Malignant Pleural Mesothelioma (MPM) Presenting as Hydropneumothorax

Our plain-English summary of Malignant Pleural Mesothelioma (MPM) Presenting as Hydropneumothorax, by M. Kuramochi, T. Muraoka, M. Shinonaga, et al (Curēus, 2023).

The study

• Authors: M. Kuramochi, T. Muraoka, M. Shinonaga, H. Ohtani, S. Kuraoka
• Journal: Curēus
• Published: 2023;15(7):e41243
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

An 86-year-old man presented with bilateral lower limb edema and was found to have hydropneumothorax on chest radiography. CT revealed a substantial pleural effusion and plaques. The patient had a history of working in a stone workshop, but the extent of asbestos exposure remained unknown. Thoracic drainage and subsequent thoracoscopic surgery confirmed the presence of biphasic malignant mesothelioma through pathological examination. Hydropneumothorax as a presentation of malignant pleural mesothelioma (MPM) is rare, with only a few similar cases reported. Remarkably, despite the coexistence of plural effusion and pneumothorax, the patient did not experience dyspnea. The examination also revealed tumor rupture and disruption of the pleura. Considering the possibility of MPM in patients with asymptomatic hydropneumothorax is essential for early diagnosis and appropriate management.

Copyright © 2023, Kuramochi et al.

In plain English

This article was a case report about one patient treated at a hospital in Mito, Japan. An 86-year-old man with high blood pressure went to a local clinic with swelling in both lower legs. A chest X-ray suggested a right-sided hydropneumothorax, meaning fluid and air together in the chest cavity. A CT scan showed a large amount of fluid on the right side and multiple pleural plaques. He had worked in a stone workshop, and the extent of his asbestos exposure was unknown. About 1,500 mL of fluid was drained, and tests of the fluid found no abnormal cells. Because air kept leaking, he had surgery seven days later. Tissue examination confirmed biphasic malignant mesothelioma, staged as stage IA, and also found asbestos bodies. He did not complain of breathlessness. He was treated with ipilimumab plus nivolumab and was alive and stable eight months later. The authors found 18 reported cases since 2000, including this one. The authors concluded that mesothelioma should be considered when hydropneumothorax occurs without symptoms.

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 brief literature search
• Who was studied: One 86-year-old man with a history of hypertension, treated at Mito Saiseikai General Hospital, Mito, Japan; he had never smoked and had no history of tuberculosis
• Exposure: Work history in a stone workshop; the extent of asbestos exposure was unknown; fiber type not stated. Asbestos bodies were found in tissue
• Main results:
  • CT showed a significant right-sided pleural effusion and multiple pleural plaques
  • Drainage removed approximately 1,500 mL of serous pleural fluid; cytology of the fluid found no atypical cells
  • Because of persistent air leakage, thoracoscopic surgery was performed seven days after drainage
  • Pathology confirmed biphasic malignant mesothelioma
  • Tumor cells invaded 1.0 mm into the lung tissue in one area
  • Asbestos bodies were detected with Berlin blue staining
  • The tumor was staged pT2cN0cM0, stage IA
  • Despite fluid and air in the chest, the patient did not complain of breathlessness
  • After treatment with immune checkpoint inhibitors (ipilimumab plus nivolumab), the patient was alive and stable for eight months
  • The authors' literature search from 2000 onward found 18 reported cases of MPM presenting as hydropneumothorax, including this one
• The authors' conclusion: The authors concluded that the patient lacked symptoms because of preexisting pleural effusion and lung collapse, and that MPM should be considered and investigated thoroughly in cases of asymptomatic hydropneumothorax

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Bilateral, Pleural Effusion, Asbestos Exposure, Biphasic Mesothelioma, Malignant Mesothelioma, Pneumothorax, Dyspnea.

Related studies

• Lepidic intrapulmonary growth of malignant mesothelioma presenting as recurrent hydropneumothorax — H. Wu, G. Tino, et al. (1996)
• Recurrent hydropneumothorax as a presenting feature of malignant mesothelioma — K. Guha, D. Jones, et al. (2008)
• Malignant pleural mesothelioma presenting with a spontaneous hydropneumothorax: a report of 2 cases — H.Z. Saleh, E. Fontaine, et al. (2012)
• Diffuse epithelioid malignant mesothelioma of the pleura presenting as a hydropneumothorax and vertebral body invasion — C.A. Hinkamp, S.N. Dalal, et al. (2020)
• Recurrent hydropneumothorax: An unusual presentation for malignant pleural mesothelioma — D. DeLapp, C. Chan, et al. (2016)
• Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma — H.E. Fayed, V.K. Woodcock, et al. (2013)

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