Mesothelioma: a soon to be forgotten disease in the United States?

Our plain-English summary of Mesothelioma: a soon to be forgotten disease in the United States?, by D. Thomas, R. Geck, D. Rozas, et al (Journal of Bronchology & Interventional Pulmonology, 2012).

The study

• Authors: D. Thomas, R. Geck, D. Rozas, C. Muro-Cacho, M. Rumbak
• Journal: Journal of Bronchology & Interventional Pulmonology
• Published: 2012;19(3):258-61
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is an uncommon cancer that commonly presents with a large unilateral bloody pleural effusion long after asbestos exposure. Its prevalence is decreasing with the decreasing exposure to asbestos in the United States. We present a patient with malignant pleural mesothelioma who underwent evaluation and treatment during medical thoracoscopy. The thoracoscopic evaluation revealed multiple, varied, and severe but characteristic findings of malignant pleural mesothelioma. Medical thoracoscopy is the procedure of choice for the diagnosis of pleural mesothelioma.

In plain English

This brief case report described one patient with malignant pleural mesothelioma. He was an 86-year-old white man, a nonsmoker, who came to the emergency department with fatigue, cough, poor appetite and rapidly worsening breathlessness. He had worked in construction with his eldest brother in his 20s and 30s and served in the US Navy during World War II. The authors reported that both brothers had repeated exposure to loose asbestos in buckets and cut asbestos tiles with a band saw. No fiber type was named. A brother had died of mesothelioma in his 70s. A CT scan showed a large right-sided pleural effusion (fluid around the lung) and pleural plaques. During medical thoracoscopy, a camera examination of the chest cavity, 3.6 L of bloody fluid was drained and biopsies were taken. Cytology of the fluid was negative, but the biopsies showed epithelioid malignant mesothelioma. After pleurodesis he declined further intervention. The authors judged the very severe pleural involvement probably due to his excessive exposure. They concluded that medical thoracoscopy is the procedure of choice in malignant cases.

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 (single patient)
• Who was studied: One 86-year-old white man, a nonsmoker, who presented to an emergency department with anorexia, fatigue, cough and rapidly progressive dyspnea
• Exposure: Construction work with his eldest brother in his 20s and 30s and US Navy service in World War II. Both brothers had significant recurrent exposure to loose asbestos in buckets and cut asbestos tiles with a band saw. No fiber type was specified.
• Main results:
  • Family history: a brother with dementia died in his 70s from mesothelioma
  • CT of the thorax showed a large right pleural effusion with compressive atelectasis, and pleural plaques
  • At pleuroscopy, 3.6 L of bloody pleural fluid was aspirated from the right pleural cavity
  • The parietal pleura showed countless areas of deeply erythematous irritation, multiple areas of hemorrhage and white nodules. The visceral pleura had 2 areas of pearly white nodularity.
  • Cytology of the thoracentesis fluid was negative. The more than 3 L of fluid sent from pleuroscopy was also negative.
  • Pleural biopsies were classified as malignant mesothelioma, epithelioid type, with tumor cells strongly positive for calretinin
  • The right lung took just over 24 hours to reexpand after the procedure
  • After successful pleurodesis, the patient declined any further intervention
  • The authors attributed the very severe pleural involvement, with significant thickening and hemorrhage, probably to the excessive exposure
• The authors' conclusion: The authors concluded that medical thoracoscopy is the procedure of choice in malignant cases, because it can provide a diagnosis and help decide on treatment. They encouraged its use in patients who need pleural biopsies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Pleural Effusion, Asbestos Exposure, Medical Thoracoscopy.

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