Simultaneous presence of lung adenocarcinoma and malignant pleural mesothelioma: A case report

Our plain-English summary of Simultaneous presence of lung adenocarcinoma and malignant pleural mesothelioma: A case report, by M. Yamazoe, H. Tomioka, T. Kamada, et al (Respiratory Medicine Case Reports, 2019).

The study

• Authors: M. Yamazoe, H. Tomioka, T. Kamada, M. Kaneko, E. Katsuyama
• Journal: Respiratory Medicine Case Reports
• Published: 2019;26:45-49
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The co-presence of malignant pleural mesothelioma (MPM) and lung cancer is rare. We report a 70-year-old male with exposure to asbestos. Chest computed tomography revealed a right mediastinal mass combined with an enlarged ipsilateral lymph node and left pleural effusion. Transbronchial lung biopsy revealed lung adenocarcinoma. Thoracoscopic examination revealed multiple left pleural nodules, leading to the diagnosis of MPM. Despite aggressive anticancer drug therapy, he expired due to disease progression 2.5 years after diagnosis. Autopsy confirmed an epithelioid MPM in the left pleura. MPM comorbidity in patients diagnosed with lung cancer should be considered, especially in those exposed to asbestos.

In plain English

This was a case report from Kobe City Medical Center West Hospital, Japan, about a 70-year-old man with chronic obstructive pulmonary disease, a smoking history (printed as "65 packs per year"), and asbestos exposure. The article did not name the fiber type or the source of exposure. A bronchial biopsy showed adenocarcinoma, a type of lung cancer, in the right lung. Fluid from the left chest showed markers that pointed to mesothelioma, and biopsies taken through a chest scope led to a diagnosis of epithelioid malignant pleural mesothelioma (MPM) in the left pleura. The authors said this diagnosis was not definite before death. The patient received five lines of drug treatment and died of disease progression 2.5 years after diagnosis. Autopsy confirmed epithelioid MPM in the left pleura, and lung adenocarcinoma that had spread to other organs. The authors judged that the lung cancer, not the mesothelioma, determined the outcome. The authors concluded that in lung cancer patients with pleural effusion (fluid around the lung), especially those exposed to asbestos, doctors should consider that MPM may also be present.

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 a single patient, including autopsy findings
• Who was studied: One 70-year-old man with chronic obstructive pulmonary disease, treated at Kobe City Medical Center West Hospital, Japan (the authors' hospital); dates of care not given
• Exposure: A history of asbestos exposure, with no fiber type, product, job or dose given; also a smoking history printed as 65 packs per year
• Main results:
  • A biopsy of a tumor in the right main bronchus showed adenocarcinoma, and the patient was diagnosed with lung adenocarcinoma
  • The left pleural fluid was bloody, with high hyaluronic acid (more than 80,000 ng/mL), CYFRA (466.9 ng/mL) and TPA (7636 U/L), and low CEA (1.2 ng/mL)
  • Biopsies of left pleural nodules taken during thoracoscopy were positive for mesothelial markers, and the patient was also diagnosed with epithelioid mesothelioma
  • The MPM diagnosis made during life was not definitive
  • After five lines of chemotherapy, the patient died of disease progression 2.5 years after diagnosis
  • At autopsy, atypical mesothelial cells in the left pleura were positive for calretinin and negative for TTF-1, confirming epithelioid MPM
  • At autopsy, the right lung adenocarcinoma had spread to the lymph nodes, epicardium, right diaphragm, liver and jejunum
  • According to the authors, the patient survived long-term and the lung adenocarcinoma determined the prognosis
  • The mesothelioma examined at autopsy had a PD-L1 Tumor Proportion Score of less than 1%
• The authors' conclusion: The authors concluded that in patients with lung cancer and pleural effusion, especially those with a history of asbestos exposure, possible co-existing MPM should be considered, and that treatment should take into account the prognosis of each cancer
• Limitations the authors state:
  • The thoracoscopic specimens were too limited to examine whether mesothelial cells were growing into the fibrous pleural tissue, so reactive mesothelial hyperplasia (a non-cancerous change) could not be ruled out before death
  • The authors could not rule out mesothelioma in situ (a very early form) as a reason the MPM did not progress

Topics

Medical terms in this study, explained in our Lexicon: Lung Adenocarcinoma, Pleural Mesothelioma, Lung Cancer, Pleural Effusion, Biopsy, Disease Progression, Autopsy, Epithelioid.

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