresectable stages, precluding optimal cytoreduction and diminishing long-term survivability. CASE REPORT We report 2 cases of advanced and unresectable PM (stages III and IV) presenting with symptomatic with low-grade epithelioid disease. Both cases had a high peritoneal cancer index (PCI >30) and extensive small-bowel involvement. The patients underwent pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin as downstaging conversion therapy. Patient 1 was a 47-year-old man with a laparoscopic PCI of 34 and progression of disease despite 5 months of systemic intravenous chemotherapy. After 2 cycles of PIPAC, the patient showed disease regression and complete resolution of large ascites; CRS-HIPEC was feasible with complete cytoreduction (CC-0). The patient was discharged after a 60-day hospital stay. Patient 2 was a 43-year-old man with a laparoscopic PCI of 30 and no prior lines of therapy. After a single PIPAC cycle, there was clear disease regression (PCI=23), allowing CRS-HIPEC with optimal cytoreduction (CC-1). The patient was discharged after 10 days. CONCLUSIONS PIPAC is established as a suitable option for palliation of massive ascites in PM; however, in selected candidates with favorable prognostic biomarkers and appropriate fitness for surgery, the procedure can serve as a bridge to definitive open surgery (CRS-HIPEC) aimed at achieving complete cytoreduction.

• Delayed Diagnosis of Peritoneal Mesothelioma in Recurrent Ascites: A Case Report. H. Javed, A. Ahmad, A. Rehman, et al. 2025;26:e946777. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Ascites is a common clinical sign noted in 3% to 4% of hospitalized medical patients. Nearly 94% of patients with ascites have non-malignant etiologies, with the most common being chronic liver disease. Peritoneal mesothelioma is an exceedingly rare malignancy associated with asbestos exposure. Here, we report the case of an elderly man who presented with recurrent loculated ascites and received a diagnosis of peritoneal mesothelioma after a delay of approximately 10 weeks. CASE REPORT A 67-year-old man with a history of asbestos exposure presented with abdominal distension and muscle wasting for 1 month. Initial abdominal CT was notable for smooth liver contour and massive ascites. Ascitic fluid analysis was consistent with low serum albumin-ascites gradient but showed negative cytology for malignant cells. Upper and lower endoscopies did not reveal lesions. Due to recurring ascites, serial abdominal paracenteses were performed, although cytology was negative for malignant cells. Repeat abdominal CT performed after 6 weeks showed worsening loculated ascites, with possible peritoneal carcinomatosis. At this point, percutaneous omental biopsy was performed, which established the diagnosis of peritoneal mesothelioma (75 days after initial presentation). CONCLUSIONS In patients presenting with recurrent ascites and a history of asbestos exposure, it is important to consider the diagnosis of peritoneal mesothelioma. While 94% of patients with ascites have non-malignant etiologies, a small proportion of patients can have malignant ascites. In patients in which the first set of ascitic fluid studies are inconclusive, repeat abdominal paracentesis and omental biopsy or diagnostic laparoscopy should be expedited to avoid delays in diagnosis.

• Navigating Fertility Preservation in Epithelioid Peritoneal Mesothelioma: A Case Study. D.W. Qiu, Y.J. Lin Lee, G. Tripathi, et al. 2025;26:e946585. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare and aggressive neoplasm, with low-grade epithelioid subtypes presenting diagnostic and therapeutic challenges. With nonspecific symptoms and diagnostic challenges, definitive diagnosis relies on histopathological and immunohistochemical analysis. This study reviews the current research on the epidemiology, diagnosis, and treatment of MPM, focusing on preserving fertility and achieving successful childbirth following surgery, chemotherapy, and immunotherapy, despite immune-related adverse events. CASE REPORT We report the case of a 44-year-old nulliparous woman, initially diagnosed with a uterine leiomyoma, who was incidentally found to have MPM during surgery. Diagnostic laparoscopy and subsequent imaging revealed extensive peritoneal involvement, confirmed by histopathology and immunohistochemistry. The patient's desire to preserve fertility complicated the treatment approach, leading to chemotherapy followed by immunotherapy, with complete disease control. Without evidence of disease recurrence or metastasis, the patient proceeded with in vitro fertilization (IVF) and embryo transfer. During an emergency cesarean section at 30 weeks 2 days of gestation, performed due to preterm premature rupture of membranes, intraabdominal residual tumors were discovered and excised. No evidence of malignancy was found elsewhere. CONCLUSIONS MPM is a rare disease, often with a delayed diagnosed due to nonspecific symptoms. Treatments like cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) improve survival for operable cases, while systemic therapies and immune-checkpoint inhibitors (ICIs) are options for inoperable cases; however, further research on early-detection biomarkers and the impact of ICIs on fertility is needed to enhance clinical practice. This case highlights the intricate balance between oncologic control and fertility preservation in MPM, illustrating the need for individualized treatment strategies.

