Malignant mesothelioma presenting as a breast mass

Our plain-English summary of Malignant mesothelioma presenting as a breast mass, by A. Aujayeb, H. Clague, S. Pollock, et al (The Journal of the Royal College of Physicians of Edinburgh, 2012).

The study

• Authors: A. Aujayeb, H. Clague, S. Pollock, S. Stamenkovic, A. Hughes
• Journal: The Journal of the Royal College of Physicians of Edinburgh
• Published: 2012;42(1):27-31
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We present a case of a male patient with a breast mass, found to be a malignant mesothelioma. We discuss the diagnostic challenges, the need for heightened awareness in suspected cases, the histological classification of mesotheliomas and the treatments available. We believe this to be the second reported case of a mesothelioma presenting as a breast mass.

In plain English

This article was a case report of one patient. A 60-year-old man in the north east of England came to doctors with suspected breast cancer. He was an ex-smoker and had worked as a labourer, and the authors reported no known asbestos exposure. Examination found a 13 cm mass in the right breast that was invading the chest muscle. A CT scan showed a 14 cm mass straddling the chest wall and a large fluid collection around the right lung. Keyhole chest surgery drained 4.8 litres of blood-stained fluid, and the tumour was seen to involve the lining of the lung and chest wall. Tissue tests pointed to epithelioid mesothelioma as the most likely diagnosis. Chemotherapy was not possible because of the patient's condition. Palliative radiotherapy was considered for pain control, but he died before treatment could begin. The authors believed this was the second reported case of mesothelioma presenting as a breast mass. They concluded that a tumour starting inside the chest should be considered when doctors see unusual chest wall or breast masses.

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), with a discussion of the wider medical literature
• Who was studied: One 60-year-old man who lived and worked in the north east of England (UK). He had a history of hypertension, learning difficulties and previous alcohol abuse, and no family history of breast cancer.
• Exposure: The patient was a labourer and an ex-smoker (15 pack-years). The authors reported no known asbestos exposure. They noted that asbestos use was widespread in the north east of England, where the patient lived and worked.
• Main results:
  • On examination there was a non-tender 13 cm mass in the right breast. It was invading the pectoralis muscle and extending into the armpit area.
  • The CT scan showed a 14 cm mass in the right breast straddling the chest wall. It also showed a large right pleural effusion with two soft tissue nodules on the pleura.
  • A video-assisted thoracic surgery (VATS) procedure drained 4.8 litres of blood-stained fluid. The tumour involved both the visceral and parietal pleura.
  • Based on the cell appearance and positive immunostaining (calretinin, cytokeratin 5/6, D2-40, thrombomodulin and WT1), the most likely diagnosis was epithelioid mesothelioma.
  • Chemotherapy was not possible because of the patient's condition.
  • Palliative radiotherapy was considered for pain control, but the patient's health deteriorated and he died before treatment could be started.
  • The authors believed this was the second reported case of mesothelioma presenting as a breast mass.
• The authors' conclusion: The authors concluded that mesothelioma spreads by direct invasion into surrounding structures. They said an intrathoracic origin should be considered in the differential diagnosis of unusual chest wall or breast masses.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Histological Subtype, Mesothelioma.

Related studies

• Metastatic pleural mesothelioma presenting in a breast fine needle aspiration specimen — P.W. Shield, D.L. Ribu (2017)
• Occupational exposures and male breast cancer: A nested case-control study in the Nordic countries — M. Talibov, J. Hansen, et al. (2019)
• Treatment of recurrent isolated right atrial metastatic cavitary mass from breast cancer with radiation therapy: A case report and review of literature — L. Ya'qoub, S. Larson, et al. (2018)
• Diffuse epithelial pleural mesothelioma presenting as a solitary lung mass — M.H. Gotfried, S.F. Quan, et al. (1983)
• Peritoneal mesothelioma presenting as an adnexal mass — R.A. Komorowski, D.H. Bobert (1975)
• Rosai-Dorfman disease presenting as a solitary mediastinal mass — A.I. Hida, S. Yagi, et al. (2009)

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