Massive localized malignant pleural mesothelioma (LMPM): manifestations on computed tomography in 6 cases

Our plain-English summary of Massive localized malignant pleural mesothelioma (LMPM): manifestations on computed tomography in 6 cases, by W. Yao, H. Yang, G. Huang, et al (International Journal of Clinical and Experimental Medicine, 2015).

The study

• Authors: W. Yao, H. Yang, G. Huang, Y. Yan, H. Wang, D. Sun
• Journal: International Journal of Clinical and Experimental Medicine
• Published: 2015;8(10):18367-74
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

Objective: Our study analyzed the clinical symptoms and computed tomography (CT) manifestations of massive localized malignant pleural mesothelioma (LMPM) patients to improve the knowledge and diagnosis of this disease.

Methods: Our study collected 6 massive LMPM patients pathologically confirmed by CT in the department of Radiology of the People's Hospital of Yuyao, Zhejiang Province, from January, 2007 to June, 2013; data of patients were also collected. The clinical symptoms, clinicopathological characteristics, CT manifestations, treatments and prognosis of enrolled patients were analyzed.

Results: Our study enrolled 6 LMPM patients (2 males; 4 females) classified to epitheliated type (n = 4) and sarcomatous type (n = 2) with mean age of 62.7 ± 7.4, and 5 of them had a history of asbestos exposure. CT manifestations revealed that large soft-tissue mass close to pleura, which was smooth and lobulated, was discovered in all patients with maximum diameter of 10~15 cm and mean diameter of 13.67 ± 1.15 cm; The mean value of CT was 36.29 ± 2.62 HU; after enhancement, the mean value was increased to 76.36 ± 7.73 HU; patients showed zones of small patchy necrosis and large patchy necrosis. The following presentations were founded: enlargement of tumor vessel which showed arborization (2 patients), mass wrap around the descending aorta in left lower chest (1 patient), strips of fat density in mediastinum superior (1 patient), pleural tail sign (3 patients). Among 6 patients, pleural effusion (n = 4), mediastinal lymph node enlargement (n = 3), invasion and destruction of local ribs (n = 2). Median survival time of patients were 20 months (2 cases conducted operation), 24 (2 cases chose combined radiotherapy and chemotherapy) and less than 6 months (2 cases underwent chemotherapy).

Conclusion: To sum up, CT showed important diagnostic values on massive LMPM patients; patients with a history of asbestos exposure, large soft-tissue mass of pleura with an abundant blood supply and wrap around large vessels might increase the risk of massive LMPM.

In plain English

This case series described six patients with massive localized malignant pleural mesothelioma seen at the People's Hospital of Yuyao, Zhejiang Province, China, between January 2007 and June 2013. Two were men and four were women, aged 56 to 76. Five of the six had done asbestos hand-spinning for 1 to 10 years. The article states that one had not handled asbestos but lived in an asbestos-production area. Four tumors were the epitheliated type and two were sarcomatous. On CT scans, every patient had a large soft-tissue mass next to the pleura, 10 to 15 cm across (mean 13.67 cm). Four had pleural effusion, three had enlarged mediastinal lymph nodes and two had rib invasion. Two patients had surgery (median survival 20 months) and two had radiotherapy plus chemotherapy (median survival 24 months). Two had chemotherapy alone, and both died within 6 months. The authors concluded that CT had diagnostic value. They also wrote that asbestos exposure, a large pleural mass with abundant blood supply, and wrapping around large vessels "might have the potential risk" of this disease. They noted that the number of cases was small.

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 6 patients (clinical, pathology and CT findings, treatment and follow-up)
• Who was studied: 6 patients with massive localized malignant pleural mesothelioma (2 male, 4 female, aged 56 to 76, mean 62.7) at the People's Hospital of Yuyao, Zhejiang Province, China, January 2007 to June 2013
• Exposure: Asbestos hand-spinning for 1 to 10 years in five of six patients. One patient had not handled asbestos but lived in an asbestos-production area. Fiber type was not specified for these patients.
• Main results:
  • Of the 6 patients, 4 had the epitheliated type and 2 had the sarcomatous type
  • All 6 patients had a large soft-tissue mass associated with the pleura. In 5 it was in the chest (4 left, 1 right).
  • Mass maximum diameter was 10 to 15 cm, with a mean diameter of 13.67 plus or minus 1.15 cm
  • Mean CT density of the masses was 36.29 plus or minus 2.62 HU, rising to 76.36 plus or minus 7.73 HU after contrast enhancement
  • 4 patients had small patchy areas of necrosis and 2 had large patchy areas
  • In 2 of 6 patients, the mass showed enlarged, branching tumor vessels. In 1 patient, the mass encircled the descending aorta.
  • Pleural effusion was found in 4 patients
  • Enlarged mediastinal lymph nodes were found in 3 patients
  • Local ribs were invaded and destroyed in 2 patients
  • Two patients treated with surgery had recurrence and metastasis 1 year after the operation. Their median survival was 20 months.
  • Two patients given thoracic radiotherapy plus chemotherapy had their mass shrink by about one third at 3 months. Their median survival was 24 months.
  • In the 2 patients given chemotherapy alone, the mass grew by about one quarter at 3 months, and both died within 6 months
  • The authors interpreted the treatment outcomes (two patients per treatment) as indicating that combined chemotherapy and radiotherapy might be the most effective treatment
  • One patient was initially misdiagnosed with tuberculosis
  • Blood tumor markers: CA153 was raised (177 u/ml) in 1 of 6 patients, and markers were normal in 4 patients
• The authors' conclusion: The authors concluded that CT had diagnostic value for massive localized malignant pleural mesothelioma. They also concluded that a history of asbestos exposure, a large pleural soft-tissue mass with abundant blood supply, and wrapping around large vessels might indicate potential risk of the disease.
• Limitations the authors state:
  • The small number of cases means that the marker differences between tumor types need confirmation in further research
  • CT was not compared with other imaging methods (chest X-ray, MRI, PET-CT)

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Asbestos Exposure, Pleura, Necrosis, Mediastinum, Pleural Effusion, Median Survival.

Related studies

• Computed tomography of localized pleural mesothelioma — C.G. Dedrick, T.C. McLoud, et al. (1985)
• Surface of localized pleural plaques quantitated by computed tomography scanning: no relation with cumulative asbestos exposure and no effect on lung function — J. Van Cleemput, H. De Raeve, et al. (2001)
• Predictive accuracy of the Liverpool Lung Project risk model for stratifying patients for computed tomography screening for lung cancer: a case-control and cohort validation study — O.Y. Raji, S.W. Duffy, et al. (2012)
• High resolution computed tomography and lung function in asbestos-exposed workers with normal chest radiographs — C.A. Staples, G. Gamsu, et al. (1989)
• Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases — M. Metintas, I. Ucgun, et al. (2002)
• Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study — H. Yildirim, M. Metintas, et al. (2009)

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