• Use of Neoadjuvant Immunotherapy in Malignant Peritoneal Mesothelioma as a Bridge to Surgical Intervention: A Case Report. S. Faleh, T. Odisho, F. Lebel-Guay, et al. 2025;26:e949777. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare subtype of malignant mesothelioma (MM) that arises from mesothelial/serosal surfaces of the peritoneal lining and carries a poor prognosis. Given the rarity of this disease, many expert groups such as the Peritoneal Surface Oncology Group International (PSOGI) and the National Comprehensive Cancer Network (NCCN) have developed recommendations to guide the optimal treatment for MPM. Currently, the standard of care for resectable MPM is a combination of cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC). There are no clear guidelines for treatment of inoperable malignant mesothelioma, but several studies have demonstrated a benefit of incorporating immunotherapy in the treatment plan. CASE REPORT We present a case of a 63-year-old woman who sought medical attention for several months of persistent vague abdominal discomfort, weight loss, and night sweats. Laboratory workup and diagnostic imaging led to the diagnosis of borderline/unresectable MPM. A multidisciplinary tumor board discussion based on the published literature and guidelines on malignant mesothelioma (MM) was undertaken, and the decision was made to treat the patient with nivolumab-ipilimumab in the perioperative period. The patient had a positive clinical response allowing for subsequent CRS and HIPEC. She remains disease free 30 months following her surgery, with the intention to continue the immunotherapy. CONCLUSIONS This case report contributes to the current literature demonstrating a potential role for perioperative immunotherapy in the treatment of aggressive subtype or borderline resectable/unresectable MPM and a bridge to consolidative CRS/HIPEC.

• A Case of Thoracic Empyema Caused by Actinomyces naeslundii. Y. Matsubayashi, K. Mizuno, T. Yamashita, et al. 2024;25:e943030. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Actinomycosis is a clinically significant but uncommon infectious disease caused by anaerobic commensals of Actinomyces species, and the incidence of thoracic empyema is rare. We report an extremely rare case of empyema caused by Actinomyces naeslundii (A. naeslundii). CASE REPORT A 39-year-old man presented to our hospital with fever and dyspnea. He had massive pleural effusion and was diagnosed with a left lower-lobe abscess and left thoracic empyema. Thoracic drainage was performed and Ampicillin/Sulbactam was administered for 3 weeks. Four years later, the patient presented with back pain, and chest X-ray showed increased left pleural effusion. After close examination, malignant pleural mesothelioma was suspected, and computed tomography-guided needle biopsy was performed, which yielded a viscous purulent pleural effusion with numerous greenish-yellow sulfur granules. A. naeslundii was identified through anaerobic culture. Thoracoscopic surgery of the empyema cavity was conducted, and Ampicillin/Sulbactam followed by Amoxicillin/Clavulanate was administered for approximately 6 months. No recurrence has been observed for 1 year since the surgical procedure. CONCLUSIONS Actinomyces empyema is a rare condition, and this case is the second reported occurrence of empyema caused by A. naeslundii. The visual identification of sulfur granules contributed to the diagnosis. Long-term antibiotic therapy plays a crucial role in treatment.

