Modern Malignant Mesothelioma Manifestation

Our plain-English summary of Modern Malignant Mesothelioma Manifestation, by A.N. Razzak, A. Syed, E.R. Procknow, et al (Curēus, 2023).

The study

• Authors: A.N. Razzak, A. Syed, E.R. Procknow, A. Bequest, P. Jha
• Journal: Curēus
• Published: 2023;15(3):e36479
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) involves the uncontrolled growth of mesothelial cells that form the lining of pleural serous layers. MPM has been linked with asbestos exposure in mining and manufacturing occupations with an unforgiving prognosis of 4-18 months. In this case report, we present a 56-year-old male with a significant past medical history of hypertension, hyperlipidemia, hepatic steatosis, and ulcerative colitis who presented to the emergency department for worsening cough, eight-pound weight loss over the previous year, night sweats, and fatigue. The patient was admitted due to right pleural effusion with lower lobe collapse seen on imaging; upon diagnostic workup including pleural biopsy, results were consistent with malignant mesothelioma of the epithelioid type. Over the course of six months post-diagnosis, the patient underwent multiple hospital admissions due to acute hypoxic respiratory failure from the segmental left upper lobe and subsegmental right upper lobe pulmonary emboli, recurrent pleural effusion, and anemia. Given the aggressive nature of MPM, the patient was determined not to be a surgical candidate and underwent palliative chemotherapy sessions until his passing. As the patient worked in heating/ventilation/air conditioning with asbestos exposure, taking a full occupational history was crucial. MPM is relatively rare; however, the incidence has increased over the last decade due to tumor development lag time post-asbestos exposure and an increase in do-it-yourself projects. There is no cure for MPM. Multimodal treatment approaches with surgery, chemotherapy, radiotherapy, and immunotherapy have been noted in the literature.

Copyright © 2023, Razzak et al.

In plain English

This case report described one patient, a 56-year-old man whose medical history included hypertension and ulcerative colitis. He first went to an emergency department with tongue swelling and a minor cough, which were attributed to his blood-pressure drug. Ten days later he returned with a worsening cough, an 8-pound weight loss over the prior year, night sweats and fatigue. A CT scan showed thickening of the right pleura (the lung lining) and fluid around the right lung. An early workup favored a reactive, non-cancerous change. A right pleural biopsy was later reported as consistent with malignant mesothelioma of the epithelioid type. He reported past work in heating, ventilation and air conditioning (HVAC) and maintenance at old construction sites with asbestos exposure. The article does not name a fiber type. He developed blood clots in his lungs and was judged not a surgical candidate. He had five palliative chemotherapy sessions, deteriorated over six months, and died at home in hospice care. The authors concluded that the case highlighted the importance of taking an occupational 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 (one patient)
• Who was studied: One 56-year-old man with a history of anxiety, gastrointestinal reflux disease, hypertension, hyperlipidemia, hepatic steatosis and ulcerative colitis. The authors are affiliated with the Medical College of Wisconsin, USA. The dates of care are not given.
• Exposure: Asbestos exposure, which the patient reported from past work in HVAC and maintenance at old construction sites. Fiber type, duration and amount of exposure are not reported. He also had a smoking history of one pack-year and 20 years of secondhand smoke.
• Main results:
  • At his first emergency visit, his tongue swelling and cough were diagnosed as a reaction to his ACE-inhibitor blood-pressure drug (lisinopril).
  • At his second visit, 10 days later, he reported an 8-pound weight loss over the prior year, night sweats, right upper quadrant pain with deep breathing, and fatigue.
  • A CT scan of his chest showed diffuse nodular thickening of the right pleura and fluid around the right lung, with collapse of the lower lobe.
  • The first inpatient workup was read as atypical mesothelial proliferation favoring reactive mesothelial hyperplasia.
  • A right pleural biopsy/cryobiopsy was consistent with malignant mesothelioma of the epithelioid type.
  • He was readmitted with acute respiratory failure from blood clots in both lungs, recurrent pleural fluid and anemia, which the authors considered likely due to the cancer.
  • The tumor board judged him not a candidate for surgery, and palliative chemotherapy was pursued.
  • He completed five palliative chemotherapy sessions with carboplatin, pemetrexed and bevacizumab.
  • He was not given ipilimumab/nivolumab immunotherapy because of concern about a flare linked to his ongoing ulcerative colitis treatment.
  • His condition deteriorated over six months, and he died at home while enrolled in hospice care.
  • The authors wrote that, although he had a one pack-year smoking history, the literature suggests his occupational history was the primary cause of his mesothelioma.
• The authors' conclusion: The authors concluded that the case highlighted the importance of taking an occupational history. In their view, knowing about his prior asbestos exposure as an HVAC worker may have led to earlier diagnosis and treatment planning. They also called for complete rather than focused history-taking at first presentation.

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleural Mesothelioma, Mesothelial Cells, Asbestos Exposure, Prognosis, Pleural Effusion, Pleural Biopsy, Epithelioid.

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