Spontaneous pneumothorax and lung carcinoma: should one consider synchronous malignant pleural mesothelioma?

Our plain-English summary of Spontaneous pneumothorax and lung carcinoma: should one consider synchronous malignant pleural mesothelioma?, by T.A. Flood, H.S. Sekhon, J.M. Seely, et al (Journal of Thoracic Oncology, 2009).

The study

• Authors: T.A. Flood, H.S. Sekhon, J.M. Seely, F.M. Shamji, M.M. Gomes
• Journal: Journal of Thoracic Oncology
• Published: 2009;4(6):770-2
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We describe the clinical and pathologic findings of a 68-year-old smoker with previous asbestos exposure who presented with spontaneous hydropneumothorax and was diagnosed with synchronous undifferentiated lung carcinoma and incidental malignant pleural mesothelioma. The synchronous occurrence of these two neoplasms is an extremely rare event with fewer than 20 reported cases in the English literature. The accurate diagnosis of synchronous tumors can be extremely challenging and the identification of a concomitant mesothelioma in our case was not made until an extensive immunohistochemical analysis was done on the resection specimen. Spontaneous pneumothorax occurs much more commonly in patients with malignant mesothelioma than with primary lung carcinomas. Consequently, although synchronous pleural mesotheliomas and lung carcinomas are infrequent, this diagnosis should be considered when a patient with a lung mass and a history of asbestos exposure presents with spontaneous pneumothorax and pleural thickening on imaging. Identification of synchronous tumors is of critical importance for determining the patient's stage and management and can have significant medicolegal implications should the patient seek compensation.

In plain English

This case report described a 68-year-old former electrician and smoker (40 pack-years) with occupational asbestos exposure who had two months of shortness of breath and fatigue. Imaging showed a large mass in the right upper lobe of the lung and a large hydropneumothorax (air and fluid around the lung). A needle biopsy and testing of the pleural fluid showed non-small cell lung carcinoma, staged as IIIB. Surgeons removed the lung and its lining (extrapleural pneumonectomy). Microscopic examination found an undifferentiated large cell lung carcinoma and, separately, a malignant pleural mesothelioma (epithelioid, with focal sarcomatoid features) in both layers of the pleura. The two tumors met at one spot. Special stains (immunohistochemistry) confirmed two different cancers. No asbestosis or ferruginous bodies were found in the lung. Imaging and fluid testing had not detected the mesothelioma. It was found only in the removed tissue. The authors concluded that this combination, though rare, should be considered when a patient with a lung mass and a history of asbestos exposure presents with spontaneous pneumothorax and pleural thickening on imaging.

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 man, a former electrician with a 40-pack-year smoking history, who had a 2-month history of shortness of breath and fatigue
• Exposure: Occupational asbestos exposure (fiber type, duration and amount not stated), plus smoking
• Main results:
  • CT showed a mass in the posterior segment of the right upper lobe with a large hydropneumothorax
  • Pleural fluid cytology was positive for non-small cell carcinoma, and the lung cancer was staged as IIIB
  • An extrapleural pneumonectomy was performed
  • The lung mass was a large cell undifferentiated carcinoma that expressed epithelial antigens, with ambiguous results for subtype markers
  • Both the visceral and parietal pleura showed an epithelioid malignant mesothelioma with focal sarcomatoid morphology
  • The pleural tumor diffusely expressed mesothelial markers
  • The two tumors met at the site of pleural adhesion
  • The non-cancerous lung tissue showed no asbestosis, and no ferruginous bodies were found
  • The mesothelioma was identified only in the resection specimen, after immunohistochemical study
• The authors' conclusion: The authors concluded that imaging and cytology identified the lung carcinoma but not the mesothelioma. They concluded that, although rare, synchronous mesothelioma should be considered when a patient with a lung mass and asbestos exposure history presents with spontaneous pneumothorax and pleural thickening on imaging.

Topics

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

Medical terms in this study, explained in our Lexicon: Pneumothorax, Carcinoma, Pleural Mesothelioma, Asbestos Exposure, Neoplasm, Mesothelioma, Malignant Mesothelioma, Pleural Thickening.

Related studies

• Simultaneous bilateral spontaneous pneumothorax in a patient with peritoneal and pleural papillary mesothelioma — P. Höllinger, D. Gaeng (1997)
• Pleural granuloma mimicking malignancy 42 years after slurry talc injection for primary spontaneous pneumothorax — S. Tenconi, L. Luzzi, et al. (2010)
• Malignant pleural mesothelioma detected by spontaneous pneumothorax — A. Makidono, M. Matsusako, et al. (2010)
• Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage — P. Lange, J. Mortensen, et al. (1988)
• Spontaneous pneumothorax and pulmonary malignant disease--a syndrome sometimes associated with cavitating tumours. Report of nine new cases, four with metastases and five with primary bronchial tumours — F.W. Wright (1976)
• Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review — S. Alkhuja, A. Miller, et al. (2000)

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