• Incidental Diagnosis of Malignant Peritoneal Mesothelioma During Liver Transplantation Surgery: A Case Report. S. Khan, A. Malik, S. Qureshi, et al. 2024;25:e943787. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare, lethal tumor of serous membranes. The most common factor reported in association with MPM is asbestos exposure, while viral infections, genetic predisposition, paraneoplastic syndrome, and altered immunity have been described as well. The diagnosis can be challenging among those with lower tumor burden as well as nonspecific symptoms, and it is not unusual to discover the diagnosis incidentally. CASE REPORT A middle-aged woman with decompensated cirrhosis underwent extensive pre-transplant workup, showing no evidence of malignancy. She had a personal history of asbestos exposure and family history of MPM in the extended family. During transplant surgery, a few peritoneal nodules were noted, leading to termination of the procedure. Pathological analysis confirmed malignant MPM. A multidisciplinary discussion led to following a conservative treatment approach without any intervention, due to higher risk of worsening hepatic decompensation associated with peritonectomy and intraperitoneal chemotherapy. The patient's hepatic decompensation resolved 6 months after the aborted liver transplant operation. Since the diagnosis of MPM, positron emission tomography scans have shown no recurrence of MPM for 3 consecutive years. CONCLUSIONS This is the first case of MPM diagnosed incidentally during a liver transplantation surgery. This case highlights the challenges in the diagnosis and management of MPM in a patient with decompensated liver disease. A multidisciplinary approach and following a consensus decision led to prolonged survival in the described patient.

• Rapid Progression of Malignant Peritoneal Mesothelioma Mimicking a Postoperative Complication in a Young Woman: A Case Report. P.C. Altshuler, A.L. Newman, J.A. Garibay. 2024;25:e942948. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Malignant peritoneal mesothelioma is a rare disease with a poor prognosis that often presents with vague symptoms and inconclusive laboratory test results. Causes include industrial pollutants, primarily asbestos, and certain genetic mutations, such as BAP1. Due to the nonspecific symptoms, it is often incidentally diagnosed during or after other surgical procedures. CASE REPORT A 35-year-old healthy woman underwent an uncomplicated laparoscopic left salpingo-oophorectomy for a symptomatic large ovarian mature cystic teratoma. She subsequently presented with late-onset postoperative fever, leukocytosis, and multiple intra-abdominal masses. Following an exploratory laparotomy, extensive infectious disease evaluation, and multiple biopsies requiring interdisciplinary collaboration, malignant peritoneal mesothelioma was diagnosed by positive histologic staining of an omental biopsy for D2-40 and CK5/6. This first specimen was positive for BAP1, with the second, a liver biopsy, testing negative for BAP1. The tumor cell testing was also notable for mutations in NF2, MLL2, and ARID1A, and the hereditary cancer genetic testing was overall unremarkable. Her disease progressed rapidly, and she died 6 months after her initial procedure. CONCLUSIONS This case of rapidly developing malignant peritoneal mesothelioma following surgical management of an ovarian mature teratoma highlights the complexity in diagnosing a rare disease that presents with nonspecific symptoms in an otherwise young and healthy woman. The rapid disease course was likely accelerated by expansive intraperitoneal spread and multiple somatic oncogenic mutations in BAP1, NF2, MLL2, and ARID1A. Gynecologists should keep a broad differential for postoperative complications, as occult malignancies can present with symptoms that mimic postoperative complications.

• A 51-Year-Old Woman with Advanced Peritoneal Mesothelioma and Stage 3b Chronic Kidney Disease Treated with Cytoreductive Surgery and Bidirectional Intraperitoneal Cisplatin and Ifosfamide Chemotherapy: A Case Report. M. Alaswad, F. ElKordy, H. Jaamour, et al. 2023;24:e941726. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Malignant mesotheliomas are rare, yet highly malignant tumors. Mesotheliomas are tumors that develop from mesothelial surfaces, with the pleura being the most common, followed by the peritoneum. The diagnosis of malignant peritoneal mesothelioma (MPM) is usually established when the disease is advanced, owing to the nonspecific clinical appearance and abdominal symptoms. Initially, MPM was treated with palliative systemic chemotherapy, with or without palliative surgery. However, cytoreductive surgery (CRS) combined with bidirectional intraoperative chemotherapy (BDIC) has recently emerged as a treatment option for MPM. BDIC creates a bidirectional chemotherapy gradient in the peritoneal tumor cells through the simultaneous use of intraperitoneal and intravenous chemotherapy. CRS, combined with BDIC (CRS-BDIC), allows the complete elimination of residual tiny tumor cells after complete removal of the visible tumor nodules. CASE REPORT Herein, we present a case of a 51-year-old woman with MPM and chronic kidney disease (CKD) stage 3b. Her treatment consisted of neoadjuvant chemotherapy and immunotherapy, followed by CRS-BDIC using intraperitoneal cisplatin and doxorubicin, and intravenous ifosfamide. The surgery was successful, with no immediate complications or decline in the patient's kidney function. On follow up 2 months later, the patient denies suffering any chemotherapy-related adverse effects, and her kidney profile remains stable. CONCLUSIONS In conclusion, nephrotoxicity, a known adverse effect of cisplatin and ifosfamide, might not be a contraindication for the use of these potentially nephrotoxic drugs in CRS-BDIC in patients with renal impairment.

