Malignant pleural mesothelioma in a patient with systemic sclerosis: the first report

Our plain-English summary of Malignant pleural mesothelioma in a patient with systemic sclerosis: the first report, by N. Singh, K. Madan, A. Bhattacharya, et al (Respiration; International Review of Thoracic Diseases, 2013).

The study

• Authors: N. Singh, K. Madan, A. Bhattacharya, R. Nijhawan
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 2013;85(1):66-71
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is a relatively rare but aggressive pleural tumor. Systemic sclerosis (SSc) is associated with the development of lung cancer and other malignancies. We describe a 58-year-old never-smoker female, previously diagnosed with limited cutaneous SSc, who presented with chest pain on the left side, dyspnea and circumferential nodular left pleural thickening. Fluorodeoxyglucose positron-emission tomography-computed tomography showed intense uptake in the thickened left pleura, mediastinal lymph nodes and left femur. Pleural fluid cytological examination along with nuclear and membranous positivity for Wilms tumor-1 antigen and epithelial membrane antigen on immunocytochemistry confirmed the diagnosis of MPM. To the best of our knowledge, this is the first report of MPM in a patient with SSc.

Copyright © 2012 S. Karger AG, Basel.

In plain English

This article was a case report about one patient. She was a 58-year-old woman who had never smoked and was a housewife with no history of asbestos exposure, chest trauma or radiation exposure. Two years earlier she had been diagnosed with limited cutaneous systemic sclerosis. She came to the hospital with left-sided chest pain and breathlessness. A CT scan showed nodular, mass-like thickening, about 2.5 cm thick, of the left parietal pleura (the lining of the left side of the chest cavity). A PET-CT scan showed intense uptake in the thickened left pleura and in lymph nodes in the middle of the chest, and a spot of uptake in the left femur (thigh bone). Fluid drained from around the lung contained malignant cells that tested positive for the markers WT-1 and EMA. She refused a pleural biopsy. She was diagnosed with stage IV malignant pleural mesothelioma and started chemotherapy with pemetrexed and cisplatin. The authors concluded that this was, to their knowledge, the first reported case of malignant pleural mesothelioma in a patient with systemic sclerosis, and that it can occur without any 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 58-year-old woman, a never-smoker, previously diagnosed with limited cutaneous systemic sclerosis (LC-SSc)
• Exposure: No asbestos exposure was reported. The patient was a housewife with no history of asbestos exposure, chest trauma or radiation exposure, and no family history of asbestos exposure. The condition studied alongside the tumor was limited cutaneous systemic sclerosis, diagnosed two years before.
• Main results:
  • A contrast-enhanced CT scan showed circumferential nodular, mass-like thickening of the left parietal pleura measuring about 2.5 cm.
  • PET-CT showed intense uptake in the thickened left pleura (maximum standardized uptake value 8.7) and in mediastinal lymph nodes (maximum standardized uptake value 5.2 in the prevascular node).
  • PET-CT also showed a focus of uptake in the intertrochanteric region of the left femur.
  • Pleural fluid contained malignant cells that showed nuclear positivity for WT-1 and membranous positivity for EMA on immunocytochemistry.
  • The final diagnosis was limited cutaneous systemic sclerosis with stage IV (T2N3M1) malignant pleural mesothelioma.
  • The patient was started on chemotherapy with pemetrexed (500 mg/m2) and cisplatin (65 mg/m2), each given on day 1 of a 3-weekly cycle.
• The authors' conclusion: The authors concluded that, to their knowledge, there was no previous report of malignant pleural mesothelioma in a patient with systemic sclerosis. They stated that this cancer can occur in systemic sclerosis without any asbestos exposure.
• Limitations the authors state:
  • Because the patient refused consent, no pleural biopsy was obtained and a wider panel of immunohistochemical markers could not be performed. The diagnosis rested on pleural fluid cytology, immunocytochemistry and the imaging picture.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Lung Cancer, Dyspnea, Pleural Thickening, Pleura, Mediastinal Lymph Nodes, Epithelial Membrane Antigen (EMA).

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