The journey of mesothelioma: from postmortem to FNA

Our plain-English summary of The journey of mesothelioma: from postmortem to FNA, by M. Gorecka, J. Scott, R. Casey, et al (BMJ Case Reports, 2014).

The study

• Authors: M. Gorecka, J. Scott, R. Casey, D. Breen
• Journal: BMJ Case Reports
• Published: 2014;2014
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

A 73-year-old man, non-smoker presented with an 8-week history of left-sided chest pain and shortness of breath on exertion. He had no significant medical history. He worked in construction for 40 years, but denied definite asbestos exposure. His initial chest X-ray demonstrated a large left-sided pleural effusion. Subsequent CT thorax revealed circumferential thickening of the pleura with associated pleural plaques and calcification. A provisional diagnosis of mesothelioma was made. Initial ultrasound-guided thoracocentesis revealed a transudate with negative cytology. In addition, thoracoscopy and CT-guided pleural biopsy failed to obtain a definitive diagnosis. A surgical biopsy was planned, but at the time of admission, the patient developed unilateral neck swelling. Ultrasound-guided fine-needle aspiration (FNA) and core biopsies of the lymph node were diagnostic for pleural mesothelioma. Treatment with palliative chemotherapy was planned, but the patient's clinical status rapidly deteriorated and he passed away prior to the beginning of therapy.

In plain English

This case report described one patient at Galway University Hospitals in Ireland: a 73-year-old man, a non-smoker, with 8 weeks of left-sided chest pain and breathlessness. He had worked in construction for 40 years but denied definite asbestos exposure. A CT scan showed a large left-sided pleural effusion (fluid around the lung), pleural thickening, and calcified and non-calcified pleural plaques, which the authors said confirmed previous asbestos exposure. Fluid drained from his chest showed no cancer cells, and biopsies taken at thoracoscopy and by CT-guided needle found no definite diagnosis. Before a planned surgical biopsy, a tender swollen lymph node appeared in his neck. Needle sampling (fine-needle aspiration and core biopsy) of this node confirmed malignant mesothelioma. Chemotherapy was planned, but his condition worsened and he died in a hospice 4 weeks after diagnosis. The authors concluded that ultrasound-guided needle sampling of a lymph node is a safe, rapid tool that may give a tissue diagnosis in a portion of patients with malignant mesothelioma.

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 73-year-old man, a non-smoker, reported from the Interventional Respiratory Unit, Galway University Hospitals, Ireland. Dates of care are not given.
• Exposure: 40 years of work in construction, described elsewhere in the article as being in the UK. The patient denied definite asbestos exposure. No fiber type is named.
• Main results:
  • The CT scan showed calcified and non-calcified pleural plaques, which the authors said confirmed previous asbestos exposure.
  • Fluid drawn from the chest under ultrasound guidance was a transudate with negative cytology.
  • Multiple biopsies taken at thoracoscopy found no malignancy.
  • A CT-guided biopsy was inconclusive.
  • A swollen lymph node in the left side of the neck was found on ultrasound to be causing venous obstruction.
  • Fine-needle aspiration and core biopsy of that neck lymph node confirmed malignant mesothelioma.
  • Palliative chemotherapy was planned, but the patient deteriorated and died in a hospice 4 weeks after diagnosis.
• The authors' conclusion: The authors concluded that ultrasound-guided FNA and/or core biopsy of a lymph node is a safe and rapid diagnostic tool that may obtain a tissue diagnosis in a portion of patients with malignant mesothelioma. They added that it may be especially useful when the usual investigations fail.

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: Mesothelioma, Asbestos Exposure, Chest X-Ray, Pleural Effusion, Thorax, Pleura, Pleural Plaques, Ultrasound.

Related studies

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• Postmortem findings of malignant pleural mesothelioma: a two-center study of 318 patients — R.S. Finn, F.J.H. Brims, et al. (2012)
• Talc pneumoconiosis: a report of six patients with postmortem findings — M. Kleinfeld, C.P. Giel, et al. (1963)
• Effect of tobacco smoking on the presence of asbestosis at postmortem and on the reading of irregular opacities on roentgenograms in asbestos-exposed workers — E. Hnizdo, G.K. Sluis-Cremer (1988)
• A postmortem case control study of asbestos burden in lungs of malignant mesothelioma cases — S.D. Visonà, B. Bertoglio, et al. (2023)
• Antemortem diagnosis of asbestosis by screening chest radiograph correlated with postmortem histologic features of asbestosis: a study of 273 cases — K.N. Mizell, C.G. Morris, et al. (2009)

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