Asbestos-Related Pulmonary Spindle Cell Carcinoma Presenting With Ileus: An Autopsy Case Report

Our plain-English summary of Asbestos-Related Pulmonary Spindle Cell Carcinoma Presenting With Ileus: An Autopsy Case Report, by K. Yamane, S. Moriyama, S. Ishikawa, et al (Curēus, 2025).

The study

• Authors: K. Yamane, S. Moriyama, S. Ishikawa, K. Fukutani, A. Yamasaki
• Journal: Curēus
• Published: 2025;17(5):e83634
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

We present the case of an 84-year-old male with a history of occupational asbestos exposure who initially developed ileus, which was later found to be related to an aggressive pulmonary malignancy. Imaging revealed extensive pleural thickening, peritoneal dissemination, and ileus. Postmortem examination confirmed a diagnosis of pulmonary spindle cell carcinoma (PSCC), supported by immunohistochemical analysis and the presence of numerous asbestos bodies in lung tissue. This case highlights the diagnostic complexity of rare thoracic malignancies, particularly when presenting with atypical features such as ileus. Further investigation is warranted to better understand asbestos-related carcinogenesis and to improve diagnostic and treatment approaches.

Copyright © 2025, Yamane et al.

In plain English

This was a case report of one patient: an 84-year-old non-smoking man exposed to asbestos at work in a boiler room on cargo ships from his 20s to his 40s. He came to the authors' hospital with lower abdominal pain. Scans showed a mass in the right lower lung, fluid around the right lung and the heart, pleural thickening, and abdominal nodules with bowel obstruction (ileus), but no pleural plaques or interstitial lung disease. He died on the eighth hospital day, before a lung biopsy could be done. At autopsy, the authors diagnosed pulmonary spindle cell carcinoma, a rare lung cancer. It had spread through the abdomen and narrowed the sigmoid colon, which they considered the cause of the ileus. Tumor stains were negative for mesothelial markers. The authors said this argued against sarcomatoid mesothelioma, though it could not be completely excluded. Non-tumorous lung tissue held 12,183 asbestos bodies per gram of dried tissue, above the Helsinki Criteria threshold of 5,000 cited by the authors. The authors concluded this asbestos burden suggests a potential causal role in the tumor's sarcomatoid transformation.

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: Autopsy case report (single patient)
• Who was studied: One 84-year-old man who came to the authors' hospital with lower abdominal pain; date of presentation not given
• Exposure: Occupational asbestos exposure from his 20s to his 40s while working in a boiler room on cargo ships; the asbestos fiber type is not reported; asbestos bodies were counted in lung tissue
• Main results:
  • The patient was a non-smoker
  • On CT at admission there were no findings of pleural plaques or interstitial lung disease
  • Pericardial drainage removed 560 mL of bloody fluid, which contained malignant cells
  • The patient died on the eighth hospital day
  • At autopsy, spread tumor surrounded and narrowed the sigmoid colon, which was considered the cause of the ileus
  • The tumor stained positive for vimentin and the epithelial markers AE1/AE3, CK7 and EMA
  • The tumor stained negative for the mesothelial markers calretinin, D2-40, WT-1 and CK5/6
  • Non-tumorous lung tissue contained 12,183 asbestos bodies per gram of dried lung tissue
  • The authors stated that this count far exceeded the Helsinki Criteria threshold of 5,000 or more asbestos bodies per gram of dried lung tissue
  • The cause of death was determined to be progression of primary pulmonary spindle cell carcinoma originating in the right lung
• The authors' conclusion: The authors concluded that the significant asbestos burden suggests a potential causal (etiologic) role in the process of sarcomatoid transformation
• Limitations the authors state:
  • Sarcomatoid mesothelioma could not be completely excluded
  • Because of rapid deterioration, no biopsy of the lung lesion could be performed during life
  • Symptoms such as constipation may have been underreported because of the patient's cognitive impairment

Topics

Medical terms in this study, explained in our Lexicon: Spindle Cell, Carcinoma, Autopsy, Asbestos Exposure, Pleural Thickening, Asbestos Bodies, Carcinogenesis.

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