Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review

Our plain-English summary of Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review, by S. Alkhuja, A. Miller, A.J. Mastellone, et al (American Journal of Industrial Medicine, 2000).

The study

• Authors: S. Alkhuja, A. Miller, A.J. Mastellone, S. Markowitz
• Journal: American Journal of Industrial Medicine
• Published: 2000;38(2):219-23
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) is thought to arise from the mesothelial cells that line the pleural cavities. Most patients initially experience the insidious onset of chest pain or shortness of breath, and it rarely presents as spontaneous pneumothorax.

Case Reports: We report four patients who presented in this manner. Three of the patients were exposed to asbestos directly or indirectly at shipyards during World War II; the fourth was exposed as an insulator's wife. Two of our cases were not recognized to have MPM on histologic examination at first thoracotomy and remained asymptomatic for 12 and 22 months, respectively. In none of the patients described herein, was spontaneous pneumothorax the cause of death.

Conclusions: Since many people were exposed to asbestos during and after World War II, spontaneous pneumothorax in a patient with the possibility of such exposure should raise the suspicion of malignant pleural mesothelioma.

Copyright 2000 Wiley-Liss, Inc.

In plain English

This is a case series of four patients plus a literature review on malignant pleural mesothelioma. In each, the authors described a spontaneous pneumothorax (a collapsed lung without injury or other obvious cause) as the disease's first presentation; one man had eight weeks of breathlessness and cough before it. Three were men aged 81, 81 and 56; one was a woman aged 70. The men were exposed through shipyard work or as a construction laborer and asbestos insulator; the woman as the daughter of a World War II shipyard worker and wife of a boiler installer. No fiber types were named. In two patients, tissue from the first surgery was not recognized as mesothelioma; the disease was diagnosed about 12 and 22 months later. For one, review of the earlier slides showed mesothelioma. Two patients died 6 months after diagnosis or presentation, one lived 5.5 years, and the woman was alive 3 years later. The pneumothorax caused no patient's death. The authors concluded that pneumothorax in someone possibly exposed to asbestos should raise suspicion of mesothelioma, even when it resolves.

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 series of four patients, with a review of the literature
• Who was studied: Four patients whose malignant pleural mesothelioma first presented as spontaneous pneumothorax: men aged 81, 81 and 56, and a woman aged 70. The setting and dates are not stated, except that the woman's illness began in 1996 and was followed to September 1999.
• Exposure: Patient 1 worked in shipyards for 9 years, including World War II. Patient 2 was a construction laborer and asbestos insulator from 1946 to 1976. Patient 3 was stationed in a naval shipyard for 18 months, 35 years earlier. Patient 4 was the daughter of a World War II shipyard, electrical and chemical maintenance worker, and the wife of a boiler installer employed for 19 years. No fiber types are named.
• Main results:
  • Patient 1 (81-year-old man) had 8 weeks of exertional breathlessness and dry cough before presenting with left pleuritic pain. He was found to have a left hydropneumothorax.
  • In Patient 1, pleural biopsies confirmed mesothelioma by immunohistochemistry. He received no radiotherapy or chemotherapy and died 6 months after diagnosis.
  • Patient 2 (81-year-old man) had a small right hydropneumothorax. He was diagnosed with sarcomatous malignant pleural mesothelioma and died 6 months after presentation.
  • Patient 3 (56-year-old man) had a recurring right pneumothorax. Tissue examined at thoracotomy showed pleural thickening but no malignancy.
  • About 1 year later, Patient 3 developed a chest wall mass. Needle biopsy showed malignant epithelial mesothelioma. He survived 5.5 years after his first pneumothorax.
  • Patient 4 (70-year-old woman) had a 50% left pneumothorax. Surgical pathology was first read as emphysema and chronic nonspecific pleuritis. Twenty-two months later, epithelial malignant pleural mesothelioma was diagnosed, and a review of the earlier slides then also showed epithelial mesothelioma.
  • Patient 4 was treated in a phase II trial of cisplatin and gemcitabine and was alive 3 years later.
  • In none of the four patients was the spontaneous pneumothorax the cause of death.
• The authors' conclusion: The authors concluded that, because many people were exposed to asbestos during and after World War II, spontaneous pneumothorax in a patient who may have had such exposure should raise suspicion of malignant pleural mesothelioma, even when the pneumothorax resolves. They suggested that the 12- and 22-month symptom-free periods in two cases indicated a quiescent phase of the disease.

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, Pneumothorax, Mesothelial Cells, Insulator, Thoracotomy.

Related studies

• Spontaneous pneumothorax and pulmonary malignant disease--a syndrome sometimes associated with cavitating tumours. Report of nine new cases, four with metastases and five with primary bronchial tumours — F.W. Wright (1976)
• Simultaneous bilateral spontaneous pneumothorax in a patient with peritoneal and pleural papillary mesothelioma — P. Höllinger, D. Gaeng (1997)
• Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage — P. Lange, J. Mortensen, et al. (1988)
• Spontaneous pneumothorax and lung carcinoma: should one consider synchronous malignant pleural mesothelioma? — T.A. Flood, H.S. Sekhon, et al. (2009)
• Pleural granuloma mimicking malignancy 42 years after slurry talc injection for primary spontaneous pneumothorax — S. Tenconi, L. Luzzi, et al. (2010)
• Malignant pleural mesothelioma detected by spontaneous pneumothorax — A. Makidono, M. Matsusako, et al. (2010)

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