Sudden death as the initial manifestation of diffuse pleural mesothelioma

Our plain-English summary of Sudden death as the initial manifestation of diffuse pleural mesothelioma, by J.T. Lie (Chest, 1989).

The study

• Author: J.T. Lie
• Journal: Chest
• Published: 1989;95(3):682-4
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000117).

Abstract

Malignant mesotheliomas are generally considered pathognomonic of asbestos exposure. The prognosis of mesothelioma varies with clinical staging of the disease. The overall survival of patients from the time of diagnosis is six to 16 months. Although patients with malignant mesotheliomas often have nonspecific symptoms and signs, occult diffuse pleural mesothelioma is uncommon, and one that occurs in a patient with no evidence of asbestos exposure must be exceedingly rare. Sudden death as the initial manifestation of pleural mesothelioma, to our knowledge, has not been previously reported in the literature. One such unusual case is documented here.

In plain English

This case report described a 44-year-old, previously healthy rural man who first complained of shortness of breath on the morning he died. He had a cardiac arrest, received cardiopulmonary resuscitation, and was dead on arrival at the nearest hospital. At autopsy, about 4 L of fluid was removed from the right pleural cavity. A firm, lobulated pleural tumor covered the right side of the chest, invading the chest wall, the outer part of the right lung, nearby lymph nodes and the right diaphragm. There were no distant metastases. Under the microscope the tumor was malignant mesothelioma with a mixed epithelial-sarcomatoid pattern. No asbestos bodies were found despite an extensive search of multiple tissue samples. Interviews with family and co-workers found no known work or household contact with asbestos. A fresh clot was also found in the left main pulmonary artery. The author concluded that even if this clot caused his final symptoms, this was sudden death as the first sign of diffuse pleural mesothelioma, which the author knew of no earlier report of.

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 autopsy case)
• Who was studied: One 44-year-old, previously healthy rural man, a nonsmoker, examined at autopsy (Division of Pathology, Mayo Clinic, Rochester, MN)
• Exposure: No known asbestos exposure. Interviews with family and co-workers found no known occupational contact with asbestos and no possible household exposure. He worked as a quality control officer in a food processing and packaging plant, and earlier as a school teacher for six years and as a seasonal bartender. No fiber type is named.
• Main results:
  • He had a cardiac arrest after first complaining of shortness of breath that morning, received CPR for 15 min before the ambulance arrived and for another 20 to 25 min en route, and was dead on arrival at the hospital.
  • At autopsy, about 4 L of serosanguineous fluid was removed from the right pleural cavity. A lobulated, firm pleural tumor covered the right hemithorax, invading the chest wall and subpleural regions of the right lung and involving regional lymph nodes and the right dome of the diaphragm.
  • There were no distant metastases.
  • Tumor samples from multiple sites showed predominantly a mixed epithelial-sarcomatoid biphasic pattern of malignant mesothelioma, with a few foci of desmoplastic pattern.
  • On immunohistochemistry the tumor stained negative for carcinoembryonic antigen and vimentin, and positive for low and high molecular weight cytokeratin, epithelial membrane antigen and human milk fat globule protein.
  • No ferruginous asbestos bodies were found, even after an extensive search in multiple tissue samples.
  • A fresh acute thromboembolus (blood clot) was found in the left main pulmonary artery, with no other abnormal autopsy finding.
• The authors' conclusion: The author concluded that even if the pulmonary thromboembolism caused the man's acute symptoms and death, this was still a case of sudden death as the initial manifestation of diffuse pleural mesothelioma. The author stated that, to their knowledge, no such case in a person without a history of asbestos exposure had been reported before.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Malignant Mesothelioma, Asbestos Exposure, Prognosis, Mesothelioma, Staging, Overall Survival.

Related studies

• Sudden death due to a cystic atrio-ventricular node tumour — G. Maujean, A. Tabib, et al. (2010)
• Primary mesothelioma of atrioventricular node: cause of sudden death — E.H. Hemsted (1986)
• Sudden death of an elderly man with multiple malignant neoplasms — L.R. Boglioli, M.L. Taff, et al. (1991)
• Occult primary cardiac lymphomas causing unexpected/sudden death or acute heart failure — A. De Martino, F. Del Re, et al. (2020)
• Cisplatin-induced sudden cardiac death with hemodynamic collapse: a severe adverse drug reaction: Case report — S. Abramavicius, M. Zemaitis, et al. (2017)
• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)

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