Pleural mesothelioma in a young male patient

Our plain-English summary of Pleural mesothelioma in a young male patient, by A. Voulgaridis, V. Apollonatou, D. Lykouras, et al (Monaldi Archives for Chest Disease = Archivio Monaldi Per le Malattie del Torace, 2013).

The study

• Authors: A. Voulgaridis, V. Apollonatou, D. Lykouras, A. Giannopoulos, M. Iliopoulou, K. Karkoulias, P. Kraniotis, C. Prokakis, M. Gkermpesi, K. Spiropoulos
• Journal: Monaldi Archives for Chest Disease = Archivio Monaldi Per le Malattie del Torace
• Published: 2013;79(2):96-9
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We present the case of a 33-year-old male patient suffering from lymphocytic pleural effusion, as a result of pleural mesothelioma. Mesothelioma is a malignant tumor of the pleura that is mainly caused by chronic exposure to asbestos fibers and more than 40 years of exposure are needed to develop the disease. Early studies on the relationship of asbestos and mesothelioma were issued in the 1960s. Fibers migrate from the parenchyma of the lung to the visceral pleura. It is widely known that asbestos is an oncogenic factor which can cause damage to DNA. A chest x-ray may reveal pleural effusion with or without pleural thickening, whereas a chest CT may also reveal pleural thickening, uniform and/or lobular. Specific tests, such as immunohistochemical staining, are used in order to help differential diagnosis. Extrapleural pneumonectomy is used as a therapeutic option which involves removal of the lung as well as both the visceral and parietal pleura, the affected part of the pericardium and diaphragm. Surgery should be followed up by radiotherapy and chemotherapy. The surgery may lead to a mean survival rate of approximately 9-21 months. The case presented underlines that in the event of pleural effusion with a lymphocyte type physicians should consider the possibility of a pleural mesothelioma during differential diagnosis, even in relatively young patients.

In plain English

This article is a case report from the University Hospital of Patras, Greece, about a single patient. A 33-year-old male farmer who smoked (10 pack years) was admitted with fever and fluid on one side of the chest (a unilateral pleural effusion). Fluid drawn from the chest was a lymphocytic exudate that included 13% atypical cells. A tuberculin skin test and bacterial stains were negative, and bronchoscopy showed no airway lesions. In open surgery, doctors found extensive masses on the parietal pleura, and biopsies showed epithelioid mesothelioma. A PET-CT scan showed the disease had invaded the left side of the diaphragm and nearby tissues of the peritoneum. The CT showed no calcified pleural plaques. The patient started chemotherapy with cisplatin and pemetrexed without major side effects. The article reports no later outcome. Questioning after diagnosis showed the patient had lived for more than 20 years in a warehouse with an asbestos-covered roof. The fiber type was not stated. The authors noted that this age is quite uncommon for pleural mesothelioma. They concluded that doctors should consider pleural mesothelioma when a lymphocytic pleural effusion is found, even in relatively young patients. The article's figures on latency and survival come from its discussion of other studies, not from this patient.

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 (one patient)
• Who was studied: One 33-year-old male farmer and smoker (10 pack years) with no past medical history, admitted to the University Hospital of Patras, Greece
• Exposure: Domestic exposure: the patient had lived for more than 20 years in a warehouse with an asbestos-covered roof. No fiber type or dose is given.
• Main results:
  • Thoracentesis in this patient produced a lymphocytic exudative pleural effusion of 3500 cells/mm3: lymphocytes 47%, neutrophils 3%, eosinophils 5%, atypical cells 13%, mesothelial cells 32%
  • The tuberculin skin test was 0 mm. Stains of the pleural fluid showed no bacteria.
  • Biopsies of the parietal pleural masses taken during open surgery showed epithelioid mesothelioma
  • PET-CT showed the lesions had invaded the left side of the diaphragm and nearby tissues of the left dorsolateral peritoneum
  • The patient's CT showed no calcified pleural plaques
  • The patient began chemotherapy with cisplatin and pemetrexed without major side effects. No later outcome is reported.
• The authors' conclusion: The authors noted that age 33 is quite uncommon for pleural mesothelioma. They concluded that clinicians should consider pleural mesothelioma when a lymphocytic pleural effusion is found, even in relatively young patients.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Effusion, Mesothelioma, Pleura, Parenchyma, Visceral Pleura, Chest X-Ray, Pleural Thickening.

Related studies

• A Rare Case of Malignant Pleural Mesothelioma in a Young Healthy Male Without Asbestos Exposure — S. Khatib, O. Asad, et al. (2021)
• Peritoneal Malignant Mesothelioma Metastasizing to Lymph Node in Young Male-a Case Report — A. Singh, C. Bansal, et al. (2024)
• Extrapleural pneumonectomy for primary pleural mullerian tumor in a young woman — A.S. Farivar, B.E. Louie, et al. (2012)
• A young woman with apparent increase in the transverse cardiac diameter — W.K. Lam, S.Y. So, et al. (1986)
• A Case of Diffuse Intrapulmonary Malignant Mesothelioma — M. Kumazawa, H. Arakawa, et al. (2019)
• Pleural plaques: only an imagiologic finding? — P. Almeida, A. Araújo (2019)

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