Mesothelioma With a Large Prevascular Lymph Node: N1 Involvement or Something Different?

Our plain-English summary of Mesothelioma With a Large Prevascular Lymph Node: N1 Involvement or Something Different?, by L. Berzenji, P.E. Van Schil, A. Snoeckx, et al (The Annals of Thoracic Surgery, 2018).

The study

• Authors: L. Berzenji, P.E. Van Schil, A. Snoeckx, M. Hertoghs, L. Carp
• Journal: The Annals of Thoracic Surgery
• Published: 2018;105(5):e189-e191
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

A 64-year-old man presented with a large amount of right-sided pleural fluid on imaging, together with calcified pleural plaques and an enlarged nodular structure in the prevascular mediastinum, presumably an enlarged lymph node. Pleural biopsies were obtained during video-assisted thoracoscopic surgery to exclude malignancy. Histopathology showed an epithelial malignant pleural mesothelioma. Induction chemotherapy with cisplatin and pemetrexed was administered followed by an extended pleurectomy and decortication with systematic nodal dissection. Histopathology confirmed the diagnosis of a ypT3N0M0 (stage IB) mesothelioma, and an unexpected thymoma type B2 (stage II) was discovered in the prevascular nodule. Simultaneous occurrence of a mesothelioma and thymoma is extremely rare.

Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This case report from Antwerp University Hospital in Belgium described a 64-year-old man whose abdominal scan showed a large amount of fluid around the right lung. Imaging also showed small calcified pleural plaques, which a figure caption in the article said indicated asbestos exposure, and a 15-mm nodule in the prevascular (front) part of the chest that was presumed to be an enlarged lymph node. He had worked as a fireman for several years. Biopsies taken during video-assisted thoracoscopic (keyhole) surgery showed epithelioid malignant pleural mesothelioma. He received three cycles of cisplatin and pemetrexed chemotherapy, with a partial response. This was followed by an extended pleurectomy and decortication with removal of lymph nodes. Final staging of the mesothelioma was ypT3N0M0 (stage IB). Unexpectedly, the nodule turned out to be a type B2 thymoma (Masaoka-Koga stage IIA), not a lymph node. He needed further operations for a wound problem. At 16 months he was in good condition with no signs of recurrence. The authors concluded that mesothelioma and thymoma occurring together is extremely rare. They found no similar cases in the English literature.

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 64-year-old man referred to thoracic oncology at Antwerp University Hospital, Edegem, Belgium; dates of care not given
• Exposure: The patient had worked as a fireman for several years. A calcified pleural plaque seen on CT was described in a figure caption as indicating asbestos exposure. No fiber type, product or dose is given.
• Main results:
  • Pleural biopsies taken during video-assisted thoracoscopic surgery showed epithelioid malignant pleural mesothelioma, confirmed by immunohistochemical staining
  • Three cycles of induction chemotherapy with cisplatin and pemetrexed gave a partial response
  • After extended pleurectomy and decortication with systematic nodal dissection, the mesothelioma was staged ypT3N0M0, stage IB
  • The 15-mm prevascular nodule, presumed to be an enlarged lymph node, was a thymoma type B2, staged pT2N0M0, Masaoka-Koga stage IIA, and was completely resected
  • Chronic wound fistulization at the sixth rib required several debridements, partial removal of the rib and a pectoral muscle flap
  • At 16 months of follow-up the patient was in good general clinical condition with no signs of recurrent disease on chest CT
• The authors' conclusion: The authors concluded that coexistence of mesothelioma and thymoma is extremely rare and that they could not find similar cases in the English literature. Because the patient had no myasthenia gravis, thymoma was not considered beforehand and was a surprise finding.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Plaques, Mediastinum, Video-Assisted Thoracoscopic Surgery (VATS), Histopathology, Pleural Mesothelioma, Chemotherapy, Cisplatin.

Related studies

• Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma — E. de Bree, S. van Ruth, et al. (2002)
• Local and systemic exposure of cisplatin during hyperthermic intrathoracic chemotherapy perfusion after pleurectomy and decortication for treatment of pleural malignancies — M. Ried, T. Potzger, et al. (2013)
• A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma — S. Sonoda, Y. Kumagawa, et al. (2010)
• Right diaphragm metastasis of endometrial cancer: a case report — T. Zhang, X. Li, et al. (2020)
• Pleural metastasis of malignant thymoma. A pitfall in the CT-diagnosis of pleural mesothelioma — J. Görich, S.A. Beyer-Enke, et al. (1989)
• 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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