• A Case of Primary Epithelioid Sarcoma of the Pleura. T. Yamashita. 2023;24:e938696. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Epithelioid sarcoma is a rare tumor and that is extremely rare as a primary pleural neoplasm. On imaging, it may appear similar to malignant pleural mesothelioma; thus, it can be difficult to diagnose. CASE REPORT A 64-year-old Asian woman, who had a treatment history of cervix adenocarcinoma, was admitted with dyspnea and right massive pleural effusion. Chest drainage was performed, and malignant cells were found in the pleural effusion. The malignant cells were thought to be metastasized from previous cervical cancer. We continued pleural drainage; however, the volume of the pleural effusion did not decrease. On the 5th hospital day, the chest tube became occluded. Computed tomography showed structures similar to empyema. Pleural irrigation and fibrinolytic therapy did not improve her condition. Empyema curettage was performed on the 14th hospital day. The resected pleura was submitted for pathological examination and showed tumor lesion but not metastatic adenocarcinoma of the cervix. The intrathoracic tumor grew extremely rapidly, and the patient died of respiratory failure on postoperative day 8 (22nd hospital day) before a diagnosis could be made. The final pathological diagnosis obtained on the 34th hospital day was epithelioid sarcoma. CONCLUSIONS For patients who appear to have empyema complicated by neoplastic lesions, a histopathological examination should also be performed to ensure accurate diagnosis. In addition, if a tumorous lesion is detected and it is neither metastatic nor malignant pleural mesothelioma, pleural epithelioid sarcoma should be added to the differential diagnosis in the presence of a rapidly growing and histologically difficult-to-diagnose pleural tumor.

• Bidirectional Intraoperative Chemotherapy Using Cisplatin and Ifosfamide for Intraperitoneal Mesothelioma in Severe Renal Impairment: A Case Report. R. Almesned, A.Z. Azzam, A. Aldeheshi, et al. 2023;24:e938192. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm with a poor prognosis. Bidirectional intraoperative chemotherapy (BDIC) using concurrent intraperitoneal and intravenous chemotherapy in combination with cytoreductive surgery (CRS) is an emerging treatment option for selected cases of MPM. It is a locoregional treatment that involves intraoperative chemoperfusion of heated chemotherapy. The administration of systemic along with intraperitoneal chemotherapy allows for a bidirectional chemotherapy gradient in peritoneal tumor cells. The aim of this treatment is eradication of microscopic residual cancer cells after major removal of macroscopic tumor nodules. To date, there is no consensus on the chemotherapeutic regimen that can be used in BDIC to manage MPM in patients with severe renal impairment. Administering intravenous ifosfamide with hyperthermic intraperitoneal cisplatin and doxorubicin is a promising regimen in treating peritoneal mesothelioma. Nephrotoxicity is a dose-limiting adverse effect of cisplatin and ifosfamide. Therefore, dose adjustment is required in patients with renal impairment. CASE REPORT In this report, we describe a 46-year-old female patient with recurrent MPM and severe renal impairment. Her treatment was managed with hyperthermic intraperitoneal cisplatin and doxorubicin along with intravenous ifosfamide following CRS. The cisplatin dose was reduced to 50% and the ifosfamide dose was reduced by 25%. The patient tolerated the procedure well, without deterioration in her renal function. At her 9-month follow-up, she did not report experiencing chemotherapy-related adverse effects, and her kidney function remained stable. CONCLUSIONS Severe renal impairment might not be a contraindication to using potentially nephrotoxic chemotherapeutic agents in CRS-BDIC.

