Pleural small cell carcinoma with massive pleural effusion: A case report

Our plain-English summary of Pleural small cell carcinoma with massive pleural effusion: A case report, by J.G. Jang, M.H. Jang, J.H. Ahn (Medicine, 2019).

The study

• Authors: J.G. Jang, M.H. Jang, J.H. Ahn
• Journal: Medicine
• Published: 2019;98(48):e18251
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Rationale: Small cell carcinoma (SCC) occurs mostly in the lung, and small cell lung cancer accounts for 13% of newly diagnosed lung cancers. Only 2.5% of SCC occurs in extrapulmonary sites, and SCC of pleural origin is especially very uncommon.

Patient Concerns: An 85-year-old man presenting with progressive dyspnea for more than 7 days.

Diagnoses: Computed tomography scan of the chest showed massive pleural effusion and diffuse nodular thickening of the pleura on the right chest. Sonography-guided needle biopsy of the pleural mass was performed and histologic and immunohistochemical findings revealed SCC. Since no parenchymal lung lesion was observed, the patient was finally diagnosed with SCC of the pleura (SCCP).

Interventions: Due to the patient's old age and poor performance status, chemotherapy was not performed and only drainage of pleural effusion was conducted for symptom relief.

Outcomes: Dyspnea improved after pleural effusion drainage. The patient was discharged and transferred to a local medical center for hospice care.

Lessons: Although primary SCCP is extremely rare, SCCP should also be considered as well as mesothelioma in case of presence of a pleural-based mass with massive pleural effusion.

In plain English

This case report from Yeungnam University Medical Center in Daegu, Republic of Korea, described one patient with small cell carcinoma of the pleura. The authors called this cancer extremely rare and knew of only 5 earlier reported cases. The patient was an 85-year-old man, a farmer with a 60 pack-year smoking history and an unknown history of asbestos exposure, who had worsening shortness of breath for 7 days. Chest CT showed massive fluid on the right side of the chest and diffuse nodular thickening of the pleura, with no mass in the lung itself. The case was first thought to be mesothelioma. A needle biopsy of the pleural mass and staining tests showed small cell carcinoma instead, and further scans found no tumor in the lung. Because of the patient's old age and poor general condition, chemotherapy was not given. Only the fluid was drained, and the shortness of breath improved. The patient was transferred to hospice care. The authors concluded that this cancer should be considered alongside mesothelioma when a pleural-based mass appears with massive pleural effusion.

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 85-year-old man, a farmer with a 60 pack-year smoking history, referred for progressive shortness of breath to Yeungnam University Medical Center, Daegu, Republic of Korea
• Exposure: Asbestos exposure history unknown; the patient was a farmer and a smoker (60 pack-years)
• Main results:
  • Chest CT showed massive right pleural effusion and diffuse nodular thickening of the pleura
  • No mass-like lesion was seen in the lung tissue itself
  • CEA in the pleural fluid was elevated to 12.75 ng/mL (reference range 0 to 10 ng/mL); serum tumor markers were within normal limits
  • The case was initially considered mesothelioma because of the CT findings
  • The biopsy tumor cells stained positive for neuroendocrine markers, supporting small cell carcinoma
  • Chest CT and PET/CT showed no evidence of a cancer inside the lung, supporting a pleural origin
  • Chemotherapy was not given because of old age and poor performance status; only drainage of the pleural fluid was done
  • Shortness of breath improved after drainage, and the patient was discharged to hospice care
  • According to the authors' knowledge, only 5 cases of pleural small cell carcinoma had been reported before; massive pleural effusion set this case apart from those
• The authors' conclusion: The authors concluded that, although primary small cell carcinoma of the pleura is extremely rare, it should be considered as well as mesothelioma when a pleural-based mass occurs with massive pleural effusion. They also suggested that an observational strategy might be appropriate for patients with poor performance status.

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Pleural Effusion, Small Cell Lung Cancer, Lung Cancer, Dyspnea, Pleura, Needle Biopsy, Performance Status.

Related studies

• Pleural Small Cell Lung Carcinoma: An Unusual Culprit in Pleural Effusion — O.D. Adejorin, A. Sodhi, et al. (2015)
• Small cell carcinoma presenting with massive pleural spread mimicking malignant pleural mesothelioma — T. Takeda, M. Saitoh, et al. (2014)
• Clinically occult primary fallopian tube carcinoma presenting as a malignant pleural effusion — R. Hiensch, K. Meinhof, et al. (2017)
• Pleural small cell carcinoma in pre-existent asbestos related pleural disease — H.F. van der Heijden, Y.F. Heijdra, et al. (2002)
• Positive pleural cytology is an indicator for visceral pleural invasion in metastatic pleural effusions — M.E. Froudarakis, J. Plojoux, et al. (2018)
• Collision tumour of the pleura composed of small cell carcinoma and malignant mesothelioma — A.H. Lee, I.N. Soomro (2004)

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