25-year old male with pleural thickening

Our plain-English summary of 25-year old male with pleural thickening, by A. Ahuja, D. Gothi, G. Amonkar, et al (Lung India, 2008).

The study

• Authors: A. Ahuja, D. Gothi, G. Amonkar, J.M. Joshi
• Journal: Lung India
• Published: 2008;25(2):82-4
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The growth of some of the adenocarcinomas is virtually identical to that of malignant mesothelioma, also known as pseudomesotheliomatous adenocarcinoma of lung. Their differentiation on the basis of histopathology can pose diagnostic difficulties; hence immunohistochemistry and electron microscopy may be required for further differentiation.

In plain English

This case report described a single patient: a 25-year-old male non-smoker who had left-sided chest pain, dry cough and breathlessness on exertion for two months. He had been treated with antituberculosis drugs for a left-sided pleural effusion. He denied any history of exposure to organic or inorganic dust, and the article does not mention asbestos. CT scanning showed diffuse left-sided pleural thickening and a large soft tissue mass. Fluid from the pleura was negative for malignant cells. Under the microscope, a biopsy of the mass looked like either adenocarcinoma or the epitheloid type of mesothelioma. Immunohistochemical staining favored adenocarcinoma. The diagnosis was pseudomesotheliomatous adenocarcinoma of the lung at stage 3b. This is a lung cancer that spreads along the pleura in the way mesothelioma does. The patient was referred to oncology. The authors stated that this tumor is rare in an HIV-negative patient in the third decade of life. They wrote that telling it apart from mesothelioma may require immunohistochemistry and electron microscopy.

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 25-year-old male non-smoker. The authors describe him as HIV negative.
• Exposure: No asbestos or other dust exposure was reported: the patient denied exposure to organic or inorganic dust. Asbestos is not mentioned in the article.
• Main results:
  • The patient had been treated with antituberculosis drugs for two months for a left-sided pleural effusion before this diagnosis.
  • CT of the thorax showed left-sided diffuse pleural thickening and a large soft tissue mass arising from the thoracic and mediastinal pleura.
  • Pleural fluid was an exudate, negative for malignant cells, bacteria, fungi and mycobacteria.
  • Biopsy histopathology was suggestive of either adenocarcinoma or epitheloid mesothelioma.
  • Immunohistochemistry showed:
• diffuse positivity for cytokeratin (CK) and epithelial membrane antigen (EMA);
• fluffy positivity for carcinoembryonic antigen (CEA);
• thin membrane positivity for HBME-1.

The authors said this pattern favored adenocarcinoma.

• The final diagnosis was peripheral adenocarcinoma of the lung with extensive pleural involvement (pseudomesotheliomatous adenocarcinoma), stage 3b. The patient was referred to oncology.
• The authors' conclusion: The authors concluded that this tumor can be hard to tell apart from mesothelioma on histopathology alone. They said immunohistochemistry and electron microscopy may be required, and that its occurrence in an HIV-negative patient in the third decade of life, as in this case, is rare.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Thickening, Adenocarcinoma, Mesothelioma, Pseudomesotheliomatous Adenocarcinoma, Histopathology, Immunohistochemistry.

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