Mediastinal malignant mesothelioma discovered in a patient with dysphagia

Our plain-English summary of Mediastinal malignant mesothelioma discovered in a patient with dysphagia, by D. Amore, S. Massa, U. Caterino, et al (Respirology Case Reports, 2020).

The study

• Authors: D. Amore, S. Massa, U. Caterino, D. Casazza, A. Palma, C. Curcio
• Journal: Respirology Case Reports
• Published: 2020;8(6):e00592
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A mediastinal mass in patients with a history of asbestos exposure should raise the suspicion of malignant mesothelioma.

© 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This case report from Monaldi Hospital in Naples, Italy, described a 73-year-old man with progressive difficulty swallowing solid foods and a persistent cough. The patient was not a smoker, had no past history of cancer, reported weight loss, and reported long-term asbestos exposure as a worker in a steel-making industry. No fiber type was named. Endoscopy showed narrowing of the lower oesophagus from outside pressure, with no sign of tumour within it. A chest CT scan showed a 51 × 43 mm mass in the posterior mediastinum (the back of the space between the lungs). A needle sample was inconclusive, and uncontrollable cough meant the patient was not considered an ideal candidate for a needle biopsy through the skin, so tissue was taken by right-sided thoracoscopy. The tissue showed biphasic malignant pleural mesothelioma. The authors noted that difficulty swallowing is an unusual presentation of malignant mesothelioma and the posterior mediastinum an uncommon site for this pleural tumour. Their key message was that a mediastinal mass in a patient with past asbestos exposure should raise suspicion of malignant mesothelioma. The report described a single patient.

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 (brief 'Clinical Image' article) of a single patient
• Who was studied: One 73-year-old man admitted to Monaldi Hospital, Naples, Italy, with progressive difficulty swallowing solid foods and persistent cough
• Exposure: Long-term asbestos exposure reported by the patient from work in a steel-making industry; fiber type not stated
• Main results:
  • The patient was not a smoker and had no past medical history of cancer or infectious disease
  • Oesophagogastroscopy showed narrowing of the distal oesophagus due to extrinsic (outside) compression
  • Oesophagogastroscopy showed no evidence of local malignancy in the oesophagus
  • Contrast-enhanced chest CT showed a posterior mediastinal mass measuring 51 × 43 mm
  • Cytology from a bronchoscopy-guided transtracheal fine-needle aspiration biopsy of the lesion was inconclusive
  • Because of uncontrollable cough, the patient was not considered an ideal candidate for percutaneous image-guided core needle biopsy, so a diagnostic right thoracoscopy was performed for surgical biopsies
  • Surgical biopsies taken by diagnostic right thoracoscopy showed biphasic malignant pleural mesothelioma
  • The authors stated that the posterior mediastinum is an uncommon site for this pleural tumour, and that dysphagia is an unusual presentation of malignant mesothelioma
• The authors' conclusion: The authors' key message was that a mediastinal mass in patients with a history of asbestos exposure should raise the suspicion of malignant mesothelioma

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Dysphagia, Asbestos Exposure.

Related studies

• A rare cause of dysphagia: malignant pleural mesothelioma in the posterior mediastinum — M. Hayama, H. Maeda (2010)
• Dysphagia due to mesothelioma infiltrating the oesophagus: palliative treatment — C.A. Lockwood, H.W. Jones, et al. (1989)
• An unusual cause of Dysphagia in a 76-year-old heavy smoker — A. Derweduwen, P. Nafteux, et al. (2013)
• First somatic mutation of E2F1 in a critical DNA binding residue discovered in well-differentiated papillary mesothelioma of the peritoneum — W. Yu, W. Chan-On, et al. (2011)
• Evaluation of public and worker exposure due to naturally occurring asbestos in gravel discovered during a road construction project — R.A. Perkins, J. Hargesheimer, et al. (2008)
• Incidentally discovered malignant mesothelioma of the tunica vaginalis — C.H. Weng, P.Y. Ho, et al. (2013)

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