Unexpected pleural finding after a fall

Our plain-English summary of Unexpected pleural finding after a fall, by C. Giraudo, A.S. Fraia, A. Bellini, et al (The Lancet. Oncology, 2019).

The study

• Authors: C. Giraudo, A.S. Fraia, A. Bellini, F. Fortarezza, F. Rea, F. Calabrese
• Journal: The Lancet. Oncology
• Published: 2019;20(10):e606
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This case report describes one patient in Italy. A previously healthy 41-year-old man came to an emergency room near Verona in August 2017 after a fall and tibial fracture. A pre-surgical chest x-ray showed a large pleural opacity. He was a nonsmoker with no occupational exposure to dust, fumes, or vapours. The report does not describe any asbestos exposure for him. CT showed a well-defined 8.5 × 3 × 8 cm pleural lesion suggesting non-aggressive behaviour. A PET/CT scan, however, showed intense uptake (SUVmax 7.9), suggesting an aggressive malignancy. Tissue tests after surgical removal led to a diagnosis of localised malignant mesothelioma. The margins were free of tumour cells, and no chemotherapy was given. CT scans every 4 months showed no recurrence or spread up to 1 year and 3 months after diagnosis. The authors stated that this tumour is extremely rare and that the role of asbestos in it is still controversial. They added that without local invasion or pleural effusion, as in this patient, distinguishing it from benign or low-grade lesions on CT can be extremely challenging.

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 (Clinical Picture) of a single patient
• Who was studied: One previously healthy 41-year-old man admitted to the emergency room of Legnago Hospital, near Verona, Italy, in August 2017 after an accidental fall and tibial fracture
• Exposure: No asbestos exposure is described for the patient; he was a nonsmoker without any occupational exposure to dust, fumes, or vapours
• Main results:
  • CT showed a large, well-defined pleural lesion measuring 8.5 × 3 × 8 cm, without surrounding atelectasis or pleural effusion
  • PET/CT showed intense uptake of the lesion (SUVmax 7.9), suggesting an aggressive malignancy
  • The final diagnosis of localised malignant mesothelioma rested on two things. The tissue had epithelioid features. It also stained positive for cytokeratin markers (MNF116, AE1/AE3) and for the mesothelial markers calretinin, D2-40 and WT1
  • Surgical resection was complete, with margins free from tumour cells at histology, and no chemotherapy was prescribed
  • Follow-up CT scans every 4 months showed no local recurrence or metastatic spread, up to the last whole-body scan 1 year and 3 months after diagnosis
• The authors' conclusion: The authors stated that localised malignant mesothelioma is extremely rare and that the role of asbestos exposure in it is still controversial. They also said that when local invasion and pleural effusion are absent, as in this patient, distinguishing it from benign or low-grade lesions on CT can be extremely challenging. In their view, histology and immunohistochemistry remain the gold standard for precise characterisation

Topics

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

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