• Gelatinous Pleural Effusion: A Diagnostic Challenge for Pleural Mesothelioma in an 80-Year-Old Man. A.M. Ibnian, O.U. Khan, R. Chan, et al. 2023;24:e941263. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Gelatinous pleural effusion, due to raised hyaluronic acid, can be associated with pleural infection and malignancies, such as tuberculosis, metastatic pleural disease, and mesothelioma. This report is of an 80-year-old man presenting with a gelatinous pleural effusion and diagnosis of pleural mesothelioma. CASE REPORT An 80-year-old man with diabetes mellitus, ischemic heart disease, metastatic prostate cancer, 30-pack-year smoking history, and 5-year history of asbestos exposure (during his 30s), presented with a 4-week history of breathlessness and was found to have right-sided pleural effusion. Thoracic computed tomography (CT) showed mild right-sided pleural thickening. Pleural tap revealed exudative fluid, with a pH of 7.4, and unremarkable cytology and microbiology analyses. The patient was treated for pneumonia and para-pneumonic effusion and discharged home. He came back 5 weeks later with worsening of symptoms and re-accumulation of pleural fluid. Repeated thorax CT showed extensive right-sided pleural lobular thickening. Pleural tap again yielded an exudative fluid, with a pH of 7.37. Cytology and microbiology did not reveal any positive signs for malignancy or infection. This time the pleural fluid appeared gelatinous in consistency. Pleural biopsy showed atypical epithelioid mesothelial cells arranged in trabeculae, with a tubulo-papillary configuration. Also, immunohistochemistry panel showed tumor cells expressed calretinin, EMA, WT1, and D2-40, with negative TTF1, CEA, and BerEp4. Final diagnosis was epithelioid mesothelioma. CONCLUSIONS This report has shown that a gelatinous pleural effusion can be associated with malignant and inflammatory pleural diseases. In this case, imaging and pleural biopsy with histopathology confirmed a diagnosis of pleural mesothelioma.

• Herpes Simplex Virus Meningoencephalitis Following Pulse-Dose Methylprednisolone: A Case Report and Literature Review. J. Horn, J.B. Mullholand, S. Ashraf, et al. 2021;22:e933847. Case report · Review PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Several cases of herpes simplex virus type 1 meningoencephalitis (HSVE) have been reported in patients receiving steroids, but the exact contribution of steroids to the disorder remains unclear because other risk factors, such as chemotherapy, brain radiation, or surgery, were present in almost all cases. CASE REPORT We report the case of a 76-year-old man who developed HSVE following the administration of pulse-dose steroids. The patient had occupational asbestos exposure and a chronic interstitial lung disease of unclear etiology (sarcoidosis versus hypersensitivity pneumonitis) and was admitted for acute-on-chronic respiratory failure requiring mechanical ventilation. After a negative infectious workup and several days of antibiotics without improvement, pulse-dose steroids were administered. In the following days, the patient developed a fever and worsening encephalopathy. A lumbar puncture showed elevated nucleated cells and positive polymerase chain reaction for herpes simplex virus 1 in the cerebrospinal fluid, confirming the diagnosis of HSVE. Acyclovir treatment was initiated, but the patient later died as a result of persistent severe encephalopathy and respiratory failure with an inability to wean mechanical ventilation. CONCLUSIONS Clinicians should keep in mind that HSVE is a potential complication of steroids and carefully consider the benefit/risk ratio of pulse-dose steroids, taking into account associated factors of immunosuppression. A high level of awareness should be especially maintained in critically ill patients because of associated risk factors (critical illness immune paralysis) and because neurological signs of HSVE may be missed in mechanically ventilated, sedated patients.

