Retrosternal and pleural "bridging" fibrosis mimicking malignancy in a patient exposed to asbestos

Our plain-English summary of Retrosternal and pleural "bridging" fibrosis mimicking malignancy in a patient exposed to asbestos, by M.P. Debray, S. Marchand-Adam, R. Soufan, et al (European Respiratory Review, 2010).

The study

• Authors: M.P. Debray, S. Marchand-Adam, R. Soufan, J. Ostinelli, P.Y. Brillet, E. Schouman-Claeys, B. Crestani
• Journal: European Respiratory Review
• Published: 2010;19(116):158-60
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mediastinal fibrosis is a rare, benign disorder characterised by proliferation of fibrous tissue within the mediastinum. It can present as diffuse mediastinal infiltration or, more frequently, as a localised soft tissue mass, usually in the right paratracheal or subcarinal areas. 18-fluorodeoxyglucose (18-FDG) positron emission tomography (PET) imaging has only been reported in a few case reports with variable aspects. Herein, we present an unusual pattern of mediastinal fibrosis, presenting as a thick retrosternal mass contiguous with pleural thickening. 18-FDG PET showed intensely increased uptake in the mass. Both the location of fibrosis and PET imaging were confusing with malignancy. Histopathological proof of benign fibrosis was obtained by surgery. The patient had been exposed to asbestos and the possible relationship of this particular pattern of fibrosis with asbestos exposure will be discussed.

In plain English

This case report described a 64-year-old nonsmoking man with past asbestos exposure who had worked as a house and spray painter for 30 years. The article does not name a fiber type. The patient had a left pleural effusion diagnosed in 1994. In 2002 the patient received tuberculosis treatment for a right pleural effusion, without definitive proof of tuberculosis. In May 2007, after recent pain behind the breastbone, a CT scan showed a 20-mm thick mass behind the sternum. The mass extended from one pleural membrane to the other and was joined to a thickening of the right pleura. A PET scan showed markedly increased uptake in the mass. Cancer was suspected, and the mass was removed surgically in July 2007. Tissue analysis found benign fibrous tissue consistent with fibrosing mediastinitis, with no tumour cells. No recurrence was seen on a CT scan 4 months later. The authors concluded that mediastinal fibrosis can form a mass behind the breastbone that mimics cancer, and that this pattern may be related to asbestos exposure.

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
• Who was studied: One 64-year-old nonsmoking male patient, evaluated in 2007 for recent retrosternal pain, with a history of a left lymphocytic pleural effusion (1994) and a right pleural effusion treated as tuberculosis in 2002 without definitive proof
• Exposure: Past asbestos exposure from 30 years of work as a house and spray painter; fiber type and dose not stated
• Main results:
  • A CT scan in May 2007 showed a 20-mm thick, noncalcified, elongated retrosternal mass extending from one pleural membrane to the other and contiguous with noncalcified thickening of the right costal pleura
  • PET showed markedly increased 18-FDG uptake in the retrosternal mass (maximum standard uptake value 5) and mildly increased uptake in the pleural thickening, with no abnormal uptake outside the chest
  • Lung function tests showed a severe restrictive impairment, with total lung capacity at 49% of predicted
  • After surgical resection in July 2007, histopathology showed extensive fibrous tissue infiltrated by inflammatory cells, consistent with fibrosing mediastinitis, with no tumour cells, necrosis or infectious agents
  • No recurrence was detected on a thoracic CT scan 4 months after surgery
• The authors' conclusion: The authors concluded that mediastinal fibrosis can develop as a localised retrosternal mass mimicking malignancy and that this pattern may be related to asbestos exposure. They considered tuberculosis an unlikely cause in this patient.
• Limitations the authors state:
  • Because the patient received anti-tuberculous therapy in 2002, no bacteriological proof of mycobacterial infection could be established at that time
  • The authors could not exclude that the mass was a mediastinal extension of the pleural fibrosis, because the pleural thickening preceded the mass

Topics

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

Medical terms in this study, explained in our Lexicon: Fibrosis, Mediastinum, Pleural Thickening, Asbestos Exposure.

Related studies

• IGG4-Related Pleural Bridging Fibrosis, Retrosternal Fibrosclerosis and Retroperitoneal Fibrosis in an Asbestos-Exposed Patient — P.P.T.E.S. Torres, L.B.M. Fonseca, et al. (2019)
• Syndrome of pleural and retrosternal "bridging" fibrosis and retroperitoneal fibrosis in patients with asbestos exposure — V. Cottin, P.Y. Brillet, et al. (2008)
• Paraplegia due to massive asbestos-related pleural and mediastinal fibrosis — C.J. O'Brien, A.J. Franks (1987)
• Minimally invasive, ionizing-free, and ultrasound-guided technique to biopsy anterior mediastinal masses: first 60 cases — B. Lorenzati, R. Cristofori, et al. (2018)
• Length-dependent retention of carbon nanotubes in the pleural space of mice initiates sustained inflammation and progressive fibrosis on the parietal pleura — F.A. Murphy, C.A. Poland, et al. (2011)
• Pleural irregularities and mediastinal pleural involvement in early stages of malignant pleural mesothelioma and benign asbestos pleural effusion — K. Kato, K. Gemba, et al. (2016)

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