Malignant pleural mesothelioma initially diagnosed on cervical lymph node biopsy

Our plain-English summary of Malignant pleural mesothelioma initially diagnosed on cervical lymph node biopsy, by S. Ogata, S. Hiroi, A. Tominaga, et al (Pathology International, 2009).

The study

• Authors: S. Ogata, S. Hiroi, A. Tominaga, S. Aida, A. Kobayashi, K. Tamura, Y. Abe, T. Kawai
• Journal: Pathology International
• Published: 2009;59(8):592-4
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Reported herein is a case of malignant pleural mesothelioma, initially diagnosed on cervical lymph node biopsy. A 58-year-old man, without obvious evidence of asbestos exposure, exhibited repeated pleural effusion (cause unclear), which was resolved by diuretics. A neck mass was apparent and was identified pathologically as a lymph node metastasis of malignant mesothelioma. F-18 fluorodeoxyglucose positron emission tomography/CT established the diagnosis of malignant pleural mesothelioma. Two conclusions emerge from this report: (i) cervical lymph node metastasis of pleural mesothelioma, although rare, should be included in differential diagnosis; and (ii) positron emission tomography/CT is useful for establishing a diagnosis of mesothelioma.

In plain English

This case report described a 58-year-old Japanese man admitted with neck swelling and hoarseness. No definitive occupational asbestos exposure was evident. Two years earlier he had a right pleural effusion (fluid around the lung) of unknown cause. Fluid cytology was negative; the effusion recurred but disappeared with diuretics. A rapidly growing mass in the left neck was biopsied. Tumor cells in the lymph node stained positive for calretinin, D2-40, cytokeratin 5/6 and WT-1 and negative for CEA and BerEP-4, suggesting metastatic malignant mesothelioma, epithelioid type. A whole-body FDG-PET/CT scan found lesions in the left neck, right pleura, left lung and several lymph nodes. The established diagnosis was malignant pleural mesothelioma of the right pleural cavity with extensive extrapleural spread (spread beyond the pleura). He died within a few months despite chemotherapy. The authors concluded that spread of pleural mesothelioma to neck lymph nodes, though rare, should be considered in diagnosis, and that FDG-PET/CT is useful for diagnosing mesothelioma. They cautioned that very early mesothelioma accompanied by pleural effusion alone, or tuberculous pleuritis, may be hard to diagnose with it.

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, short communication)
• Who was studied: one 58-year-old Japanese man admitted with neck swelling and hoarseness, treated at National Defense Medical College Hospital, Tokorozawa, Japan
• Exposure: no definitive occupational asbestos exposure was evident; no fiber type reported
• Main results:
  • Two years earlier the patient had a right pleural effusion of unknown cause. It recurred, then disappeared with diuretic treatment about 6 months before admission.
  • A hard mass in the left neck was compressing his trachea. An incisional biopsy was performed.
  • Tumor cells in the lymph node were positive for calretinin, D2-40, cytokeratin 5/6 and WT-1 and negative for CEA and BerEP-4. This suggested metastatic malignant mesothelioma, epithelioid type.
  • FDG-PET/CT showed uptake in the left neck, right pleura, left peripheral lung and mediastinal, neck and perigastric lymph nodes.
  • The established diagnosis was malignant pleural mesothelioma of the right pleural cavity with extensive extrapleural spread.
  • The patient died within a few months despite chemotherapy.
• The authors' conclusion: The authors concluded that cervical lymph node metastasis of pleural mesothelioma, although rare, should be included in differential diagnosis, and that FDG-PET/CT is useful for establishing a diagnosis of mesothelioma.
• Limitations the authors state:
  • The authors cautioned that FDG-PET/CT has diagnostic pitfalls: very early mesothelioma accompanied by pleural effusion alone, or tuberculous pleuritis, may be difficult to diagnose accurately even with it.

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, Biopsy, Asbestos Exposure, Pleural Effusion, Metastasis, Malignant Mesothelioma, Differential Diagnosis, Mesothelioma.

Related studies

• Clinical and pathological characteristic of metastatic malignant mesothelioma initially diagnosed by lymph node biopsy — X.L. Zhu, L.M. Gao, et al. (2017)
• Fine-needle aspiration biopsy of axillary lymph nodes — S. Jaffer, M. Zakowski (2002)
• Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report — N.A. Ansari, N.W. Derias (2000)
• Diagnosis of malignant pleural mesothelioma by axillary lymph node biopsy — S.B. Kim, B. Varkey, et al. (1987)
• Lymph node metastases in diffuse malignant peritoneal mesothelioma — D. Baratti, S. Kusamura, et al. (2010)
• Monitoring of fluoro-edenite fibre pollution through the study of sheep lymph nodes as a model of a biological indicator — V. Rapisarda, G. Rapisarda, et al. (2005)

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