Two malignancies or an unusual presentation of a pleural malignancy?

Our plain-English summary of Two malignancies or an unusual presentation of a pleural malignancy?, by B.J. Knipscheer, R.C. Kromontono, P.C. de Bruin, et al (Lung Cancer, 2013).

The study

• Authors: B.J. Knipscheer, R.C. Kromontono, P.C. de Bruin, M.J. van Strijen, G.J. Herder
• Journal: Lung Cancer
• Published: 2013;81(2):306-7
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is primarily located in the pleura. Progression usually involves adjacent tissue invasion. Both lymphatic and haematogenous spreads are possible, but rare. Bone involvement usually means locally invasive disease and rarely bone marrow metastases. In this report we presented two patients with a mesothelioma and bone marrow metastases.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

In plain English

This case report from St. Antonius Hospital in Nieuwegein, the Netherlands, described two 64-year-old men with pleural mesothelioma that had spread to the bone marrow. The first man, exposed to asbestos 38 years earlier, had left-sided chest and shoulder pain. Scans showed rib destruction and other bone lesions, including in the left upper arm bone. A pleural biopsy showed mesothelioma of mixed cell type, and a bone marrow biopsy led to a diagnosis of mesothelioma that had spread to the bone marrow. The second man, who had a history of non-Hodgkin lymphoma and asbestos exposure 30 years earlier, had shortness of breath, weight loss and right-sided chest pain. Scans showed pleural thickening, pleural fluid and bone lesions in the ribs and spine. A pleural biopsy showed malignant mesothelioma of mesenchymal type, and the bone marrow findings were described as compatible with metastatic mesothelioma. The article did not name the asbestos type or the jobs involved. The authors concluded that doctors should be aware of possible skeletal or bone marrow spread in patients with known mesothelioma who have bone-destroying (lytic) lesions 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 of two patients
• Who was studied: Two men, each aged 64, seen at St. Antonius Hospital, Nieuwegein, the Netherlands. The second man had a history of non-Hodgkin lymphoma. Dates of care are not given.
• Exposure: Asbestos exposure 38 years before presentation (case 1) and 30 years before (case 2). Fiber type, products and jobs are not stated.
• Main results:
  • Case 1: CT of the chest showed abnormal lung tissue, pleural activity and destruction of the outer layer of multiple ribs.
  • Case 1: PET scan showed uptake at the left pleura and multiple lytic bone lesions including the left humerus, without bone marrow involvement on the scan.
  • Case 1: pleural biopsy by video-assisted thoracoscopy showed mesothelioma of a mixed cell type.
  • Case 1: bone marrow biopsy showed tumor with stains strongly positive for vimentin, calretinin and pancytokeratin, and metastatic mesothelioma to the bone marrow was diagnosed.
  • Case 2: CT showed right-sided pleural thickening, pleural effusion and lytic bone lesions in the ribs and vertebral bodies. PET showed right pleural activity, enlarged mediastinal lymph nodes and multiple skeletal lesions.
  • Case 2: pleural biopsies showed malignant mesothelioma of a mesenchymal type.
  • Case 2: bone marrow showed widespread infiltration by spindle cells partially positive for pancytokeratin (MNF116), described as compatible with metastatic mesothelioma.
• The authors' conclusion: The authors concluded that physicians should be aware of the possibility of skeletal or bone marrow metastases in patients with known mesothelioma who have lytic lesions 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: Malignant Mesothelioma, Pleura, Mesothelioma.

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