Malignant Pleural Mesothelioma with Marked Lymphatic Involvement: A Report of Two Autopsy Cases

Our plain-English summary of Malignant Pleural Mesothelioma with Marked Lymphatic Involvement: A Report of Two Autopsy Cases, by R. Ideguchi, K. Ashizawa, S. Akashi, et al (Case Reports in Oncological Medicine, 2017).

The study

• Authors: R. Ideguchi, K. Ashizawa, S. Akashi, M. Shindo, K. Minami, T. Fukuda, J. Irie, M. Fukuda, M. Uetani
• Journal: Case Reports in Oncological Medicine
• Published: 2017;2017:6195898
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We herein report two cases of malignant pleural mesothelioma with marked lymphangiosis. The patients included a 68-year-old man and a 67-year-old man who both had a history of exposure to asbestos. Computed tomography (CT) on admission showed pleural effusion with pleural thickening. In both cases, a histopathological examination of the pleura confirmed the diagnosis of epithelioid malignant mesothelioma. They received chemotherapy, but the treatment was only palliative. The chest CT assessments during admission revealed marked pleural effusion and mediastinal lymphadenopathy. CT also showed a consolidative mass with bronchovascular bundle and septal thickening in the lungs suggesting pulmonary parenchymal involvement and the lymphangitic spread of the tumor. These CT findings mimicked lung cancer with pleuritis and lymphangitic carcinomatosis. Autopsy was performed in both cases. Macroscopically, the tumor cells infiltrated the lung with the marked lymphatic spread of the tumor. Microscopy also revealed that the tumor had invaded the pulmonary parenchyma with the marked lymphatic spread of the tumor. Although this growth pattern is unusual, malignant pleural mesothelioma should be considered as the differential diagnosis, especially in patients with pleural lesions.

In plain English

This is a case report of two autopsy cases of malignant pleural mesothelioma from a hospital in Nagasaki, Japan. Both patients were men, aged 67 and 68. Each had been regularly exposed to asbestos while working as a seaman, for 10 and 25 years respectively. The article does not name the asbestos fiber type. Both had fluid around the lung and pleural thickening, and examination of pleural tissue diagnosed epithelioid mesothelioma. Both received chemotherapy that included cisplatinum and pemetrexed. Later CT scans showed a lung mass with thickening along the lung's internal structures, which the authors said mimicked lung cancer spreading through the lymphatic vessels. The men died of respiratory failure 16 and 18 months after diagnosis. At autopsy, tumor had invaded the lung with marked spread through lymphatic vessels. The final diagnosis was epithelioid type in the first man and biphasic type in the second. The authors concluded that although this growth pattern is unusual, pleural mesothelioma should be considered in the differential diagnosis, especially in patients with pleural lesions.

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 of two autopsy cases
• Who was studied: Two men, aged 67 (case 1) and 68 (case 2), treated at Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan; dates not given
• Exposure: Occupational asbestos exposure as a seaman: 10 years in case 1 and 25 years in case 2; fiber type not stated
• Main results:
  • Case 2 (68-year-old man) had been regularly exposed to asbestos during 25 years of employment as a seaman
  • In both cases, CT showed a consolidative mass with bronchovascular bundle and septal thickening, which the authors said mimicked lung cancer with lymphangitic carcinomatosis
  • Case 1 died of respiratory failure 16 months after diagnosis
  • Case 2 died of respiratory failure 18 months after diagnosis; CT had also shown metastasis to the mediastinal lymph nodes, peritoneal metastasis and ascites
  • At autopsy in both cases, tumor involved the lung tissue with marked lymphatic spread
  • Case 1's final autopsy diagnosis was epithelioid-type malignant pleural mesothelioma
  • Case 2's final autopsy diagnosis was biphasic-type malignant pleural mesothelioma; the tumor had spread across the mediastinum to the opposite pleural cavity
• The authors' conclusion: The authors concluded that although this growth pattern is unusual, malignant pleural mesothelioma should be considered in the differential diagnosis, especially in patients with pleural lesions

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Autopsy, Pleural Effusion, Pleural Thickening, Pleura, Epithelioid, Malignant Mesothelioma, Chemotherapy.

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