Pleural mesothelioma secondary to radiotherapy: a rare association

Our plain-English summary of Pleural mesothelioma secondary to radiotherapy: a rare association, by T. Lourido-Cebreiro, V. Leiro-Fernández, A. Fernández-Villar (Archivos de Bronconeumología, 2012).

The study

• Authors: T. Lourido-Cebreiro, V. Leiro-Fernández, A. Fernández-Villar
• Journal: Archivos de Bronconeumología
• Published: 2012;48(12):482-3
• Type of article: Case report, Letter
• Language: Spanish
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter to the editor described a case of malignant pleural mesothelioma that the authors attributed to earlier radiotherapy. A 60-year-old woman was referred to an outpatient pleural unit in Vigo, Spain, with a left pleural effusion, 8 weeks of pleuritic left chest pain, dry cough and general deterioration. She had never smoked and worked as a housewife. Neither she nor her family had environmental or occupational exposure to toxic agents, including asbestos, and she did not live near asbestos-related industries. Ten years earlier she had been treated for infiltrating ductal breast carcinoma with mastectomy, chemotherapy and radiotherapy. Pleural fluid was a lymphocytic exudate with negative cytology. An ultrasound-guided Abrams needle biopsy showed no abnormality. PET-CT showed uptake in the left apical pleura (maximum SUV 6.8) and the left basal subpleural area (SUV 3.8). CT-guided fine-needle aspiration of the most active area showed atypical mesothelial proliferation. Video-assisted thoracoscopic pleural biopsy confirmed epithelial-type malignant pleural mesothelioma. In a literature review, the authors identified 6 reported cases of radiation-induced mesothelioma after breast cancer radiotherapy. The interval from radiation to mesothelioma was 10 to 30 years and the mean age at presentation was 55 years. By comparison, asbestos-related mesothelioma usually appears 30 to 40 years after exposure and in older patients. The authors concluded that this diagnosis should be considered in patients with pleural thickening suggestive of tumour and a history of chest radiotherapy. They also concluded that a guideline-based diagnostic protocol was useful.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was a letter to the editor, written in Spanish, describing a single case at a hospital in Vigo, Spain. A 60-year-old woman was referred to an outpatient pleural clinic with fluid around her left lung. She had been treated 10 years earlier for infiltrating ductal breast carcinoma with mastectomy, chemotherapy and radiotherapy. The authors reported that she had never smoked, worked as a housewife, and that neither she nor her family had environmental or occupational toxic exposure, including asbestos. Early tests did not find cancer. Pleural fluid cytology was negative for malignancy, and a needle biopsy of the pleura showed no abnormal tissue. A PET-CT scan showed two areas of increased activity, and a needle sample from one of them showed atypical mesothelial cells. A biopsy taken by video-assisted thoracoscopy confirmed malignant pleural mesothelioma of epithelial type. The authors attributed the tumor to her earlier radiotherapy. They also cited six previously published cases of pleural mesothelioma after breast-cancer radiotherapy. The authors concluded that this possibility should be considered in patients with suspicious pleural thickening and a history of radiotherapy to the chest.

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 (letter to the editor) with a brief review of published cases
• Who was studied: One 60-year-old woman referred for a left pleural effusion to the outpatient pleural unit of the authors' hospital (Complexo Hospitalario Universitario de Vigo, Spain)
• Exposure: Radiotherapy, together with mastectomy and chemotherapy, for infiltrating ductal breast carcinoma 10 years earlier. No reported environmental or occupational exposure, including asbestos, for the patient or her family.
• Main results:
  • The patient had no smoking history, worked as a housewife, and neither she nor her family had environmental or occupational toxic exposure, including asbestos.
  • In the patient, pleural fluid had an ADA of 21 UI/l and cytology was negative for malignancy.
  • In the patient, an Abrams needle pleural biopsy obtained pleural and musculoskeletal tissue without pathological changes.
  • In the patient, PET-CT showed increased uptake in the left apical pleura and the left basal subpleural area, with maximum SUV of 6.8 and 3.8 g/ml respectively.
  • In the patient, a CT-guided fine-needle aspiration of the area of greatest uptake showed atypical mesothelial proliferation.
  • In the patient, the final pathological diagnosis was made by video-assisted thoracoscopic pleural biopsy.
  • The biopsy showed malignant pleural mesothelioma of epithelial type.
  • From their review of published literature, the authors identified 6 described cases of malignant pleural mesothelioma induced by radiotherapy for breast carcinoma.
  • In those 6 published cases, the interval between radiation and mesothelioma ranged from 10 to 30 years, and the mean age at mesothelioma presentation was 55 years.
• The authors' conclusion: The authors concluded that, although pleural mesothelioma associated with radiotherapy for breast carcinoma is rare, it should be considered as a possible diagnosis in patients with pleural thickening suggesting tumor involvement and a history of radiotherapy to the chest.

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, Pleural Effusion, Occupational Exposure, Carcinoma, Chemotherapy, Exudate, Cytology, Ultrasound.

Related studies

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• Pericardial malignant mesothelioma: a latent complication of radiotherapy? — G.R. Small, M. Nicolson, et al. (2008)
• Risk of mesothelioma following external beam radiotherapy for prostate cancer: a cohort analysis of SEER database — A. Farioli, F.S. Violante, et al. (2013)
• Malignant peritoneal mesothelioma following radiotherapy for seminoma of the testis — R.J. Stock, Y.S. Fu, et al. (1979)
• Malignant mesothelioma following thoracic radiotherapy for lung cancer — S.M. Witherby, K.J. Butnor, et al. (2007)
• Bilateral diffuse pulmonary infiltrates secondary to malignant peritoneal mesothelioma - A rare clinical presentation — M. Haygarth, K.K. Zaw, et al. (2019)

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