Localized malignant pleural mesothelioma showing a thoracic mass and metastasizing to the stomach

Our plain-English summary of Localized malignant pleural mesothelioma showing a thoracic mass and metastasizing to the stomach, by H. Hayashi, K. Notohara, H. Yoshioka, et al (Internal Medicine, 2010).

The study

• Authors: H. Hayashi, K. Notohara, H. Yoshioka, T. Matsuoka, H. Ikeda, K. Kagawa, T. Fukuoka, T. Ishida
• Journal: Internal Medicine
• Published: 2010;49(7):671-5
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

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

In plain English

This article is a case report by authors at Kurashiki Central Hospital in Japan. It describes one 70-year-old man with a lump in his left chest wall. The patient denied occupational exposure to asbestos, and CT showed no pleural plaques or lung fibrosis. A biopsy suggested high-grade pleomorphic sarcoma but was not conclusive. Surgeons removed the 10 cm tumor together with ribs and chest wall. It lay mainly in the front of the chest wall, with a small part next to the pleura. Staining tests led to a diagnosis of biphasic malignant mesothelioma, which the authors classed as localized malignant mesothelioma. Three months after surgery the patient vomited blood. Scans showed possible spread to the stomach, mediastinal lymph nodes and bones. The tumor grew despite two courses of cisplatin and pemetrexed chemotherapy. The stomach was removed, and the mass was diagnosed as metastatic mesothelioma. The patient died 8 months after the first operation. The authors concluded that localized malignant mesothelioma may resemble tumors outside the chest and follow an aggressive course.

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 (single patient)
• Who was studied: one 70-year-old man with a left chest wall tumor, reported by authors at Kurashiki Central Hospital, Kurashiki, Japan
• Exposure: no asbestos exposure identified: the patient denied occupational exposure to asbestos, and CT showed no pleural plaques or lung fibrosis
• Main results:
  • The biopsy suggested high-grade pleomorphic sarcoma but was not conclusive
  • The resected chest wall tumor was solid and measured 10 cm in diameter
  • The chest wall tumor was diagnosed as biphasic malignant mesothelioma
  • Three months after surgery the patient vomited blood, and imaging showed possible metastases in the stomach, mediastinal lymph nodes and bones
  • The tumor grew despite two courses of cisplatin and pemetrexed chemotherapy
  • A total gastrectomy was performed to relieve gastric obstruction; no change was seen in the peritoneal cavity during that operation
  • The patient died 8 months after the initial operation
• The authors' conclusion: The authors concluded that localized malignant mesothelioma may resemble extrathoracic tumors and show an aggressive clinical course, and that it should be considered as a diagnosis in chest wall tumors

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Malignant Mesothelioma, Pleura, Localized Malignant Mesothelioma, Biphasic Mesothelioma, Metastasis, Mesothelioma, Sarcoma.

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• Localized mesotheliomas of the pleura. The pathologic evaluation of 18 cases — E.A. Foster, L.V. Ackerman (1960)
• Localized malignant mesothelioma, an unusual and poorly characterized neoplasm of serosal origin: best current evidence from the literature and the International Mesothelioma Panel — A.M. Marchevsky, A. Khoor, et al. (2020)
• 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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