Miliary spread of malignant pleural mesothelioma without a clinically identifiable pleural tumour

Our plain-English summary of Miliary spread of malignant pleural mesothelioma without a clinically identifiable pleural tumour, by A.W. Musk, J. Dewar, K.B. Shilkin, et al (Australian and New Zealand Journal of Medicine, 1991).

The study

• Authors: A.W. Musk, J. Dewar, K.B. Shilkin, D. Whitaker
• Journal: Australian and New Zealand Journal of Medicine
• Published: 1991;21(4):460-2
• Type of article: Case report
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 44-year-old man with past minor exposure to blue asbestos presented with supraclavicular lymphadenopathy and miliary shadowing on his chest radiograph. Cytology and electronmicroscopy on material obtained by fine needle aspiration from his cervical lymph node revealed malignant mesothelioma. Malignant mesothelioma cells were also present in bronchoalveolar lavage fluid and on transbronchial lung biopsy. At autopsy the right pleural cavity was studded with small tumour nodules. This case demonstrates that malignant mesothelioma may present as metastatic disease and without evidence on conventional investigations of a primary pleural tumour.

In plain English

This case report describes one man, aged 44, who noticed a hard lump above his right collarbone (a swollen lymph node) and had almost no other symptoms. At age 23, during three weeks of work on a jetty, he spent about 16 hours loading crocidolite (blue asbestos) onto a ship, about 12 hours of it in the ship's hold. He had also smoked and worked in mining and quarrying. His chest X-ray showed small rounded spots, 2-3 mm across, throughout both lungs, with no sign of pleural disease. Needle samples from the lymph node, lung washings and a lung biopsy showed malignant mesothelioma. Ten weeks later he returned with breathlessness and headaches, was in respiratory failure, and died ten days after that despite oxygen and chemotherapy. At autopsy, small tumour nodules of 1-8 mm covered the lining of the right chest cavity. A small kidney tumour was judged to be a separate cancer. A CT scan had not been done at presentation. The authors concluded that malignant mesothelioma may present as metastatic disease, without a primary pleural tumour being found by conventional investigations.

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 44-year-old man who presented with a lump in his right supraclavicular region, reported by authors at Sir Charles Gairdner Hospital, Nedlands, Western Australia
• Exposure: At age 23, during three weeks of work on a jetty, about 16 hours loading crocidolite (blue asbestos) onto a ship, including about 12 hours in the ship's hold. He reported no other asbestos exposure. He had worked most of his life in gold and iron-ore mining and limestone quarrying, and had smoked about 30 cigarettes a day from age 28 to 37.
• Main results:
  • At presentation, the chest radiograph showed small rounded opacities 2-3 mm in diameter throughout both lung fields, with no evidence of pleural disease.
  • Cytology and electron microscopy of material from fine needle aspiration of his cervical lymph node showed malignant mesothelioma.
  • Bronchoalveolar lavage (lung washing) contained a few clusters of malignant cells indicative of metastatic mesothelioma.
  • The transbronchial lung biopsy stained negative for CEA and positive for EMA. These findings were considered to confirm the diagnosis of malignant mesothelioma.
  • Having been discharged without symptoms, the patient returned ten weeks later with increasing breathlessness and headaches and was found to be in respiratory failure.
  • Despite continuous oxygen and chemotherapy with VP16, his gas exchange worsened and he died in respiratory failure ten days later.
  • At autopsy, the right pleural cavity was studded with multiple small tumour nodules measuring 1-8 mm, on both the parietal aspect and the surface of the right lung. The left pleural cavity was uninvolved.
  • At autopsy, tumour was found in the para-aortic, right hilar and supraclavicular lymph nodes.
  • A small (2.5 cm) right kidney tumour was found at autopsy. An independent pathology panel of the National Mesothelioma Surveillance Program confirmed that the lung lesion was malignant mesothelioma and that the kidney lesion was a separate carcinoma.
• The authors' conclusion: The authors concluded that the case demonstrates that malignant mesothelioma may present as metastatic disease, without evidence of a primary pleural tumour on conventional investigations. In this case the primary pleural tumour was not recognised until autopsy.
• Limitations the authors state:
  • Computerised tomography (CT) was not performed at presentation; only plain radiographs showed no pleural tumour.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Crocidolite, Lymphadenopathy, Chest X-Ray, Cytology, Malignant Mesothelioma, Bronchoalveolar Lavage (BAL), Biopsy.

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