• Well-Differentiated Papillary Mesothelioma with Omental Calcifications: A Case Report and Review of the Literature. A.S. Erem, S.S. Allamaneni, T.S. Braverman. 2020;21:e920487. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Omental calcifications of the peritoneum are typically small and asymptomatic. However, larger psammomatous bodies that cause symptoms such as abdominal pain and bloating are often associated with tumors such as primary serous papillary carcinoma, mesothelioma, or metastatic ovarian cancer. CASE REPORT We describe omental calcifications in a 68-year-old woman who had been asymptomatic for the last 10 years. The case details the histomorphologic features and immunohistochemical signature of a 4.0×3.5×1.0 cm mass consisting of mature adipose tissue that was surgically removed together with an 8.5×6.5×1.8 cm irregular intra-abdominal/mesenteric mass composed of yellow-red fatty tissue. Microscopic sections contained fat with variable clustered classic/psammomatous calcifications, some with a thin epithelioid periphery, in association with a very focal and subtle papillary surface epithelial/mesothelial proliferation. Tumor cell invasion was not observed during examination. Immunohistochemical staining showed that mesothelial cells in the mass were strongly positive for calretinin and focally positive for EMA, CK903, and vimentin. Strong nuclear positivity for PAX8 was also reported. Additional stains were added in response to this pattern, showing strong positivity for CK8, moderate positivity for BAP1, focal positivity for ER, minimal positivity for CD56, and negativity for CK5/6 and D2-40. Three possible explanations are suggested for the phenomenon observed in the pathology slides: reactive mesothelial hyperplasia, well-differentiated papillary mesothelioma, or serous papillary carcinoma of the peritoneum. CONCLUSIONS Findings suggest that these calcifications are a benign, reactive phenomenon, and that the abundance of psammoma bodies may be related to ongoing crops of papillary mesothelial hyperplasia or benign well-differentiated papillary mesothelioma.

2010s

• Pseudomesotheliomatous Carcinoma with a High Pleural Hyaluronic Acid Concentration Arising from a Primary Esophageal Squamous Cell Carcinoma. T. Shirahata, T. Takeshita, Y. Maeda, et al. 2019;20:447-452. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Pseudomesotheliomatous carcinomas are rare tumors that develop like malignant pleural mesothelioma (MPM). These tumors have similar features, and thus pseudomesotheliomatous carcinomas can sometimes be misdiagnosed as MPM. Most pseudomesotheliomatous carcinomas develop from primary lung cancers, although there have been some reports involving other malignancies; however, there has been no report describing a pseudomesotheliomatous carcinoma developing from an esophageal squamous cell carcinoma (ESCC). To the best of our knowledge, this is the first case report describing pseudomesotheliomatous carcinoma originating from primary ESCC. CASE REPORT A 65-year-old man was admitted to our hospital because of persistent cough and right chest pain. Radiological examination suggested MPM, and a high concentration of pleural hyaluronic acid was also observed. Cytological examination of pleural effusion confirmed metastatic squamous cell carcinoma, and ESCC was confirmed by upper-gastrointestinal endoscopy. The patient received cisplatin and 5-FU combination chemotherapy as first-line treatment, and docetaxel chemotherapy as second-line treatment. However, the patient's condition deteriorated, and he died 6 months after the diagnosis was established. We performed an autopsy and found that ESCC had invaded the lung, pleura, peritoneum, liver, stomach, ureter, bladder, spine, and lymph nodes. CONCLUSIONS We demonstrated that primary ESCC can give rise to a pseudomesotheliomatous carcinoma. This report describes the clinical features and outcome of such a patient, with an emphasis on differential diagnosis of MPM.

