Spontaneous Regression of Malignant Pleural Mesothelioma in a Patient with New-Onset Inflammatory Arthropathy

Our plain-English summary of Spontaneous Regression of Malignant Pleural Mesothelioma in a Patient with New-Onset Inflammatory Arthropathy, by J.C. Moser, T. Peikert, A.C. Roden, et al (Annals of the American Thoracic Society, 2015).

The study

• Authors: J.C. Moser, T. Peikert, A.C. Roden, D.E. Midthun, A.S. Mansfield
• Journal: Annals of the American Thoracic Society
• Published: 2015;12(9):1416-7
• Type of article: Case report, Letter
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter described a patient whose malignant pleural mesothelioma shrank without treatment after she developed an inflammatory joint disease, and discussed what this might mean for immune-based treatment. The patient was a 75-year-old woman who had never smoked and had a history of asbestos exposure. She developed worsening shortness of breath on exertion. Two masses had previously been removed from near her navel and had been reported as mesothelial hyperplasia with atypia. CT of the chest showed a large right-sided pleural effusion and a chest wall mass. A CT-guided biopsy of the mass, together with a review of the earlier masses, was consistent with epithelioid mesothelioma. She chose not to have treatment. Two months later, imaging showed a significant reduction in the size of the tumor. In the meantime she had developed joint pain and swelling in both hands, wrists and knees. Blood tests for connective tissue disease were negative. She was diagnosed clinically with an inflammatory arthropathy, most likely remitting seronegative symmetric synovitis with pitting edema, and was given 10 mg of prednisone a day. Ongoing surveillance was recommended. She remained alive as of February 2015, more than 4 years after the first resection. The authors noted that median survival is about a year with chemotherapy. They suggested that her immune system may have helped control the cancer and that the case highlights the potential of immunotherapy for mesothelioma.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This letter, written by authors at the Mayo Clinic in Rochester, Minnesota, describes one patient. A 75-year-old woman who had never smoked and had a history of asbestos exposure (fiber type not stated) developed worsening shortness of breath on exertion. A CT scan showed a large right-sided pleural effusion and a chest wall mass. A biopsy of the mass, and a re-review of masses near her navel that had been removed earlier, were consistent with epithelioid malignant pleural mesothelioma. She chose not to have treatment. Two months later, imaging showed a significant reduction in the tumor's size. Between the two scans she had developed joint pain and swelling in her hands, wrists and knees. Blood tests for connective tissue disease were negative. She was diagnosed with an inflammatory arthropathy and started on 10 mg of prednisone per day. She was alive as of February 2015, more than 4 years after the first surgery near her navel. The authors concluded that the immune system may have had a role in controlling her cancer, and that the case highlights the potential for immunotherapy in this disease.

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 (letter to the editor) of a single patient
• Who was studied: one 75-year-old female nonsmoker with malignant pleural mesothelioma, epithelioid type; she had two earlier periumbilical masses removed that were first called mesothelial hyperplasia with atypia; the letter does not say where she received care (the authors are from the Mayo Clinic, Rochester, Minnesota)
• Exposure: a history of asbestos exposure; the fiber type, source and amount are not described
• Main results:
  • Biopsy of the chest wall mass and review of the earlier resected periumbilical masses were consistent with epithelioid malignant pleural mesothelioma; the patient chose not to be treated
  • Two months later, without treatment, repeat imaging showed a significant reduction in the size of the mesothelioma
  • In the interval between the scans she developed bilateral joint pain and swelling in the hands, wrists and knees; serologic markers for connective tissue disease were negative
  • She was clinically diagnosed with an inflammatory arthropathy, most likely remitting seronegative symmetric synovitis with pitting edema, and started on 10 mg prednisone per day; surveillance of the mesothelioma was recommended
  • The patient was alive as of February 2015, more than 4 years after the initial periumbilical resection
• The authors' conclusion: The authors concluded that the regression in the setting of a seronegative inflammatory polyarthropathy indicates the immune system may have had a role in controlling her cancer, and that the case highlights the potential for immunotherapy in malignant pleural mesothelioma

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: Pleural Mesothelioma, Asbestos Exposure, Reactive Mesothelial Hyperplasia, Pleural Effusion, Biopsy, Epithelioid, Mesothelioma, Median Survival.

Related studies

• Localised spontaneous regression in mesothelioma -- possible immunological mechanism — B.W. Robinson, C. Robinson, et al. (2001)
• Malignant pleural mesothelioma detected by spontaneous pneumothorax — A. Makidono, M. Matsusako, et al. (2010)
• Rounded atelectasis due to acute exudative effusion. Spontaneous resolution — L.S. Smith, R.F. Schillaci (1984)
• Spontaneous pneumothorax and lung carcinoma: should one consider synchronous malignant pleural mesothelioma? — T.A. Flood, H.S. Sekhon, et al. (2009)
• Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma — H.E. Fayed, V.K. Woodcock, et al. (2013)
• Pleural granuloma mimicking malignancy 42 years after slurry talc injection for primary spontaneous pneumothorax — S. Tenconi, L. Luzzi, et al. (2010)

Browse more research in Annals of the American Thoracic Society, or return to medical research.