Malignant pleural mesothelioma without asbestos exposure with distant metastasis in a peripheral lymph node: a case report

Our plain-English summary of Malignant pleural mesothelioma without asbestos exposure with distant metastasis in a peripheral lymph node: a case report, by S. Kant, S.K. Verma, Sanjay (Lung India, 2008).

The study

• Authors: S. Kant, S.K. Verma, Sanjay
• Journal: Lung India
• Published: 2008;25(1):31-3
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is an uncommon pleural neoplasm and usually associated with inhalation exposure to asbestos. About 20% of the patients have no demonstrable exposure to asbestos. It rarely metastasizes in peripheral lymph nodes. Here is a case report of malignant pleural mesothelioma without asbestos exposure with cervical lymph node metastasis.

In plain English

This was a case report about one patient admitted to the Department of Pulmonary Medicine at King George's Medical University, Lucknow, India. He was a 68-year-old man, a retired clerk and chronic bidi smoker, who had had right-sided chest pain for one month and a painful lump on the right side of his neck. No contact with asbestos at work or at home could be found. Scans showed fluid around the right lung and enlarged lymph nodes inside the right side of the chest. Testing of the fluid from around the lung showed malignant mesothelioma. A closed pleural biopsy did not give a diagnosis, and the patient did not consent to an open biopsy. A biopsy of the neck lymph node, with staining positive for pancytokeratin and negative for CEA and CD-15, confirmed the diagnosis. The patient died of respiratory failure after two days in hospital, before treatment. The authors wrote that it could be presumed that smoking possibly led to his disease. They did not test this. They concluded that, although spread of mesothelioma to lymph nodes outside the chest is very rare, lymph node biopsy is needed in suspected cases to diagnose 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 (one patient)
• Who was studied: One 68-year-old man, a retired clerk and chronic bidi smoker, admitted to the authors' department in Lucknow, India. The date of admission is not given.
• Exposure: No occupational or domestic asbestos contact could be elicited. The patient was a chronic bidi smoker.
• Main results:
  • The patient had a single, hard, tender right-sided neck (cervical) lymph node measuring 4x4 cm.
  • A CT scan of the chest showed right-sided mediastinal lymph node enlargement and right-sided pleural effusion.
  • Pleural fluid cytology revealed malignant mesothelioma. Pleural fluid lactic dehydrogenase was 3775.
  • A closed pleural biopsy was nondiagnostic. An open pleural biopsy was planned, but the patient did not consent.
  • Immunohistochemical stains on the lymph node biopsy were positive for pancytokeratin and negative for CEA and CD-15.
  • The case was staged as M1, stage IV, under the IMIG system, and stage III under the Butchard system.
  • The patient died of respiratory failure after 2 days of hospital stay, before planned treatment.
  • The authors suggested, as a presumption, that smoking could possibly have led to the pleural mesothelioma.
• The authors' conclusion: The authors concluded that although extrathoracic lymph node metastases in malignant mesothelioma are very rare, lymph node biopsy needs to be performed in suspected cases to diagnose metastatic disease.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Metastasis, Malignant Mesothelioma, Neoplasm.

Related studies

• Diffuse pleural mesothelioma with distant bone metastasis. A case report — R.N. Laurini (1974)
• Distant cutaneous metastasis of malignant epithelioid mesothelioma — K. Collins, P. Nagarajan, et al. (2021)
• Asbestos content of lung tissue, lymph nodes, and pleural plaques from former shipyard workers — R.F. Dodson, M.G. Williams, et al. (1990)
• Intrapulmonary lymph nodes. Clinical, radiologic, and pathologic features — R.L. Kradin, P.W. Spirn, et al. (1985)
• Lymph node metastases in diffuse malignant peritoneal mesothelioma — D. Baratti, S. Kusamura, et al. (2010)
• Hyperplastic mesothelial cells in lymph nodes: report of six cases of a benign process that can stimulate metastatic involvement by mesothelioma or carcinoma — P. Argani, J. Rosai (1998)

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