Unexplained Pleural Effusion Leads to the Revelation of a Malignant Mesothelioma: A Case Report

Our plain-English summary of Unexplained Pleural Effusion Leads to the Revelation of a Malignant Mesothelioma: A Case Report, by M. Rhazari, O. Moueqqit, S. Gartini, et al (Curēus, 2022).

The study

• Authors: M. Rhazari, O. Moueqqit, S. Gartini, S. El Morabit, S. Diani, M. Aharmim, A. Thouil, H. Kouismi, J.E. El Bourkadi
• Journal: Curēus
• Published: 2022;14(4):e24478
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a rare and aggressive cancer that usually affects subjects with prior asbestos exposure, a major risk factor that has been widely known as carcinogenic, and its use is now controlled if not banned in many areas of the world. Malignant mesothelioma originates from mesothelial surface cells covering the serous cavities, and the pleura is its most common site. Malignant pleural mesothelioma (MPM) typically presents with pleural effusion and chest wall pain with wide pleural thickening at radiological investigation. Although the histological examination along with immunohistochemistry helps yield the diagnosis, clinicians and experts face many challenges in diagnosing malignant mesothelioma not only due to the rarity of the disease but also due to the similarities that the disease share with other malignancies. Here, we report a case of a 55-year-old male patient with a history of chronic asbestos work exposure for 12 years who initially presented with unexplained pleural effusion and chest wall pain and was lost to follow-up but came back later with a worsening clinical state. This case is specially presented to raise awareness against cases of unexplained pleural effusion and chest pain.

Copyright © 2022, Rhazari et al.

In plain English

This article was a case report describing one 55-year-old man. He had been exposed to asbestos for 12 years while working for a construction company (the discussion section instead says pipe industries), and his last exposure was 28 years earlier. The type of asbestos fiber was not stated. About a year before diagnosis, at another hospital, he had sharp left chest pain and a left pleural effusion (fluid around the lung). Fluid tests found no tuberculosis and no atypical cells, and a pleural biopsy was negative. He was given antibiotics but was lost to follow-up. He returned 11 months later with constant chest pain, breathlessness and weight loss. A CT scan showed nodular thickening of the left pleura with lymph node spread. A CT-guided biopsy with immunohistochemistry (tissue staining) led to a diagnosis of malignant epithelioid mesothelioma. He received pemetrexed plus carboplatin chemotherapy and reported clinical improvement, and he was under follow-up after three months of treatment. The authors concluded that awareness should be increased for unexplained pleural effusion and chest wall pain, with or without asbestos exposure. As a limitation, they noted that an earlier CT scan could have helped diagnose the disease sooner.

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 55-year-old male patient. The authors are from pulmonology departments and medical faculties in Oujda and Rabat, Morocco. He was first seen one year earlier at another hospital.
• Exposure: Asbestos exposure for 12 years while working for a construction company, with the last exposure 28 years earlier. The fiber type and products were not stated. The discussion section describes the work instead as pipe industries.
• Main results:
  • At first presentation, the patient had sharp left chest pain and a low left pleural effusion. The fluid was an amber exudate with a total white blood cell count of 2455/µL (19% neutrophils, 75% lymphocytes, 6% monocytes).
  • The initial work-up found no tuberculosis bacteria and no atypical cells, and the pleural biopsy was negative. After a chest x-ray showed infiltrates four weeks later, he was treated with antibiotics.
  • After being lost to follow-up, he returned 11 months later with sharp, permanent left chest pain, grade 3 mMRC dyspnea and subjective weight loss.
  • A chest CT scan showed left nodular thickening of the pleura with pulmonary, sub- and supradiaphragmatic lymph node metastasis.
  • A CT-guided biopsy with immunohistochemistry (tumor cells reacting strongly to D2-40, calretinin, WT1, CK 5/6 and EMA) led to a diagnosis of malignant epithelioid mesothelioma.
  • He was treated with first-line pemetrexed plus carboplatin chemotherapy. He reported clinical improvement and was under regular follow-up after three months of treatment.
• The authors' conclusion: The authors concluded that malignant mesothelioma remains a serious threat with a poor prognosis. They wrote that awareness should be increased when treating people with unexplained pleural effusion and chest wall pain, with or without a history of asbestos exposure.
• Limitations the authors state:
  • The authors stated that a CT scan should have been done after the first fluid drainage, when an infiltrative mass and high lymphocyte counts were found, and that this could have helped diagnose the condition earlier. Instead, an infection was accepted as the explanation and antibiotics were started.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Malignant Mesothelioma, Asbestos Exposure, Carcinogenic, Serous Cavities, Pleura, Pleural Mesothelioma, Pleural Thickening.

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