• A Rare Case of Pulmonary Mucoepidermoid Carcinoma in an 81-Year-Old Male. M. Abdalla, P. Sinyagovskiy, W. Mohamed, et al. 2018;19:1499-1502. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Lung mucoepidermoid carcinoma is a form of non-small cell lung carcinoma that originates from the submucosal glands of the tracheobronchial tree; it is rare and causes 0.1% to 0.2% of lung malignancies. In this article, we report on an occurrence of this condition in an 81-year-old male, which is rare occurrence in this age group. In this case, we found a history of smoking and asbestos exposure which might suggest that exposure to both of these factors can possibly increase the risk for this malignancy. CASE REPORT An 81-year-old male presented with chronic cough and yellow sputum, associated with right upper back pain. The patient was a smoker of 30 packs per year and reported a history of asbestos exposure. He had past medical history of rectal cancer, but no previous history of salivary glands tumors. Physical examination was normal, laboratory investigations were unremarkable. Computed tomography chest showed endobronchial mass with post-obstructive atelectasis. Bronchoscopic evaluation revealed a whitish, endobronchial mass occluding the posterior segment of the right lower lobe. Biopsy showed benign squamous papilloma and malignancy was not excluded as only superficial parts of the mass were obtained. The decision was made to remove the lesion. A right lower lobectomy was done, and histopathology revealed a low grade mucoepidermoid carcinoma; immunohistochemical staining showed tumor cells positive for p40 and p63 supporting the diagnosis. No further adjuvant treatment was recommended, and follow-up imaging was planned for surveillance. CONCLUSIONS Mucoepidermoid carcinoma of the lung is a rare form of non-small cell lung carcinoma. Appropriate diagnosis requires correctly interpreted biopsy results along with immunohistochemical staining results.

• Nivolumab Immunotherapy in Malignant Mesothelioma: A Case Report Highlighting a New Opportunity for Exceptional Outcomes. R.G. Jones, F. Karthik, A. Dugar, et al. 2018;19:783-789. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Malignant pleural mesothelioma (MPM) is a highly lethal cancer with a median survival of ~12 months even with aggressive intervention. Frontline therapy relies on systemic cisplatin and pemetrexed chemotherapy and has a response rate of ~35-41%; currently, there are no US Food and Drug Administration approved second-line therapies for MPM. Herein, we present a patient with MPM who experienced rapid disease progression after standard therapy but who had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab. CASE REPORT A 68-year-old male with a history of work-related asbestos exposure was diagnosed with MPM. He was treated with primary resection followed by systemic chemotherapy with cisplatin and pemetrexed. When chemotherapy failed, he was switched to immunotherapy with nivolumab and achieved an exceptional response. CONCLUSIONS We report the first case of a patient with MPM who experienced rapid disease progression after standard therapy but had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab. As outcomes with traditional chemotherapy regimens remain disappointing, there is a substantial need for new approaches to MPM; our case highlights a new therapeutic opportunity even in the face of aggressive disease. Indeed, a new era of investigation utilizing immunotherapy for mesothelioma is beginning, with much anticipation.

• Rapamycin Treatment for Benign Multicystic Peritoneal Mesothelioma: A Rare Disease with a Difficult Management. G. Stallone, B. Infante, L. Cormio, et al. 2017;18:632-636. Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND Benign multicystic peritoneal mesothelioma (BMPM) is a rare intra-abdominal tumor. Although considered by many to be benign, this tumor has a high local recurrence rate. Because of its rarity, preoperative diagnosis is difficult and its origin and pathogenesis are uncertain. There are no evidence-based treatment strategies for BMPM. It is agreed that the best treatment strategy for BMPM is the combination of surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). An increasing body of evidence supports a pivotal role of the cytoplasmic serine/threonine kinase mTOR in the development and progression of several neoplastic diseases and specific mTOR inhibitors, including rapamycin, have been suggested as potential therapeutic options for different cancers. CASE REPORT A 65-year-old male with end-stage renal disease on hemodialysis for seven years presented with BMPM. He underwent surgery to remove multiple peritoneal cysts, but four months later he experienced a recurrence of the disease. Immunohistochemistry of the cysts demonstrated a high level of phosphorylation of p70S6 kinase, a downstream mTOR target, and since a target therapy that blocks PI3K/Akt/mTOR pathway has been shown to have a scientific and logical rationale to treat this rare intra-abdominal neoplasia, we started the patient on low dose rapamycin therapy, an mTOR inhibitor. Long-term mTOR inhibition resulted in a complete and stable remission of BMPM. CONCLUSIONS The current case is the first report of BMPM successfully treated with rapamycin, which resulted in a long-lasting response to mTOR inhibition.

• Positive TTF-1 Expression in Malignant Mesothelioma: A Case Report. G. Richter, H. Heidersdorf, D. Hirschfeld, et al. 2016;17:133-6. Case report PubMed · Publisher · Free full text

  Abstract

  Background: The histopathological diagnosis of malignant mesothelioma is based mainly on the immunohistological profile of the neoplasia, using different immunohistochemical markers to distinguish between a malignant mesothelioma and a carcinoma.

