Pleural mesothelioma with initial presentation as cervical lymphadenopathy

Our plain-English summary of Pleural mesothelioma with initial presentation as cervical lymphadenopathy, by E.J. Wills (Ultrastructural Pathology, 1995).

The study

• Author: E.J. Wills
• Journal: Ultrastructural Pathology
• Published: 1995;19(5):389-94
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 41-year-old woman presented with a left neck mass. Light microscopy suggested metastatic large cell carcinoma, but subsequent electron microscopy demonstrated typical epithelial mesothelioma. Initial clinical investigations were negative and the primary pleural tumor remained inapparent for a further 8 months. The woman ultimately died from the effects of superior vena caval obstruction. Mesotheliomas frequently metastasize late in the course of the disease, but it is exceptional for them to present as a metastatic tumor of unknown primary origin.

In plain English

This article is a case report describing one patient: a 41-year-old woman who sought medical attention for a lump in her neck. She had previously smoked 15 cigarettes a day but had not smoked for the preceding 10 years. Under the light microscope, the first lymph node biopsy suggested metastatic large cell carcinoma, and in a later neck dissection, 12 of the 16 nodes from neck levels IV and V also contained tumor. Electron microscopy instead showed a typical epithelial mesothelioma, with profuse microvilli on the tumor cells. Initial clinical investigations were negative, and the primary tumor in the pleura stayed undetected for a further 8 months. A later pleural biopsy showed the same appearance as the neck tumor. A limited trial of chemotherapy proved ineffective. She died 16 months after first presenting, from superior vena caval obstruction, and no autopsy was performed. Specific questioning of the patient found no evidence of exposure to asbestos. The author concluded that the case was exceptional because the primary site remained hidden for so long.

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 41-year-old woman who presented with a left neck mass. The author was based at the Department of Anatomical Pathology, Royal Prince Alfred Hospital, New South Wales, Australia. The article does not give dates.
• Exposure: No asbestos exposure was found on specific questioning. The patient was a former smoker of 15 cigarettes a day who had not smoked for the preceding 10 years.
• Main results:
  • Light microscopy of the neck lymph node suggested metastatic large cell carcinoma.
  • Electron microscopy showed typical epithelial mesothelioma. The most conspicuous feature was profuse microvilli on the tumor cells.
  • The initial lymph node biopsy contained metastatic tumor. In a later selective neck dissection (levels II to V), 12 of the 16 nodes from neck levels IV and V also contained metastatic tumor.
  • Serum CA-125 was slightly elevated at 55 IU/mL (normal range 0 to 35).
  • The primary pleural tumor remained undetected for a further 8 months after presentation.
  • A later pleural biopsy showed the same histology and immunohistochemical reactions as the metastatic neck tumor.
  • A limited trial of chemotherapy proved ineffective.
  • The patient died of superior vena caval obstruction that did not respond to radiotherapy, 16 months after her initial presentation.
• The authors' conclusion: The author concluded that the case was exceptional because the primary tumor site remained hidden for so long.
• Limitations the authors state:
  • Electron microscopy tissue from the later pleural biopsy was too poorly preserved for detailed comparison with the earlier neck specimen.
  • No autopsy was performed.

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, Lymphadenopathy, Carcinoma, Mesothelioma, Metastasis.

Related studies

• Peripheral lymphadenopathy as the initial manifestation of malignant mesothelioma in a child — Y.S. Gong, Y.T. Rong, et al. (2013)
• Malignant pleural mesothelioma initially diagnosed on cervical lymph node biopsy — S. Ogata, S. Hiroi, et al. (2009)
• Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report — N.A. Ansari, N.W. Derias (2000)
• Floor of mouth and tongue metastasis from malignant pleural mesothelioma — D. Kirke, K. Horwood, et al. (2010)
• Hyperplastic mesothelial cells in lymph nodes: report of six cases of a benign process that can stimulate metastatic involvement by mesothelioma or carcinoma — P. Argani, J. Rosai (1998)
• British Thoracic Society study of cryptogenic fibrosing alveolitis: current presentation and initial management. Fibrosing Alveolitis Subcommittee of the Research Committee of the British Thoracic Society — I.D. Johnston, R.J. Prescott, et al. (1997)

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