Spindle Cell Malignancy and Asbestos Exposure: A Case Report

Our plain-English summary of Spindle Cell Malignancy and Asbestos Exposure: A Case Report, by N. Walker, C. Okafor, N. Gandhi, et al (Curēus, 2024).

The study

• Authors: N. Walker, C. Okafor, N. Gandhi, S. Sharma
• Journal: Curēus
• Published: 2024;16(2):e54382
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

We outline the presentation of a 68-year-old woman who received a chest radiograph due to her insurance requirements, resulting in the discovery of a left-sided pleural effusion. The effusion was further characterized as loculated on subsequent imaging. Thoracentesis yielded exudative fluid, leading to the patient undergoing video-assisted thoracoscopic surgery (VATS). During this procedure, a cystic mass was visualized, with the conversion of the operation to an open thoracotomy and left lower lobe lobectomy. Pathology was positive for spindle cell sarcoma. A thorough history of the patient revealed a decades-long occupational exposure to asbestos. The significance of this report is to illustrate the clinical presentation, immunohistochemical characteristics, and management of a rare spindle cell malignancy. Our case also raises the importance of screening patients on an individualized, shared decision-making basis.

Copyright © 2024, Walker et al.

In plain English

This case report described one patient: a 68-year-old woman with no smoking history who had worked 30 to 40 years in an electrical plant with asbestos exposure. A chest X-ray required by her insurance showed fluid around her left lung (a pleural effusion). She reported no cough, shortness of breath or weight loss. During keyhole chest surgery a large cystic mass was found, and she then had open surgery that removed the lower lobe of her left lung. The grade 1 tumor measured 25×13×12.5 cm, and lymph nodes were not involved. Because the tumor was rare, the final pathology interpretation was an estrogen and progesterone receptor-positive mesenchymal tumor, with sarcoma among the possible diagnoses. She chose not to have chemotherapy, and radiation therapy was also decided against. A PET scan showed no remaining disease, and follow-up had not raised concern for recurrence. The authors considered the cancer likely linked to her occupational exposure. They encouraged individualized care, including screening imaging, for people with asbestos exposure. The article did not name an asbestos fiber type.

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 (single patient)
• Who was studied: One 68-year-old woman with no smoking history who had a screening chest radiograph for insurance requirements. She was referred to the authors' facility (the authors are at Louisiana State University Health Sciences Center, Shreveport, USA). Dates of care are not stated.
• Exposure: 30 to 40 years working in an electrical plant with asbestos exposure. No fiber type, product or dose is given.
• Main results:
  • The patient had no cough, shortness of breath, hemoptysis or weight loss.
  • Thoracentesis of the left pleural effusion yielded exudative fluid.
  • A large cystic mass was seen during video-assisted thoracoscopic surgery. The patient then had an open thoracotomy with left lower lung lobectomy and thoracic lymph node dissection.
  • Pathology showed a grade 1 tumor measuring 25×13×12.5 cm.
  • There were no fusion genes and no lymph node involvement.
  • The final histological interpretation was an estrogen and progesterone receptor-positive mesenchymal tumor with chondromatous heterologous components. The differential diagnosis was sarcoma versus biphasic epithelial and stromal tumors.
  • The patient decided against chemotherapy.
  • Radiation therapy was decided against.
  • A PET scan was negative for residual disease.
  • A chest CT five months after the operation showed resolution of the effusion, scarring of the left lung base and no intrathoracic metastasis.
  • Follow-up had so far not raised concern for recurrence.
• The authors' conclusion: The authors stated that the screening radiograph led to discovery of a lung cancer they considered likely linked to her occupational exposure. They aimed to encourage individualized plans of care, including screening imaging, for patients with a history of asbestos exposure.

Topics

Medical terms in this study, explained in our Lexicon: Spindle Cell, Asbestos Exposure, Chest X-Ray, Discovery, Pleural Effusion, Thoracentesis, Video-Assisted Thoracoscopic Surgery (VATS), Thoracotomy.

Related studies

• The differential diagnosis between pleural sarcomatoid mesothelioma and spindle cell/pleomorphic (sarcomatoid) carcinomas of the lung: evidence-based guidelines from the International Mesothelioma Panel and the MESOPATH National Reference Center — A.M. Marchevsky, N. LeStang, et al. (2017)
• Immunohistochemical differentiation of sarcomatoid mesotheliomas from other spindle cell neoplasms — P.T. Cagle, L.D. Truong, et al. (1989)
• Deep-learning based classification distinguishes sarcomatoid malignant mesotheliomas from benign spindle cell mesothelial proliferations — J.R. Naso, A.B. Levine, et al. (2021)
• Unusual primary lung neoplasms: spindle cell and undifferentiated lung carcinomas expressing only vimentin — S.P. Hammar, K.O. Hallman (1990)
• Asbestos, the mesothelial cell and malignancy: a matter of life or death — V.C. Broaddus (1997)
• Expression profiling stratifies mesothelioma tumors and signifies deregulation of spindle checkpoint pathway and microtubule network with therapeutic implications — M.B. Suraokar, M.I. Nunez, et al. (2014)

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