Pleural mesothelioma: an unusual case diagnosed on pleural fluid cytology and immunocytochemistry

Our plain-English summary of Pleural mesothelioma: an unusual case diagnosed on pleural fluid cytology and immunocytochemistry, by V.K. Arora, S. Aggarwal, S. Mathur, et al (Diagnostic Cytopathology, 2009).

The study

• Authors: V.K. Arora, S. Aggarwal, S. Mathur, G.K. Rath, P.K. Julka
• Journal: Diagnostic Cytopathology
• Published: 2009;37(7):509-12
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesothelioma is a rare neoplasm with relationship to occupational and environmental exposure to asbestos. Its accurate and early diagnosis is often difficult. We present an unusual clinical presentation and diagnostic dilemma in a 30-year-male, who presented with neck pain and diffuse edema of left upper limb. The color Doppler ultrasound revealed venous thrombosis. The right supraclavicular lymph node biopsy revealed a poorly differentiated carcinoma. The patient had mild bilateral pleural effusion, the characteristic cytomorphological features of mesothelioma on fluid cytology were helpful in establishing the diagnosis.

2009 Wiley-Liss, Inc.

In plain English

This was a case report, by doctors in Delhi, India, describing one patient. In September 2006 a 30-year-old man had sudden pain and swelling in the left side of his neck. Scans showed clots in veins of the neck, shoulder and armpit, swollen lymph nodes, and small fluid collections around both lungs. The clots cleared with blood thinners, but he returned in February 2007, and a lymph node biopsy showed a poorly differentiated carcinoma. Cells in the fluid around the lungs looked like mesothelioma. Stains were positive for calretinin and negative for Ber-EP4, which supported a diagnosis of pleural mesothelioma that had spread to a lymph node. After chemotherapy, a PET scan in January 2008 showed no uptake. The patient was a nonsmoker who worked as a management system auditor. His father did road manufacturing work for 5 years when the patient was 14. The authors suggested that asbestos exposure at a young age and a family history of cancer may have contributed. The article did not describe any specific asbestos exposure or fiber type. The authors concluded that fluid cytology can help in suspecting mesothelioma even when the presentation is unusual.

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 30-year-old man, first seen in September 2006; the authors were at hospitals in Delhi, India
• Exposure: No asbestos exposure is documented for this patient. He was a management system auditor. His father did road manufacturing work for 5 years when the patient was 14. The article does not say this work involved asbestos and names no fiber type. The authors speculated about bystander (indirect) exposure through family members.
• Main results:
  • The patient first presented with blood clots in neck and arm veins, seen on color Doppler ultrasound
  • When symptoms recurred in February 2007, a right supraclavicular lymph node biopsy showed a poorly differentiated carcinoma
  • Cell features in the pleural fluid were suggestive of mesothelioma
  • Tumor cells in the fluid stained positive for calretinin and negative for Ber-EP4; the lymph node biopsy gave a similar result
  • Diagnosis was pleural mesothelioma with spread to the right supraclavicular lymph node
  • Tests for clotting disorders were normal or negative, including Factor V Leiden mutation analysis
  • After chemotherapy, a PET scan in January 2008 showed no uptake
• The authors' conclusion: The authors concluded that characteristic cell features on fluid cytology, even with an unusual clinical presentation, may help in suspecting malignant mesothelioma, which can then be confirmed with additional techniques. They also suggested that asbestos exposure at a young age and a family history suggesting genetic factors may have contributed to the early onset in this case.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Fluid Cytology, Mesothelioma, Neoplasm, Environmental Exposure, Doppler Ultrasound, Biopsy, Carcinoma.

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