Local recurrence of lung adenocarcinoma 10 years after left upper lobectomy resembling pseudomesotheliomatous adenocarcinoma: a case report

Our plain-English summary of Local recurrence of lung adenocarcinoma 10 years after left upper lobectomy resembling pseudomesotheliomatous adenocarcinoma: a case report, by J. Okamoto, H. Kubokura, N. Motoda, et al (Journal of Nippon Medical School = Nippon Ika Daigaku Zasshi, 2014).

The study

• Authors: J. Okamoto, H. Kubokura, N. Motoda, H. Hoshina, H. Ishii, Y. Kitayama, J. Usuda
• Journal: Journal of Nippon Medical School = Nippon Ika Daigaku Zasshi
• Published: 2014;81(3):173-8
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

The form and timing of the local recurrence of lung cancer can be unpredictable and unexpected. Pseudomesotheliomatous adenocarcinoma is a rare tumor that mimics malignant pleural mesothelioma both clinically and pathologically. Distinguishing pseudomesotheliomatous adenocarcinoma from malignant pleural mesothelioma on the basis of clinical findings can be difficult; therefore, a biopsy is usually required for diagnosis. Here we report on a 73-year-old Japanese man who presented with extensive dissemination along the pleural surfaces and clinical findings similar to those of pseudomesotheliomatous lung cancer 10 years after undergoing left upper lobectomy for lung adenocarcinoma. This report provides information that will help physicians establish an accurate diagnosis in similar cases.

In plain English

This article is a case report about one patient: a 73-year-old Japanese man who had worked in the construction industry, had a history of asbestos exposure, and had never smoked. The report does not name a fiber type or give exposure levels. The patient had earlier had the upper lobe of his left lung removed for a stage IA lung adenocarcinoma (pT1bN0M0). Four years later a blood marker (CEA) was raised. He took the anticancer drug UFT-E for 5 years, and scans showed no spread. Afterwards, fluid around the left lung and diffuse pleural thickening appeared. Because the findings fit both a lung-cancer recurrence and malignant mesothelioma, a surgical biopsy was taken. During surgery the tumor looked like mesothelioma. Tissue tests, however, led to a final diagnosis of metastatic adenocarcinoma consistent with recurrence of the lung cancer. The patient received 4 cycles of carboplatin and paclitaxel, was followed for 2 years, and eventually died of metastases to the brain and lungs. The authors concluded that this kind of recurrence should be considered when CEA is elevated, even many years after surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: one 73-year-old Japanese man, a never-smoker who had worked in the construction industry, followed up after left upper lobectomy for lung adenocarcinoma
• Exposure: a history of asbestos exposure from work in the construction industry; no fiber type, amount or duration is given. The patient had never smoked.
• Main results:
  • The original lung tumor was pathological stage pT1bN0M0 (stage IA invasive adenocarcinoma, papillary predominant).
  • Four years after surgery serum CEA was elevated. UFT-E (400 mg per day) was given for 5 years, while scans including PET/CT and chest CT showed no evidence of metastasis.
  • After UFT-E was stopped, imaging showed left-sided pleural effusion and diffuse pleural thickening. Cytology of the pleural fluid suggested adenocarcinoma.
  • At video-assisted thoracic surgery, the tumor spread across the visceral and parietal pleura and resembled a malignant mesothelioma.
  • Pleural tumor cells were positive for CK7, CEA, napsin A and surfactant apoprotein, and negative for calretinin, D2-40, CK5/6 and CK20. The final diagnosis was metastatic adenocarcinoma consistent with recurrence of lung cancer.
  • The authors stated that the clinical presentation was not pseudomesotheliomatous adenocarcinoma (PMAC) but was similar to it.
  • After 4 cycles of carboplatin plus paclitaxel and 2 years of follow-up, recurrence was found. The patient eventually died of metastasis to the brain and multiple locations in the lungs.
• The authors' conclusion: The authors concluded that, even if surgery was performed many years earlier, a PMAC-like local recurrence and additional therapy should be considered if serum CEA levels are elevated. They suggested the patient's long survival might be attributed to being a nonsmoker and to the UFT-E or platinum doublet chemotherapy.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Lung Adenocarcinoma, Pseudomesotheliomatous Adenocarcinoma, Lung Cancer, Pleural Mesothelioma, Biopsy.

Related studies

• Local recurrence model of malignant pleural mesothelioma for investigation of intrapleural treatment — I. Opitz, D. Lardinois, et al. (2007)
• Recurrence of malignant pleural mesothelioma at the resection borders--local or distant recurrence? — S. Bölükbas, M. Eberlein, et al. (2013)
• Recurrence of malignant pleural mesothelioma at the resection borders--local or distant recurrence? — D. Gomez, A. Tsao, et al. (2013)
• Case reports of primary pulmonary adenocarcinoma with pleural spread: so-called pseudomesotheliomatous adenocarcinoma — R. Saito, A. Kasajima, et al. (2012)
• Pseudomesotheliomatous adenocarcinoma of the lung with rhabdoid features — J.H. Attems, F. Lintner (2001)
• Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies — D.A. Mahvi, R. Liu, et al. (2018)

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