Paraneoplastic phenomenon in mesothelioma

Our plain-English summary of Paraneoplastic phenomenon in mesothelioma, by A.B. Waqar, D. Menzies, M. Casey, et al (Thorax, 2019).

The study

• Authors: A.B. Waqar, D. Menzies, M. Casey, M. Doran
• Journal: Thorax
• Published: 2019;74(7):719-720
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 71-year-old man presented with breathlessness and visual disturbance. On examination of the chest, he had signs suggestive of a right-sided pleural effusion and a neurological examination yielded conjugate vertical gaze palsy. Subsequent investigations revealed pleural thickening and mesothelioma. His anti-Ma2 antibodies were positive indicating a paraneoplastic syndrome as the cause of the vertical gaze palsy.

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This article was a case report, written as a discussion among four clinicians at hospitals in Bodelwyddan and Rhyl, UK. It described a 71-year-old man referred to a respiratory clinic with one month of worsening breathlessness and a change in his vision. He was a retired building surveyor who reported incidental exposure to asbestos. The article did not name a fiber type. Scans showed a left-sided pleural effusion with irregular pleural thickening, and 1.1 litres of fluid were drained. Pleural biopsies confirmed epithelioid type malignant mesothelioma. His eye examination showed a palsy limiting voluntary upward and downward eye movement. A neurologist found no other abnormal neurological sign. His anti-Ma2 antibodies were positive. The authors stated that he met the agreed definition of a definite paraneoplastic syndrome, an immune-mediated condition they described as only rarely reported in people with mesothelioma. They wrote that a trial of plasma exchange should be considered, but the article did not report any treatment outcome. As a case report, it describes one patient and gives no rates.

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, presented as a case-based discussion among clinicians
• Who was studied: one 71-year-old man referred to a respiratory clinic (authors based at hospitals in Bodelwyddan and Rhyl, UK); dates of care not given
• Exposure: incidental asbestos exposure reported by the patient, a retired building surveyor; no fiber type, products or dose given (he also had a 50 pack-year smoking history)
• Main results:
  • In this patient, CT showed irregular soft-tissue pleural thickening and a pleural effusion on the left side
  • In this patient, 1.1 L of fluid was drained, and the fluid tests showed an exudative effusion
  • In this patient, pleural biopsies taken at thoracoscopy confirmed epithelioid type malignant mesothelioma
  • In this patient, eye examination showed a conjugate gaze palsy affecting voluntary upward and downward eye movement
  • In this patient, the neurologist found severe restriction of vertical gaze as the only abnormal neurological sign
  • This patient had positive anti-Ma2 antibodies. With a confirmed cancer and a non-classical neurological syndrome, the authors judged that he met the agreed definition of a definite paraneoplastic syndrome
• The authors' conclusion: The authors noted that paraneoplastic syndromes are only rarely reported with mesothelioma. They suggested that a trial of plasma exchange should be considered for this patient. No outcome was reported.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Effusion, Pleural Thickening.

Related studies

• Anti-Yo antibody-mediated paraneoplastic cerebellar degeneration in a female patient with pleural malignant mesothelioma — O. Tanriverdi, N. Meydan, et al. (2013)
• The fake fat phenomenon in organizing pleuritis: a source of confusion with desmoplastic malignant mesotheliomas — A. Churg, P. Cagle, et al. (2011)
• Pifithrin-μ induces necroptosis through oxidative mitochondrial damage but accompanies epithelial-mesenchymal transition-like phenomenon in malignant mesothelioma cells under lactic acidosis — Y.J. Lee, K.S. Park, et al. (2019)
• Mesothelioma and anti-Ma paraneoplastic syndrome; heterogeneity in immunogenic tumours increases — H.A. Archer, A. Panopoulou, et al. (2014)
• Ban asbestos phenomenon: the winds of change — L. Kazan-Allen (2011)
• The American compensation phenomenon — A. Bale (1990)

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