Localized malignant pleural mesothelioma: report of two cases

Our plain-English summary of Localized malignant pleural mesothelioma: report of two cases, by S. Tanzi, M. Tiseo, E. Internullo, et al (Journal of Thoracic Oncology, 2009).

The study

• Authors: S. Tanzi, M. Tiseo, E. Internullo, G. Cacciani, R. Capra, P. Carbognani, M. Rusca, G. Rindi, A. Ardizzoni
• Journal: Journal of Thoracic Oncology
• Published: 2009;4(8):1038-40
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Localized malignant pleural mesothelioma is very rare tumor disease. There are sporadic reports in the literature showing that this entity has a different biologic behavior compared with diffuse pleural mesothelioma. We report two cases of radically resected localized pleural malignant mesothelioma, with a previous history of asbestos exposure. Both cases showed a microscopic and immunohistochemical findings of malignant mesothelioma, biphasic and sarcomatoid lympho-histiocitoid variant type, respectively, without evidence of diffuse pleural spread. The first is very peculiar case of bilateral localized malignant pleural mesothelioma with complete response to chemotherapy and localized late recurrence, radically resected and treated with adjuvant radiotherapy. The second case revealed as a solitary localized mass, underwent a complete en bloc resection and adjuvant radiotherapy. Both cases demonstrate that the localized malignant mesothelioma should be distinguished from diffuse form and that complete resection is associated with good prognosis.

In plain English

This case report described two men treated in Parma, Italy, for localized malignant pleural mesothelioma. This is a rare form that appears as a defined mass in the pleura (the lining of the chest) without diffuse spread. Both men had a history of occupational asbestos exposure. Fiber types and jobs were not given. The first, a 68-year-old smoker, was diagnosed in 1998 with localized mesothelioma on both sides of the chest. Chemotherapy produced a complete response on scans that lasted until 2005, when a right-sided recurrence appeared. He received more chemotherapy, then surgery and radiotherapy. The tumor recurred near the surgical site two years later and was removed again. He was reported alive and free of disease for 11 months. The second, a 64-year-old former smoker, had a left-sided mass found on a scan after a chest injury in 2007. It was completely removed, diagnosed as sarcomatoid mesothelioma, and followed by radiotherapy. He was alive and free of disease at 22 months. The authors concluded that their cases agreed with reports that this form behaves differently from diffuse mesothelioma.

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 (two cases)
• Who was studied: Two men treated at the Azienda Ospedaliero-Universitaria di Parma, Italy. Case 1 was a 68-year-old smoker with asbestos exposure, diagnosed in 1998 with bilateral localized pleural epithelial mesothelioma. Case 2 was a 64-year-old former smoker with known asbestos exposure, first studied in March 2007.
• Exposure: History of occupational asbestos exposure in both patients. Fiber type, job and amount of exposure were not reported.
• Main results:
  • Case 1: six cycles of chemotherapy (cisplatin and doxorubicin) gave a radiologic complete response that lasted until 2005.
  • Case 1: after a 2005 recurrence and further chemotherapy, the tumor was excised in May 2006. It was diagnosed as mixed type mesothelioma, and the surgical margins were negative.
  • Case 1: two years later the disease recurred near the site of the previous surgery and was resected again.
  • Case 1: at the time of the report the patient was alive and free of disease for 11 months.
  • Case 2: the pleural mass was found on a CT scan done because of an accidental blunt chest trauma. A needle biopsy had suggested an inflammatory pseudotumor.
  • Case 2: the completely resected tumor was diagnosed as sarcomatoid malignant mesothelioma, lympho-histiocitoid variant.
  • Case 2: after surgery and adjuvant radiotherapy, the patient was alive and free of disease at 22 months.
• The authors' conclusion: The authors concluded that their cases agree with most literature reports that localized malignant mesothelioma behaves differently from typical diffuse malignant pleural mesothelioma. They also stated that the role of adjuvant chemotherapy and radiotherapy needs further evaluation.
• Limitations the authors state:
  • The authors stated there is no published evidence for or against chemotherapy in localized malignant mesothelioma. They said the same applies to the adjuvant radiotherapy both patients received.
  • The authors stated it is unclear whether localized malignant mesothelioma is a separate entity or diffuse mesothelioma diagnosed at an early stage.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Malignant Mesothelioma, Asbestos Exposure, Biphasic Mesothelioma, Sarcomatoid, Bilateral, Chemotherapy, Localized Malignant Mesothelioma.

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• Molecular characterization of localized pleural mesothelioma — Y.P. Hung, F. Dong, et al. (2020)
• Benign localized fibrous tumor of the pleura: report of 25 new cases — S. Enon, D. Kilic, et al. (2012)
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