A case of malignant mesothelioma in a young patient with childhood leukaemia who had received total body irradiation

Our plain-English summary of A case of malignant mesothelioma in a young patient with childhood leukaemia who had received total body irradiation, by R. Hayat, S. Ahmed, R. Badiger, et al (Oxford Medical Case Reports, 2023).

The study

• Authors: R. Hayat, S. Ahmed, R. Badiger, S.H. Lee, A. Peryt, D. Gilligan, Z. Khalid
• Journal: Oxford Medical Case Reports
• Published: 2023;2023(5):omac151
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This case report explores a 34-year-old male diagnosed with mesothelioma who had no known risk factors. The patient initially was treated for empyema with antibiotics but later represented to hospital with worsening symptoms. He underwent a surgical Video-assisted thoracoscopic surgery procedure and lung biopsy, which revealed a diagnosis of mesothelioma. The young age of the patient as well as absence of significant risk factors for mesothelioma made the diagnosis unexpected. The patient had total body irradiation (TBI) therapy for leukaemia as a child, which increases the risk of developing cancer. However, there are limited studies exploring the risk of pleural mesothelioma post-TBI. Young patients who represent to hospital, with limited response to initial treatment, and suspicious radiological features should be considered for lung biopsy to reduce the risk of a missed diagnosis. Patients with a background of TBI should also be considered for follow-up to monitor for any subsequent malignancy.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2022.

In plain English

This UK case report described a 34-year-old man diagnosed with pleural mesothelioma. As a child he had received total body irradiation (TBI) for leukaemia. He had also had thyroid cancer, was a non-smoker, and had no asbestos exposure history. The authors described an absence of asbestos tissue in his body. A CT scan showed marked thickening of the left lung lining, with fluid. He was first treated with antibiotics for a suspected empyema, a collection of pus around the lung. He returned two months later with worse symptoms. Pleural fluid tests found no organisms. A biopsy of the left parietal pleura showed epithelioid mesothelioma, stage T4 N1 M0. Too unwell for chemotherapy, he died 17 months after first presenting, aged 35. TBI preceded the mesothelioma by 29 years. The authors considered whether TBI may have contributed. Their literature search found no similar prior case. They suggested early imaging and then biopsy for young patients with extensive pleural thickening when infection seemed unlikely. They also suggested lifelong monitoring after TBI. The report describes one patient and does not give a rate or establish a cause.

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
• Who was studied: One 34-year-old man in the UK with a history of childhood leukaemia and of thyroid cancer (thyroidectomy), and no family history of note
• Exposure: Total body irradiation given as treatment for childhood leukaemia, 29 years before the mesothelioma developed. The patient had no history of asbestos exposure and was a non-smoker.
• Main results:
  • A CT scan of the thorax showed marked pleural thickening with a left-sided effusion. The working diagnosis was empyema, which was treated with intravenous antibiotics.
  • Microbiology and cytology of the left pleural fluid found no organisms and no growth
  • Biopsies of the left lung parietal pleura, taken during video-assisted thoracoscopic surgery, showed epithelioid mesothelioma T4 N1 M0
  • The tumour was diffusely positive for the mesothelial markers calretinin and WT1
  • The authors described an absence of asbestos tissue in the patient's body. The report does not describe how this was assessed.
  • The patient was unsuitable for palliative chemotherapy and received supportive care. He died 17 months after his initial presentation, at age 35.
  • The authors' systematic literature search found no similar prior cases. They believed this was the first case of its kind.
• The authors' conclusion: The authors considered that total body irradiation may have contributed to this patient's mesothelioma. They suggested early radiological investigation and subsequent biopsy for young patients with extensive pleural thickening and a low suspicion of an infective cause. They said lifelong monitoring after TBI is important for early detection of later cancers. They called for further research on the risk of pleural mesothelioma after TBI.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Empyema, Video-Assisted Thoracoscopic Surgery (VATS), Biopsy, Pleural Mesothelioma.

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• Select mortality and cancer incidence among residents in various U.S. communities that received asbestos-contaminated vermiculite ore from Libby, Montana — D.K. Horton, F. Bove, et al. (2008)
• Malignant Pleural Mesothelioma in Patients Who Previously Received Radiotherapy for Their First Malignant Tumor — I. Sekine, Y. Yamamoto, et al. (2021)
• Anti-cancer therapy using dendritic cells and apoptotic tumour cells: pre-clinical data in human mesothelioma and acute myeloid leukaemia — M. Grégoire, C. Ligeza-Poisson, et al. (2003)
• Changes in surfactant in bronchoalveolar lavage fluid after hemithorax irradiation in patients with mesothelioma — M. Hallman, P. Maasilta, et al. (1990)

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