Multiple distant metastases in a case of malignant pleural mesothelioma

Our plain-English summary of Multiple distant metastases in a case of malignant pleural mesothelioma, by K.C. Tertemiz, A. Ozgen Alpaydin, D. Gurel, et al (Respiratory Medicine Case Reports, 2014).

The study

• Authors: K.C. Tertemiz, A. Ozgen Alpaydin, D. Gurel, R. Savas, A. Gulcu, A. Akkoclu
• Journal: Respiratory Medicine Case Reports
• Published: 2014;13:16-8
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is a malignant of mesodermal neoplasm and arises from multipotential mesothelial or subserosal cells of the pleura, pericardium and peritoneum.

Case: A seventy five year-old male patient was admitted with chest and lower limb pain. He was a heavy smoker and exposed to environmental asbestos in his childhood. PET-CT scans showed multiple pathological FDG uptakes in lungs and other organs. Biopsies performed from lung and anterior thigh muscles were reported as epitheloid type malignant pleural mesothelioma.

Discussion: We emphasize that unexpected distant metastases can be observed in MPM and occasionally primary diagnosis can be determined by the biopsy of the metastatic regions. This case also points out the role of PET-CT in the staging of malign mesothelioma by determining different metastatic sites.

In plain English

This case report, from a university medical faculty in Izmir, Turkey, described one patient: a 75-year-old man admitted to a pulmonary diseases clinic with chest and lower limb pain. He was a heavy smoker and had been exposed to environmental asbestos in his childhood. The article does not name a fiber type. His thigh muscles were thick, hard and painful, and he had a few nodules on his scalp. A chest CT scan showed a 5 cm pleural mass on the left side. A PET-CT scan showed abnormal uptake of the tracer FDG at many sites, including lymph nodes, the pericardium, the wall between the heart's chambers, the liver, the scalp, and muscles of the neck, back, abdomen, buttocks and thighs. Biopsies of the left lung mass and of the front thigh muscles both showed epitheloid type malignant pleural mesothelioma. Among the distant sites, only the muscle spread was confirmed by biopsy. The patient was alive 14 months after diagnosis while receiving cisplatin and pemetrexed. The authors concluded that unexpected distant metastases can occur in this cancer, that diagnosis can occasionally be made by biopsy of a metastasis, and that PET-CT has a role in staging.

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 75-year-old man, a heavy smoker, admitted to the pulmonary diseases clinic of Dokuz Eylul University Medical Faculty, Izmir, Turkey, with chest and lower limb pain
• Exposure: Environmental asbestos exposure in childhood; no fiber type, source or dose is given. He was also a heavy smoker.
• Main results:
  • On examination the thigh muscles were thick, hard and painful to the touch, and there were a few nodules on the scalp that the patient said had appeared 2 months earlier
  • Chest CT showed a 5 cm pleural mass in the left mediastinal and lateral pleural region, left hilar lymphadenopathy of about 2 cm, pleural thickening in the left lung, a 1 cm nodule in the right lung and right pleural calcification
  • PET-CT showed pathological FDG uptake at many sites, including the neck ligament, paraspinal muscles, posterior scalp, lymph nodes, left pleura and diaphragm, anterior pericardium, interventricular septum, liver segment 8, abdominal oblique muscles, and both gluteal and thigh muscles
  • A tru-cut biopsy of the left apical mass was diagnosed as epitheloid type malignant pleural mesothelioma
  • A biopsy of the anterior thigh muscles showed the same pathological pattern as the lung biopsy
  • The mesothelial markers calretinin and cytokeratin 5/6 were strongly positive in the tumor cells
  • FDG uptake was 8.3 in the left lung lesions and 9.4 in the thigh muscles
  • The patient was alive 14 months after diagnosis while receiving cisplatin and pemetrexed
• The authors' conclusion: The authors concluded that unexpected distant metastases can be seen in malignant pleural mesothelioma, that the primary diagnosis can occasionally be made by biopsy of metastatic sites, and that the case points to a role for PET-CT in staging. They also stated that PET-CT should be done for all such patients for staging and for detecting distant spread that causes no symptoms.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Neoplasm, Pleura, Pericardium, Peritoneum, PET-CT, Biopsy, Staging.

Related studies

• Peritoneal malignant mesothelioma with multiple distant skin metastases — N.G. Ordóñez, J.L. Smith (1983)
• Distant visceral metastases in pleural mesothelioma — G.H. Roberts (1976)
• An autopsy case of serous papillary carcinoma of peritoneum with distant metastases but no peritoneal dissemination — O. Miyaishi, K. Iida, et al. (1994)
• Multiple skeletal muscle metastases from malignant pleural mesothelioma — W. Grellner, M. Staak (1995)
• Multiple intracranial metastases from postoperative giant sarcomatoid malignant pleural mesothelioma: A case report and literature review — D. Tian, H. Wen, et al. (2018)
• Jugular vein thrombosis associated with distant malignancy — B.M. Carrington, J.E. Adams (1988)

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