Small cell carcinoma presenting with massive pleural spread mimicking malignant pleural mesothelioma

Our plain-English summary of Small cell carcinoma presenting with massive pleural spread mimicking malignant pleural mesothelioma, by T. Takeda, M. Saitoh, S. Fukita, et al (Internal Medicine, 2014).

The study

• Authors: T. Takeda, M. Saitoh, S. Fukita, S. Takeda
• Journal: Internal Medicine
• Published: 2014;53(6):613-6
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Small cell carcinoma (SCC) predominantly spreading over the pleura is exceedingly rare and difficult to diagnose without proof of malignant effusion. A 65-year-old man presented with right pleural thickening and effusion and was diagnosed with SCC based on a thoracoscopic pleural biopsy. He received combined chemotherapy consisting of cisplatin and irinotecan hydrochloride, which resulted in a complete response. Seven months later, local relapse was observed. Thereafter, he received second-, third- and fourth-line chemotherapies and died of tumor progression 21 months after the diagnosis. Considering the possibility of SCC with pleural spread, performing early invasive procedures is important for diagnosing pleural malignancies.

In plain English

This case report, from Uji Tokushukai Medical Center in Japan, described a 65-year-old man with an 80 pack-year smoking history. His cancer looked like malignant pleural mesothelioma but turned out to be small cell carcinoma, a type of lung cancer. The article does not mention asbestos exposure. The patient had right chest pain. Scans showed thickening of the pleura (the lining around the lung), nodular masses and fluid in the right chest. Tests of the fluid found no cancer cells. A tissue sample taken by video-assisted thoracic surgery (VATS) confirmed small cell carcinoma. Its origin was unclear, and a very small mass at the edge of the lung was considered the likely source. Chemotherapy with cisplatin and irinotecan produced a complete response, but the cancer returned locally after seven months. Second- and third-line chemotherapy gave partial responses. The disease progressed on fourth-line chemotherapy, and the patient died 21 months after diagnosis. The authors concluded that the case suggests the importance of early VATS to diagnose pleural tumors when the fluid shows no proof of cancer.

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 65-year-old man with an 80 pack-year smoking history who presented with right chest pain, treated at Uji Tokushukai Medical Center, Japan
• Exposure: The article does not report any asbestos exposure; the only exposure history given is smoking of 80 pack-years
• Main results:
  • Chest X-rays and CT scans showed thickening of both parietal and visceral pleurae, nodular masses and pleural effusion in the right thoracic cavity
  • Cytology of the pleural effusion was negative
  • Serum ProGRP was 2,578.0 pg/mL (normal range below 46.0 pg/mL) and NSE was 39.3 ng/mL (normal range below 16.3 ng/mL)
  • Histology of the pleural biopsy obtained by VATS confirmed small cell carcinoma
  • The origin of the small cell carcinoma was unclear even on VATS; the clinical stage was cT2aN0M1a, stage IV
  • First-line cisplatin plus irinotecan hydrochloride for four cycles resulted in a complete response; local relapse followed after seven months of progression-free survival
  • Second-line treatment with the same regimen gave a partial response with four months of progression-free survival; third-line amrubicin hydrochloride gave a partial response with seven months of progression-free survival
  • Fourth-line paclitaxel resulted in progressive disease, and the patient died of tumor progression 21 months after diagnosis
• The authors' conclusion: The authors concluded that the case suggests the importance of performing early VATS to diagnose pleural tumors in patients without proof of malignant pleural effusion, considering the possibility of small cell carcinoma spreading mainly over the pleura

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Pleural Mesothelioma, Pleura, Pleural Thickening, Pleural Biopsy, Chemotherapy, Cisplatin.

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• Small cell mesothelioma: A rare entity and diagnostic pitfall mimicking small cell lung carcinoma on fine-needle aspiration — Y. Zhang, A. Afify, et al. (2016)
• Pleural small cell carcinoma with massive pleural effusion: A case report — J.G. Jang, M.H. Jang, et al. (2019)
• Future directions for clinical research with CPT-11 (irinotecan) — D. von Hoff (1996)
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• Primary small cell carcinoma of the pleura: a case report with immunohistochemical and molecular genetic analyses of KIT and PDGFRA genes — T. Terada (2010)

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