Pleural Mesothelioma: A Rapid Evolution of an Indolent Disease

Our plain-English summary of Pleural Mesothelioma: A Rapid Evolution of an Indolent Disease, by M. Romano, P. Pinto, R. Afonso, et al (Curēus, 2023).

The study

• Authors: M. Romano, P. Pinto, R. Afonso, J. Fontes, M. Ferreira
• Journal: Curēus
• Published: 2023;15(1):e33965
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelioma is a rare and insidious neoplasm and is characterized by its highly malignant and aggressive nature. The most common etiology is asbestos exposure, but there are some reports without known asbestos exposure and other factors leading to malignant pleural mesothelioma (MPM). Here, we present the case of a 58-year-old woman with pleuritic chest pain, dyspnea, and fever on presentation to the emergency department (ED), which caused several admissions to the ED in 20 days. The patient was then admitted to the internal medicine department with a diagnosis of community-acquired pneumonia with parapneumonic effusion. During hospitalization, a positron emission tomography (PET) scan, thoracic computed tomography (CT), and pleural biopsy were performed and a final diagnosis of malignant epithelioid pleural mesothelioma was made. Six weeks after the onset of symptoms, the patient presented with an exponential disease progression, dying two months after the diagnosis, despite the initiation of chemotherapy. MPM remains a diagnostic and therapeutic challenge with a very poor prognosis. However, studies show that mesothelioma patients who undergo treatment live at least twice as long as patients who do not receive treatment. This case report is particularly significant because, although it was epithelioid mesothelioma, multiple solid masses were noted on CT and the patient exhibited rapid disease progression, dying a few weeks after starting treatment.

Copyright © 2023, Romano et al.

In plain English

This article is a case report describing one patient. A 58-year-old woman who had earlier been treated with surgery and chemoradiotherapy for endometrioid adenocarcinoma went to the emergency department in May 2021 with pleuritic chest pain, shortness of breath and fever. The patient was given antibiotics for suspected pneumonia and returned three more times over the next 10 days as symptoms worsened. About a month after the first visit, a larger right-sided pleural effusion led to hospital admission. A PET scan showed extensive malignant involvement of the pleura with no lesions elsewhere. A repeat chest CT showed rapid progression, with multiple solid masses in the pleura. A pleural biopsy confirmed epithelioid mesothelioma. The patient denied any known asbestos exposure, including at work, and the authors reported finding no cause. After two cycles of chemotherapy the disease progressed rapidly, and the patient died two months after diagnosis. The authors noted that the course was unusually severe for an epithelioid tumor. They concluded that the case illustrates diagnostic difficulties common in mesothelioma. A single case does not show how often such a course occurs.

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 58-year-old woman with a history of endometrioid adenocarcinoma, treated by surgery and then chemoradiotherapy in February 2021. She presented to the emergency department in May 2021. The authors are from internal medicine departments in Braga and Viana do Castelo, Portugal.
• Exposure: No known asbestos exposure. The patient denied any known exposure to asbestos, including occupational exposure, and the authors state that no cause (etiologic association) was found.
• Main results:
  • After a first emergency visit, the patient was discharged with antibiotics for suspected right-sided pneumonia. The patient returned to the emergency department three more times in the next 10 days with worsening symptoms.
  • A PET scan during hospitalization showed extensive malignant involvement of the pleura with pleural effusion and no lesions elsewhere.
  • A repeat thoracic CT showed rapid progression, with multiple solid masses in the pleura and right pleural space.
  • The pleural biopsy confirmed epithelioid mesothelioma.
  • The patient received two cycles of chemotherapy in the pulmonology-oncology department.
  • Despite chemotherapy, the disease progressed exponentially and the patient died two months after diagnosis.
• The authors' conclusion: The authors concluded that this case illustrates the diagnostic difficulties that are common in mesothelioma. They also pointed to the unusually severe course of the disease despite epithelioid histology and the absence of the main identified risk factors.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Neoplasm, Etiology, Asbestos Exposure, Pleuritic Chest Pain, Dyspnea, Pleural Biopsy.

Related studies

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• Rapid progression of pleural disease due to exposure to Libby amphibole: "Not your grandfather's asbestos related disease" — B. Black, J. Szeinuk, et al. (2014)
• Development and characterization of a rapid-onset rodent inhalation model of asbestosis for disease prevention — B.T. Mossman, Y.M. Janssen, et al. (1991)
• "Not your grandfather's pleural disease": rapid progression, ventilatory impairment, and chronic pleuritic pain from Libby vermiculite/amphibole — A. Miller (2014)
• Malignant mesothelioma of the tunica vaginalis: a case with an unusually indolent course following radical orchidectomy and radiotherapy — J.L. Harmse, A.T. Evans, et al. (1999)
• Monoclonal antibody HBME-1 reacts with a minor subset of B cells with villous surface and can be useful in the diagnosis of hairy cell leukemia and other indolent lymphoproliferations of villous B lymphocytes — L. Krenács, J. Tóth-Lipták, et al. (2013)

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