Minute localized malignant pleural mesothelioma coexisting with multiple adenocarcinomas

Our plain-English summary of Minute localized malignant pleural mesothelioma coexisting with multiple adenocarcinomas, by R. Maeda, N. Isowa, H. Onuma, et al (General Thoracic and Cardiovascular Surgery, 2010).

The study

• Authors: R. Maeda, N. Isowa, H. Onuma, H. Miura, H. Tokuyasu, Y. Kawasaki
• Journal: General Thoracic and Cardiovascular Surgery
• Published: 2010;58(2):91-4
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report an extremely rare case of minute localized malignant pleural mesothelioma (LMPM) coexisting with multiple lung adenocarcinomas in a 64-year-old woman without a history of smoking or asbestos exposure. A computed tomography scan of the chest displayed total five ground-glass opacities in the lung. Transbronchial lung biopsy from a ground-glass opacity in the posterior segment revealed a bronchioloalveolar carcinoma. With a diagnosis of primary lung cancer, right upper lobectomy and wedge resection of the right lower lobe with systematic lymph node dissection was performed using video-assisted thoracoscopic surgery. Incidentally, a minute gray-white nodule measuring 6 mm was detected on the visceral pleural surface of the right upper lobe. The postoperative histological diagnosis was minute LMPM coexisting with multiple adenocarcinomas.

In plain English

This case report from Matsue Red Cross Hospital in Japan described one patient: a 64-year-old woman with no symptoms and no history of smoking or asbestos exposure. A routine chest X-ray showed a shadow. A CT scan then showed five small hazy spots, called ground-glass opacities, three in the right upper lobe and two in the right lower lobe. A biopsy of one spot showed bronchioloalveolar carcinoma, a type of lung cancer. During keyhole surgery to remove the right upper lobe and part of the lower lobe, the surgeons unexpectedly found a 6 mm gray-white nodule on the lung's outer lining. They saw no pleural fluid and no pleural plaques. Under the microscope, the five spots were adenocarcinomas, and no lymph nodes were involved. The nodule was diagnosed as a minute localized malignant pleural mesothelioma of the epithelial type. The authors noted it was hard to tell apart from reactive mesothelial hyperplasia, a non-cancerous overgrowth of lining cells. The patient had no recurrence after 8 months. The authors concluded that localized mesothelioma should be distinguished from the diffuse form.

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 asymptomatic 64-year-old woman, treated at Matsue Red Cross Hospital, Shimane, Japan, whose abnormal chest shadow was found at a regular checkup
• Exposure: The patient had no history of smoking or asbestos exposure.
• Main results:
  • The CT scan showed five ground-glass opacities: three in the right upper lobe and two in the right lower lobe.
  • A biopsy of the lesion in the posterior segment showed bronchioloalveolar carcinoma.
  • During surgery, a 6 mm gray-white nodule was found by chance on the visceral pleural surface of the right upper lobe.
  • Neither pleural effusion nor pleural plaques were seen in the right chest.
  • No lymph node metastasis was found from the adenocarcinomas.
  • Tumor cells in the nodule had spread into the lung tissue beyond the internal pleural elastic lamina.
  • Staining of the nodule was positive for calretinin, D2-40, thrombomodulin and WT1, indicating mesothelial origin. It was also positive for EMA and p53 and negative for desmin.
  • The final diagnosis of the nodule was minute localized malignant pleural mesothelioma of the epithelial type.
  • The patient left hospital on day 9 after surgery and had no recurrence after 8 months of follow-up.
• The authors' conclusion: The authors concluded that localized malignant pleural mesothelioma should be distinguished from diffuse malignant pleural mesothelioma because of its localized presentation, different biological behavior and far better prognosis. They also concluded that immunohistochemical stains can help tell minute localized mesothelioma apart from benign reactive mesothelial hyperplasia.
• Limitations the authors state:
  • Follow-up was short. The authors stated that longer follow-up is needed because it is unknown how the tumor will behave in this patient.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Adenocarcinoma, Lung Adenocarcinoma, Asbestos Exposure, Biopsy, Ground-Glass Opacity, Carcinoma, Lung Cancer.

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• Comparative genetic analysis of a rare synchronous collision tumor composed of malignant pleural mesothelioma and primary pulmonary adenocarcinoma — T. Naka, Y. Hatanaka, et al. (2016)
• Localized malignant lymphohistiocytoid pleural mesothelioma — A. Ouazzani, B. Rondelet, et al. (2011)
• Coalescent pleural malignant mesothelioma and adenocarcinoma of the lung, involving only minor asbestos exposure — T. Tsuzuki, H. Ninomiya, et al. (2008)
• Benign localized fibrous tumor of the pleura: report of 25 new cases — S. Enon, D. Kilic, et al. (2012)

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