Malignant mesothelioma presenting as pulmonary metastasis ahead of growth of primary tumour

Our plain-English summary of Malignant mesothelioma presenting as pulmonary metastasis ahead of growth of primary tumour, by U. Heki, M. Fujimura, K. Kasahara, et al (Respirology, 1999).

The study

• Authors: U. Heki, M. Fujimura, K. Kasahara, F. Matsubara, T. Matsuda
• Journal: Respirology
• Published: 1999;4(3):279-81
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 59-year-old woman was admitted to Houju Memorial Hospital, Ishikawa, Japan, because of cough and fever on 30 March 1997. A diagnosis of pneumonia was made and she was given antibiotics. Her symptoms improved but failed to resolve completely on antibiotic therapy. On 9 September 1997, she revisited the hospital because of bodyweight loss and malaise. There was no history of exposure to asbestos. The chest roentgenogram revealed infiltrative shadows with vague and indistinct margins suggesting inflammatory processes, which were more extensive than those investigated on her last visit. One month later, a giant tumour was detected rapidly growing from the mediastinum and open biopsy was performed. The histological examination confirmed that the tumour was a malignant mesothelioma and the intrapulmonary nodules were its metastases. This is a rare case of pulmonary metastasis being present for several months before an appearance of primary mesothelioma.

In plain English

This was a case report from Japan about one 59-year-old woman with malignant mesothelioma. The article stated she had no history of exposure to asbestos. She was admitted to Houju Memorial Hospital, Ishikawa, on 30 March 1997 with cough and fever. She was diagnosed with pneumonia and given antibiotics, and the shadows in her right lower lung cleared only partly. She returned on 9 September 1997 with weight loss and malaise, and chest X-ray and CT showed multiple nodular shadows, more extensive than before. Two bronchoscopies gave no diagnosis. On 17 October, imaging showed a giant tumour against the right mediastinum. A thoracoscopic biopsy also failed to give a diagnosis. An open chest biopsy on 29 November showed biphasic sarcomatous type malignant pleural mesothelioma. The lung nodules showed the same tissue pattern and were diagnosed as metastases from that tumour. The authors staged it as stage IV. They concluded that biopsy through the airways or by thoracoscopy cannot always make the diagnosis, and that the primary tumour may sometimes not show on chest X-ray and CT.

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 59-year-old woman admitted to Houju Memorial Hospital, Ishikawa, Japan, first on 30 March 1997 and again on 9 September 1997
• Exposure: The article reports no history of asbestos exposure; no fiber type or job is described
• Main results:
  • At the first admission she was treated for pneumonia with antibiotics, and the lung shadows in the right lower lobe resolved only incompletely
  • At readmission in September 1997, chest X-ray and CT showed multiple nodular shadows more extensive than at the previous admission
  • Bronchoscopy was done twice, on 9 and 30 September, without reaching a definite diagnosis
  • On 17 October imaging showed a giant tumour in contact with the right mediastinum
  • Open chest biopsy of the tumour showed biphasic sarcomatous type malignant pleural mesothelioma
  • The lung nodules showed the same histology and were diagnosed as multiple pulmonary metastases from the giant tumour
  • The tumour stained positive for vimentin and EMA and negative for CEA and CD34, which the authors said confirmed the diagnosis
  • The clinical stage was T2N0M1, stage IV
  • She was discharged because her symptoms were stable and was being followed up as an out-patient
• The authors' conclusion: The authors concluded that this case suggests diagnosis cannot always be made by transbronchial and thoracoscopic biopsy, and that the primary lesion of malignant mesothelioma may in some cases be undetectable on chest X-ray and CT. They described it as the first reported case noticed through pulmonary metastasis before the primary tumour grew.

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: Malignant Mesothelioma, Metastasis, Mediastinum, Biopsy, Mesothelioma.

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