Peripheral lymphadenopathy as the initial manifestation of malignant mesothelioma in a child

Our plain-English summary of Peripheral lymphadenopathy as the initial manifestation of malignant mesothelioma in a child, by Y.S. Gong, Y.T. Rong, W.C. Han, et al (Human Pathology, 2013).

The study

• Authors: Y.S. Gong, Y.T. Rong, W.C. Han, Y.C. Zhang
• Journal: Human Pathology
• Published: 2013;44(4):664-9
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peripheral lymphadenopathy is a rare presentation in malignant mesothelioma. We describe a unique case of malignant mesothelioma arising in an 11-year-old boy, for whom peripheral lymphadenopathy was the initial manifestation of the disease. The final diagnosis was confirmed by a broad panel of immunohistochemical markers. Literature review disclosed only 2 cases in childhood that initially presented with peripheral lymphadenopathy. Pathologists should be aware of this rare biologic behavior of malignant mesothelioma to reach the correct and prompt diagnosis.

Copyright © 2013 Elsevier Inc. All rights reserved.

In plain English

This case report described an 11-year-old boy whose malignant mesothelioma first appeared as swollen lymph nodes in the neck. The boy first sought care in November 2010 with a mass on the right side of his neck. Imaging was first read as reactive lymph node enlargement. Lymph node samples were later read as metastatic adenocarcinoma, poorly differentiated metastatic carcinoma and possible Rosai-Dorfman disease before a Shanghai cancer center diagnosed metastatic mesothelioma. The diagnostic process lasted more than 6 months. Earlier CT scans showed a small thickening in the left peritoneum, which the authors considered the primary site. The tumor cells tested positive for 8 mesothelioma markers and negative for 16 markers of other diseases. In May 2011 the boy's condition improved after antibiotics and chemotherapy, and no later outcome was reported. The authors found only 2 earlier childhood cases that began this way. They concluded that mesothelioma may first appear as swollen lymph nodes even in children. The article did not mention asbestos or any other exposure.

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), with a brief review of previously published cases
• Who was studied: one 11-year-old boy, first seen in November 2010; authors based at Xuzhou Medical College, Xuzhou, China
• Main results:
  • Imaging of the boy's neck masses was initially interpreted as reactive enlargement of the lymph nodes
  • A right axillary lymph node was removed in February 2011; a later neck lymph node biopsy (March 2011) was diagnosed as poorly differentiated metastatic carcinoma
  • On consultation in Shanghai, Rosai-Dorfman disease was considered, and then a diagnosis of metastatic malignant mesothelioma was made
  • Review of earlier CT scans found a localized thickening in the left peritoneum, considered the primary site (primary peritoneal mesothelioma)
  • Diagnosis was confirmed with a panel of 8 positive markers (calretinin, WT1, D2-40, CA-125, CK5/6, pan-keratin, EMA, CK7) and 16 negative markers of other diseases
  • The whole diagnostic process for this boy took more than 6 months
  • In May 2011 the boy had pericardial and bilateral pleural effusion, ascites and systemic lymphadenopathy; his condition improved after antibiotics and chemotherapy (no later follow-up reported)
  • The authors' literature review found only 2 previous childhood cases of mesothelioma that first presented with peripheral lymphadenopathy
• The authors' conclusion: The authors concluded that mesothelioma may first present as lymph node enlargement even in children, and that awareness of this is needed for a correct and prompt diagnosis

Topics

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

Medical terms in this study, explained in our Lexicon: Lymphadenopathy, Malignant Mesothelioma.

Related studies

• Pleural mesothelioma with initial presentation as cervical lymphadenopathy — E.J. Wills (1995)
• The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience — S. Natu, J. Hoffman, et al. (2010)
• The prevalence of enlarged mediastinal lymph nodes in asbestos-exposed individuals: a CT study — C. Sampson, D.M. Hansell (1992)
• An 8-Year-Old Child with Malignant Deciduoid Mesothelioma of the Abdomen: Report of a Case and Review of the Literature — M. Wolff-Bar, T. Dujovny, et al. (2015)
• Malignant biphasic peritoneal mesothelioma in a child: fine-needle aspiration cytology, histopathology, and immunohistochemical features along with review of literature — S.K. Arora, R. Srinivasan, et al. (2012)
• Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis — M. Alyami, J. Gagniere, et al. (2017)

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