A rare case of a huge malignant pleural mesothelioma presenting in the posterior mediastinum

Our plain-English summary of A rare case of a huge malignant pleural mesothelioma presenting in the posterior mediastinum, by Y. Mori, C. Kato, H. Yamakawa, et al (Respirology Case Reports, 2024).

The study

• Authors: Y. Mori, C. Kato, H. Yamakawa, M. Sugiura, K. Fukumitsu, S. Fukuda, Y. Kanemitsu, T. Uemura, T. Tajiri, H. Ohkubo, Y. Ito, T. Oguri, T. Murase, A. Niimi
• Journal: Respirology Case Reports
• Published: 2024;12(7):e01429
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We report a case of a 69-year-old woman with pleural mesothelioma presenting in the posterior mediastinum with a maximum diameter of 25 cm. She had a chronic cough and a pleural effusion was noted on chest X-ray. The examination of the effusion showed high hyaluronic acid levels, and mesothelioma was suspected. A chest computed tomography scan showed a huge mediastinal mass, which caused rapid progression of respiratory failure and compression of the heart. Sufficient tissue samples could not be obtained before death. The patient died approximately 1 month after the initial visit, and a pathological autopsy was performed. The diagnosis of malignant pleural mesothelioma was made. Malignant pleural mesothelioma with a huge posterior mediastinal mass such as in this case is considerably rare; however, it is a rapidly progressing form of the disease and is reported here as an important differential diagnosis for mediastinal tumours.

© 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This case report from Japan described one patient, a 69-year-old woman with a cough of 3 months and fluid around the right lung. She had worked in an office and then as a housewife. The authors found no history of asbestos exposure, but said environmental exposure could not be ruled out because a family member was a sign-maker. The fluid had a hyaluronic acid level of 271,000 ng/mL and suggested mesothelioma, but no definitive diagnosis was reached. Scans showed a huge mass in the posterior mediastinum, the space between the lungs toward the back. About a month after her first visit, the tumour compressed her heart and airways, and she died of respiratory failure before sufficient tissue could be obtained. Autopsy found a 25 cm mass invading the trachea, oesophagus and aorta, diagnosed as epithelioid pleural mesothelioma. No asbestos bodies were detected. The authors concluded that this rare form should be considered among possible causes of mediastinal tumours because it can narrow the airways quickly.

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), including autopsy findings
• Who was studied: One 69-year-old woman referred to the authors' hospital (Nagoya City University, Japan) with a cough that began 3 months before presentation and a right pleural effusion; dates not stated
• Exposure: No history of asbestos exposure and no pleural plaques. She had an office job and then was a housewife. The authors said environmental asbestos exposure could not be ruled out because a family member was a sign-maker. No asbestos bodies were found at autopsy.
• Main results:
  • The right pleural effusion had a hyaluronic acid level of 271,000 ng/mL
  • Pathological findings on the pleural fluid were more suggestive of malignant mesothelioma than reactive mesothelium, but no definitive diagnosis was reached before death
  • The patient died of respiratory failure 5 days after being brought to the emergency department, about 1 month after the first visit
  • At autopsy, a mass with a maximum diameter of 25 cm was found in the posterior mediastinum. It had invaded the trachea, oesophagus and aorta.
  • Immunostaining was positive for WT1, calretinin and D2-40. The final diagnosis was epithelioid pleural mesothelioma.
  • The disease was staged as IIIB (aT4NxM0). Asbestos bodies were not detected.
  • The pleural wall on the right mediastinal side was presumed to be the primary site
  • In their review of previous reports, the authors found only one other case of malignant pleural mesothelioma presenting as a posterior mediastinal tumour
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma extending to the mediastinum is rare but should be considered in the differential diagnosis of mediastinal tumours, because it can cause airway narrowing with a rapid course
• Limitations the authors state:
  • Sufficient tissue samples could not be obtained before death, so the diagnosis was made only at autopsy
  • Lymph node metastasis could not be evaluated
  • Environmental asbestos exposure could not be ruled out because a family member was a sign-maker

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mediastinum, Pleural Effusion, Chest X-Ray, Hyaluronic Acid, Mesothelioma, Autopsy, Differential Diagnosis.

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