Biphasic pleural mesothelioma treated successfully with multimodal therapy: a case report

Our plain-English summary of Biphasic pleural mesothelioma treated successfully with multimodal therapy: a case report, by K. Omura, R. Fukai, T. Nishida, et al (General Thoracic and Cardiovascular Surgery Cases, 2023).

The study

• Authors: K. Omura, R. Fukai, T. Nishida, N. Yamaguchi, W. Naitoh, S. Teshima, S. Tobe, M. Hibino, F. Tanaka, M. Noguchi
• Journal: General Thoracic and Cardiovascular Surgery Cases
• Published: 2023;2(1):57
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleural mesothelioma is an aggressive malignant tumor and has a poor prognosis. In particular, biphasic pleural mesothelioma is a less common histologic type, and successful outcomes are rare.

Case Presentation: A 60-year-old man was referred to our associated hospital because of dyspnea. Massive right pleural effusion and thickening of the entire right parietal pleura were revealed by radiological examination. After pleural biopsy, we diagnosed the patient's tumor as biphasic pleural mesothelioma. The patient was admitted to our hospital for multimodal treatment. Two cycles of chemotherapy were initially administered with dramatic effects. Therefore, we decided to perform surgery and achieved a macroscopic complete resection. Postoperative chemotherapy was administered with no adverse events. No recurrence has been observed 11 months post-operation.

Conclusions: We encountered a case of biphasic pleural mesothelioma that responded well to chemotherapy, enabling macroscopic complete resection.

© 2023. The Author(s).

In plain English

This case report from Japan described one 60-year-old man with breathlessness. Scans showed a large right-sided fluid build-up and thickening of the whole right chest lining. A biopsy showed biphasic pleural mesothelioma, a cancer of the lining around the lung that contains two cell types. The article described no asbestos or other exposure history. The man first received two cycles of chemotherapy with cisplatin and pemetrexed. Doctors judged this a partial response, and the PET scan signal (FDG uptake) had completely disappeared in some areas. Surgeons then removed the lung lining (pleurectomy/decortication), the diaphragm and the pericardium near a large vein, taking out all visible tumor. He went home 15 days after surgery. A marker of tumor cell growth fell from 40% in the biopsy to 10% in the removed tissue. He had four more cycles after surgery, and no recurrence had been observed 11 months after the operation. The authors said they could not determine why the tumor responded. As a single case, it shows what happened to one patient, not how often this treatment works.

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 60-year-old man with dyspnea, treated at Shonan Kamakura General Hospital, Kamakura, Japan; dates of treatment not stated
• Exposure: Not reported: the article does not describe asbestos or any other exposure history for the patient
• Main results:
  • A pleural biopsy showed epithelial and spindle-shaped non-epithelioid cells, and the tumor was diagnosed as biphasic pleural mesothelioma
  • After two cycles of cisplatin and pemetrexed, the response was judged a partial response by modified RECIST criteria
  • After chemotherapy, FDG uptake on PET had completely disappeared in some parts of the right parietal pleura
  • Non-incisional pleurectomy/decortication, with resection of the pericardium around the inferior vena cava and the diaphragm, achieved macroscopic complete resection
  • The patient was discharged 15 days after surgery; the postoperative course was generally uneventful apart from a prolonged air leak
  • Viable tumor cells were found in the resected diaphragm (but not in the pericardium and vessel sheath, according to the article)
  • The MIB-1 labeling index (a measure of tumor cell growth) was 40% in the biopsy material and 10% in the resected material
  • Chemotherapy with the same regimen was restarted three months after surgery, and four postoperative cycles were completed with no adverse events
  • No recurrence had been observed 11 months after the operation
• The authors' conclusion: The authors concluded that this was a case of biphasic pleural mesothelioma that responded well to chemotherapy, enabling macroscopic complete resection
• Limitations the authors state:
  • The authors could not determine the reason for the positive response to chemotherapy

Topics

Medical terms in this study, explained in our Lexicon: Biphasic Mesothelioma, Pleural Mesothelioma, Multimodal Therapy, Prognosis, Dyspnea, Pleural Effusion, Parietal Pleura, Pleural Biopsy.

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