Primary pleural squamous cell carcinoma misdiagnosed as localized mesothelioma: a case report and review of the literature

Our plain-English summary of Primary pleural squamous cell carcinoma misdiagnosed as localized mesothelioma: a case report and review of the literature, by X.M. Lin, C. Chi, J. Chen, et al (Journal of Cardiothoracic Surgery, 2013).

The study

• Authors: X.M. Lin, C. Chi, J. Chen, Y. Liu, P. Li, Y. Yang
• Journal: Journal of Cardiothoracic Surgery
• Published: 2013;8:50
• Type of article: Case report, Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary pleural squamous cell carcinoma is very rare, and there is a lack of experience in the diagnosis and treatment of this condition. An asymptomatic 75-year-old man was referred to us after a right pleural nodule was found on computed tomography during a routine health examination. He underwent surgery for his pleural tumor twice over the following 2 years. Histopathological examination eventually led to a diagnosis of primary pleural squamous cell carcinoma.

In plain English

This article was a case report with a review of the literature, from a hospital in Wenzhou, China. It described a 75-year-old man with no symptoms whose 31 × 15 mm right pleural nodule was found on CT during a routine health examination in August 2009. The nodule was removed by video-assisted thoracic surgery and was diagnosed as pleural mesothelioma. In April 2011 he returned with chest pain, cough, fatigue and weight loss. A blood test showed a raised squamous cell carcinoma antigen level of 5.7 μg/l. At open surgery, a chest-wall tumor was found joined to a 7 × 8 × 8 cm pleural mass that had invaded the upper lobe of the right lung, and a biopsy showed primary pleural squamous cell carcinoma. After en bloc removal and 50 Gy radiation, a CT in October 2012 showed the operated area in good condition. The article did not report any asbestos exposure for this patient. The authors concluded that this rare cancer is easily misdiagnosed as localized mesothelioma and that its prognosis is not yet clear.

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 of one patient, with a review of the literature
• Who was studied: One 75-year-old Chinese (ethnic Han) man, referred to the authors' clinic in August 2009 after a right pleural nodule was found on routine chest CT. The authors are based at Wenzhou Medical College and its First Affiliated Hospital, Wenzhou, China.
• Exposure: The article does not report any asbestos or other occupational exposure for this patient. Its only mention of asbestos is a statement in the discussion, citing other work, that solitary fibrous tumor of the pleura is not associated with asbestos exposure.
• Main results:
  • First CT (2009) showed a soft tissue nodule arising from the right pleura measuring 31 × 15 mm, with clear margins and no invasion of the ribs.
  • After complete removal of the nodule by video-assisted thoracic surgery, the tissue examination led to a diagnosis of pleural mesothelioma.
  • In April 2011 the patient returned with a 2-month history of right-sided chest pain, cough, sputum production, fatigue and weight loss. CT findings were thought to show recurrence of pleural mesothelioma.
  • Before the second operation, his squamous cell carcinoma antigen level was raised at 5.7 μg/l.
  • At thoracotomy, a 5 × 4 × 4 cm tumor under the skin was continuous with a 7 × 8 × 8 cm pleural lesion that had invaded the right upper lung lobe. Biopsy during surgery showed primary pleural squamous cell carcinoma, and the tissue examination after surgery was consistent with stage I squamous cell carcinoma.
  • The tumor was removed en bloc. One month later the patient received 50 Gy of local radiation, and a CT in October 2012 showed the operation area in good condition.
• The authors' conclusion: The authors concluded that primary pleural squamous cell carcinoma is very rare and that, because of the lack of clinical experience, early cases are easily misdiagnosed as localized mesothelioma, leading to delayed or inappropriate treatment. They stated that it can be diagnosed by preoperative tests such as FDG-PET, tumor markers and transthoracic Tru-Cut needle biopsy, and that its prognosis is not clear at present.
• Limitations the authors state:
  • The authors stated that the prognosis of primary pleural squamous cell carcinoma is not clear at present.
  • The authors stated that further observation is needed to know what follow-up these patients require after surgery and whether treatments used for recurrent lung squamous cell carcinoma also work for this disease.

Topics

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

Medical terms in this study, explained in our Lexicon: Squamous Cell Carcinoma, Localized Malignant Mesothelioma.

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