Malignant pleural mesothelioma presenting as acute empyema with severe leukocytosis

Our plain-English summary of Malignant pleural mesothelioma presenting as acute empyema with severe leukocytosis, by K. Matsuoka (Annals of Thoracic and Cardiovascular Surgery, 2014).

The study

• Author: K. Matsuoka
• Journal: Annals of Thoracic and Cardiovascular Surgery
• Published: 2014;20 Suppl:513-6
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Five months after the treatment for acute empyema, a 75-year-old woman was referred to our hospital because of marked elevation of the white blood cell (WBC) count and C-reactive protein (CRP) level, and a right pleural mass detected by chest computed tomography. At this time, the WBC count and CRP level had increased to 60400/microl and 18.2 mg/dl, respectively. We performed biopsy and the tumor was diagnosed as sarcomatoid malignant pleural mesothelioma. Malignant pleural mesothelioma occasionally presents the symptoms and findings like an acute empyema. We demonstrated the case of malignant pleural mesothelioma which had presented the symptoms and laboratory findings very similar to acute empyema and had treated as acute empyema.

In plain English

This case report described one patient in Japan whose malignant pleural mesothelioma was first treated as an infection of the chest lining (acute empyema). The patient, a 75-year-old woman, had had rheumatoid arthritis for 25 years and had been treated with oral steroid. She had right chest pain and a productive cough. The article states that she had no history of asbestos aspiration. She was first treated for lung abscess and pleuritis. When antibiotics and chest drainage did not help, she had thoracoscopic surgery for empyema. Fluid tests showed bacteria but no cancer cells, and after surgery her white blood cell count and C-reactive protein (CRP) returned to normal. Five months later her white blood cell count was 60400/microl and her CRP was 18.2 mg/dl, and a right pleural mass was found. A biopsy showed sarcomatoid malignant pleural mesothelioma. She received only supportive care and died 5 months after diagnosis. The author considered that the mesothelioma may already have been present at the first surgery. The author concluded that tissue examination should be done even when empyema seems clear.

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 75-year-old woman in Japan who had had rheumatoid arthritis for 25 years and had been treated with oral steroid. She was an ex-smoker (15 pack-years) and was referred to National Hospital Organization Himeji Medical Center.
• Exposure: No asbestos exposure was reported; the article states the patient had no history of asbestos aspiration. No fiber types are named.
• Main results:
  • The patient was first treated as having lung abscess and pleuritis.
  • Cell blocks of the pleural fluid showed only fibrin clots and necrotic tissue, with no malignant cells. Many gram-positive and gram-negative bacteria were seen.
  • After thoracoscopic surgery for empyema, the patient's WBC count and CRP level fell immediately to normal.
  • Five months after surgery, the patient's WBC count had risen to 60400/microl and her CRP to 18.2 mg/dl, and a right pleural mass was seen on CT.
  • Biopsy showed spindle-shaped cells, positive for CAM5.2 and negative for calretinin and CEA. The tumor was diagnosed as sarcomatoid malignant pleural mesothelioma.
  • Immunohistochemistry for G-CSF on the biopsy was negative.
  • The patient received only supportive care and died of malignant mesothelioma 5 months after diagnosis.
• The authors' conclusion: The author considered that hidden (occult) mesothelioma was already present at the first treatment. The author concluded that histological examination should be done even when acute empyema is clinically suspected.
• Limitations the authors state:
  • The G-CSF test was done on a biopsy that represented only a small part of the tumor.
  • Serum levels of inflammatory cytokines (G-CSF, IL-6) were not measured. The suggested cause of the high white cell count was therefore assumed rather than shown.

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: Pleural Mesothelioma, Empyema, Biopsy, Sarcomatoid.

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