Mesothelioma with non-pleural malignancy: a red herring or just an uncommon pairing?

Our plain-English summary of Mesothelioma with non-pleural malignancy: a red herring or just an uncommon pairing?, by A.J. Drain, K. Saeb-Parsy, A.K. Shah, et al (Journal of Cardiothoracic Surgery, 2006).

The study

• Authors: A.J. Drain, K. Saeb-Parsy, A.K. Shah, D. Rassl, A.J. Ritchie
• Journal: Journal of Cardiothoracic Surgery
• Published: 2006;1:39
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a highly aggressive cancer of the pleura with a well-established male predominance and causative link with asbestos exposure. We report four cases of female patients with MPM referred for palliation of symptoms thought to be due to previous non-pleural malignancy.With emerging novel treatments for MPM, this article discusses four unusual cases of MPM occurring in the setting of other malignancy, highlights the importance of considering a primary diagnosis of MPM even in patients with other malignancy, and reinforces the benefits of video-assisted surgical biopsy which allows simultaneous diagnosis and treatment.

In plain English

This case report described four women at Papworth Hospital in Cambridge, UK, found to have malignant pleural mesothelioma (MPM) after earlier, different cancers. Each was referred for surgery for a right-sided pleural effusion (persistent in three; the fourth also had a persistent pneumothorax), assumed to come from her earlier cancer. In all four, pleural fluid tests showed malignancy but not MPM. The women, aged 39 to 78, had previously had breast adenocarcinoma (two women), endometrial carcinoma (one) or Hodgkin's lymphoma involving the right lung (one), 10 to 38 years earlier. Video-assisted thoracoscopic surgery (VATS) found MPM in all four, described as the epithelioid type in three. Asbestos exposure was not confirmed in three women; the fourth had no history of significant exposure. The authors reported a delay of 2 to 8 months between presentation and referral. They stated that three of the four had received significant radiotherapy, and suggested that asbestos and radiotherapy may be synergistic. The authors concluded that MPM should be actively considered in all patients presenting with a pleural effusion after a previous cancer, regardless of asbestos history.

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 (series of four cases)
• Who was studied: Four women, aged 39 to 78, referred to Papworth Hospital, Cambridge, UK, for treatment of pleural effusion (one also for persistent pneumothorax). Their earlier cancers were breast adenocarcinoma (two), endometrial carcinoma (one) and Hodgkin's lymphoma involving the right lung (one). Dates of treatment are not given.
• Exposure: Asbestos exposure was not confirmed in three women, and the fourth (case 3) had no history of significant exposure to asbestos. Earlier cancer treatments included mastectomy, post-operative radiotherapy, hysterectomy, anastrazole and docetaxel, and mantle radiotherapy.
• Main results:
  • In all four women the pleural fluid showed malignancy but not MPM.
  • Case 1: a 59-year-old woman with a history of right-sided breast adenocarcinoma developed a right-sided pleural effusion 10 years later. At VATS cytoreductive pleurectomy the tumour was confirmed as epithelioid MPM.
  • Case 2: a 78-year-old woman with a history of breast adenocarcinoma, treated with mastectomy and post-operative radiotherapy, presented 38 years later. Pleural fluid cells were read as consistent with breast origin, but surgery found epithelioid MPM.
  • Case 3: a 74-year-old woman with a history of endometrial carcinoma presented 20 years later. Tumour infiltrated the pleura, diaphragm and pericardium, and was confirmed as MPM.
  • Case 4: a 39-year-old woman had been treated with mantle radiotherapy 14 years earlier for Hodgkin's lymphoma involving the right lung. She was referred for a persistent right-sided pneumothorax and a right-sided pleural effusion. Epithelioid MPM was confirmed, and there was no evidence of lymphoma in the lung.
  • The delay between presentation and referral was between 2 and 8 months in this series.
  • The authors stated that three of the four women received significant doses of radiotherapy for their original tumours.
  • The authors suggested, citing this and other reports, that combined exposure to asbestos and radiotherapy may be synergistic.
• The authors' conclusion: The authors concluded that MPM should be actively considered in all patients presenting with an effusion who have had a previous cancer (in their words, 'effusion relating to previous malignancies'), regardless of asbestos history. They also concluded that early, accurate diagnosis is best achieved by guided CT or VATS biopsy.

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, Pleura, Asbestos Exposure, Biopsy.

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