Malignant Pleural Mesothelioma, Biphasic Type: An Unusual and Insidious Case of Rapidly Progressive Small Blue Cell Tumor

Our plain-English summary of Malignant Pleural Mesothelioma, Biphasic Type: An Unusual and Insidious Case of Rapidly Progressive Small Blue Cell Tumor, by C. Salazar, N. Kanter Md, A. Abboud (Curēus, 2018).

The study

• Authors: C. Salazar, N. Kanter Md, A. Abboud
• Journal: Curēus
• Published: 2018;10(6):e2749
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare neoplasm. It predominantly affects elderly individuals aged over 70 years presenting with a unilateral pleural tumor usually associated with previous asbestos exposure. The respiratory symptoms are associated with ipsilateral pleural involvement with concomitant pleural effusions. The diagnosis of MPM is established by the morphologic and immunohistochemical features of a cytologic specimen. MPM can present as three histologic subtypes: epithelioid, sarcomatoid, or biphasic. We present a case of an 85-year-old Caucasian female with a history of occupational asbestos exposure. She complained of 1-week history of progressive sharp right flank and scapular pain with mild shortness of breath, dry cough and pleuritic chest pain. CT of the chest showed a large loculated right pleural effusion with adjacent pleural thickening. CT abdomen and pelvis was negative for other neoplastic findings. CT-guided core biopsy of the right pleural-based mass was positive for a spindle to plasmacytoid small blue cell tumor. An extensive immunohistochemical panel was non-specific. A focal OSCAR keratin and WT-1 expression in the absence of carcinoma markers, a malignant mesothelioma, biphasic type was diagnosed. Further workup with PET-CT and cytotoxic chemotherapy combined with immunotherapy or tyrosine kinase inhibitors was recommended by oncology. The patient refused further imaging and treatment, and palliative care was consulted.

In plain English

This case report describes one patient at a Chicago hospital: an 85-year-old Caucasian woman with 15 years of occupational asbestos exposure. The article does not name her job or the type of asbestos. She had a week of worsening sharp right flank and shoulder-blade pain, mild shortness of breath, dry cough and chest pain on breathing. She had made several earlier emergency visits with similar complaints and negative workups. A chest CT showed a large right pleural effusion (fluid around the lung) with pleural thickening and multiple masses in both lungs. Bronchoscopy samples and the pleural fluid were negative for cancer. A CT-guided needle biopsy of the right pleural mass showed a small blue cell tumor. After staining at the Mayo Clinic laboratory, it was diagnosed as malignant pleural mesothelioma, biphasic type. The patient refused further imaging and treatment, and palliative care was consulted. The authors concluded that this cancer should be considered in elderly patients with a pleural mass and effusion, especially after asbestos exposure.

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 85-year-old Caucasian woman seen at Louis A. Weiss Memorial Hospital, Chicago, USA
• Exposure: 15 years of occupational asbestos exposure. Job and fiber type are not stated. The patient was a nonsmoker.
• Main results:
  • Before diagnosis, the patient had made multiple emergency department visits with similar complaints and negative workups
  • Chest CT showed a large loculated right pleural effusion with pleural thickening and multiple masses in both lungs, more on the right
  • Bronchial washing and bronchial biopsies were negative for cancer or infection
  • Cytology of the pleural fluid was negative for malignancy
  • The core biopsy of the pleural mass showed a malignant spindle to plasmacytoid small blue cell tumor
  • External (Mayo Clinic) staining: tumor cells were diffusely positive for Vimentin, focally positive for OSCAR keratin, WT-1, CD138 and CAM5.2, and rarely positive for ALK
  • The tumor was diagnosed as malignant mesothelioma, biphasic type, based on its appearance and focal OSCAR keratin and WT-1 staining without carcinoma markers
  • The authors described the tumor's appearance, imaging pattern and staining as unusual or atypical
  • The patient refused further imaging and treatment, and palliative care was consulted
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma should be included among possible diagnoses in elderly patients with a primary pleural mass and effusion, especially with a history of asbestos exposure.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Biphasic Mesothelioma, Neoplasm, Asbestos Exposure, Pleural Effusion, Histological Subtype, Epithelioid, Sarcomatoid.

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