  Case Report: A female patient presented with a right paravertebral rapidly growing tumor and severe pain. Based on the immunohistochemical findings, we present the first case of a malignant mesothelioma with immunohistochemical expression of thyroid transcription factor-1.

  Conclusions: The detection of a positive reaction for thyroid transcription factor-1 in the tumor cells may not exclude a malignant mesothelioma.

• Pleural Small Cell Lung Carcinoma: An Unusual Culprit in Pleural Effusion. O.D. Adejorin, A. Sodhi, F.A. Hare, et al. 2015;16:912-5. Case report PubMed · Publisher · Free full text

  Abstract

  Background: Small cell lung carcinoma (SCLC) usually presents as lung or mediastinal lesions. It is very rare for SCLC to present primarily as an isolated pleural effusion with no lung or mediastinal lesions.

  Case Report: We report the case of a 77-year-old white male with a 60-pack year history of smoking, chronic obstructive pulmonary disease (stage IV), and asbestos exposure who presented with shortness of breath and left lateral chest pain for 7 days. On physical examination, he was very short of breath, with a prolonged expiratory phase on chest auscultation. Laboratory results were normal except for leukocytosis and chest radiograph revealing left-sided pleural effusion. Computerized tomography (CT) scanning of the chest with IV contrast showed left-sided pleural effusion without any lung or mediastinal lesions. Thoracentesis was performed and fluid was sent for analysis. Repeat CT chest/abdomen/pelvis, done immediately following thoracocentesis, did not show any masses or lymphadenopathy. Fluid analysis, including cytology and immunostain pattern, was consistent with small cell carcinoma.

  Conclusions: Small cell lung cancer presenting as an isolated pleural effusion is extremely rare. It requires close attention to cytology and immunohistochemistry of pleural fluid samples. It also has implications for management and should be managed as limited-stage SCLC.

• Primary Peritoneal Mesothelioma Resulting in Small Bowel Obstruction: A Case Report and Review of Literature. S.C. Frontario, A. Loveitt, A. Goldenberg-Sandau, et al. 2015;16:496-500. Case report · Review PubMed · Publisher · Free full text

  Abstract

  Background: Peritoneal mesothelioma is a rare malignancy that affects the serosal surfaces of the peritoneum. The peritoneum is the second most common site of mesothelium affected following the pleura. The aggressive nature and vague presentation pose many obstacles in not only diagnosis but also the treatment of patients with this disease.

  Case Report: We present a case of a 76-year-old woman who presented with small bowel obstruction secondary to carcinomatosis secondary to primary peritoneal mesothelioma. The patient had multiple risk factors with asbestos exposure and prior therapeutic radiation.

  Conclusions: We discuss the highly varied and elusive presentation of peritoneal mesothelioma. Cumulative asbestos exposure, either directly or indirectly, remains the leading cause of mesothelioma. However, there are other non-asbestos etiologies. Small bowel obstruction often is a late-presenting symptom of widespread tumor burden. A concise review of the current diagnostic and surgical treatment of primary peritoneal mesothelioma demonstrates that early diagnosis and implementation remains vital.

• Multicystic peritoneal mesothelioma. A.A. Tentes, G. Zorbas, N. Pallas, et al. 2012;13:262-4. PubMed · Publisher · Free full text

  Abstract

  Background: Multicystic peritoneal mesothelioma is a rare disease. It is not certain if it is a benign or a borderline tumor. Although many therapeutic approaches have been used, complete cytoreductive surgery in combination with hyperthermic intraoperative intraperitoneal chemotherapy has gained acceptance.

  Case Report: A case of multicystic peritoneal mesothelioma in a 16-year old patient is reported. The patient underwent complete cytoreduction and received intraoperative hyperthermic intraperitoneal chemotherapy. The patient is disease-free one year after surgery.

  Conclusions: Complete cytoreductive surgery in combination with hyperthermic intraoperative intraperitoneal chemotherapy appears to be a rational therapeutic approach in multicystic peritoneal mesothelioma.

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