An Unexpected Case of Malignant Mesothelioma in a Young Woman

Our plain-English summary of An Unexpected Case of Malignant Mesothelioma in a Young Woman, by U. Dhamrah, N. Solomon, O.C. Osuoji (Journal of Investigative Medicine High Impact Case Reports, 2021).

The study

• Authors: U. Dhamrah, N. Solomon, O.C. Osuoji
• Journal: Journal of Investigative Medicine High Impact Case Reports
• Published: 2021;9:2324709621997245
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

A 41-year-old female with a past medical history significant only for right retinal vein occlusion presented with chest pain, cough, and shortness of breath. After being found to have a large right-sided pleural effusion and undergoing a nondiagnostic thoracentesis, a noncontrast chest computed tomography scan revealed multiple diffuse nodules in the right lung with irregular paraspinal pleural thickening. An extensive workup followed, with computed tomography-guided biopsy ultimately revealing the diagnosis. The following report describes the patient presentation, laboratory findings, and extensive clinical investigation, and provides a discussion of the epidemiology, imaging findings, prognosis, and differential diagnoses for the illness in question.

In plain English

This case report described one patient, a 41-year-old woman whose only notable past medical history was a right retinal vein occlusion. The patient had chest pain, cough and shortness of breath. Imaging showed a large fluid collection around the right lung (pleural effusion), and a chest tube drained approximately 2400 mL of fluid. Tests on the fluid found cells thought to be malignant, but their unusual staining pattern prevented classification, and a biopsy taken through the airways was inconclusive. A CT-guided biopsy of the right pleura was consistent with malignant pleural mesothelioma, diagnosed as stage IV, epithelioid type. Tuberculosis was ruled out. When asked about exposures, the patient reported 6 months in a sewing factory 20 years earlier and denied any dust exposure there. The patient also reported cleaning up after construction workers in the apartment about 18 years earlier, and described a similar situation 2 years earlier. The authors described a lack of obvious history of exposure to asbestos. The authors concluded that this cancer may be difficult to diagnose, particularly when unexpected, and that biopsy may be required for a definitive diagnosis.

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 (one patient)
• Who was studied: One 41-year-old female patient, originally from Mexico, who had lived in the United States for 19 years, worked at a restaurant and did not smoke. Where and when the patient was treated is not stated in the text.
• Exposure: No confirmed asbestos exposure and no fiber type reported. The patient reported about 6 months of work in a sewing factory 20 years earlier, denying any dust or occupational exposures. Around 18 years earlier, the apartment had construction in 3 of the 5 rooms and the patient cleaned up after the workers. A similar situation occurred 2 years earlier.
• Main results:
  • The patient had a large right-sided pleural effusion; a chest tube drained approximately 2400 mL of serosanguinous fluid over 72 hours.
  • Pleural fluid cytology showed cells with an unusual immunostaining profile that prevented classification of the primary tumor.
  • A bronchoscopic biopsy gave findings considered consistent with mesothelial origin but could not be further characterized, so re-biopsy was recommended.
  • A CT-guided biopsy of right-sided pleural tissue showed poorly differentiated carcinoma morphology with necrosis and an immunostaining profile consistent with malignant pleural mesothelioma.
  • The patient was diagnosed with stage IV malignant pleural mesothelioma, epithelioid type, with malignant effusion, multiple pleural nodules, and mediastinal and retrocrural lymphadenopathy.
  • Pulmonary tuberculosis was ruled out, including by 3 sputum samples negative for acid-fast bacilli.
  • The authors considered asbestos-related diffuse pleural thickening less likely, citing the nodular appearance of the lesions and the lack of obvious history of asbestos exposure.
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma is an aggressive malignancy with a wide differential that may be difficult to diagnose, particularly when the diagnosis is unexpected, and that biopsy may be required in difficult cases for a definitive diagnosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Effusion, Thoracentesis, Pleural Thickening, Biopsy, Epidemiology, Prognosis.

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