Cytological Profile of a Case of Malignant Mesothelioma of Pleura with Supraclavicular Lymph Node Metastasis

Our plain-English summary of Cytological Profile of a Case of Malignant Mesothelioma of Pleura with Supraclavicular Lymph Node Metastasis, by P.V. Priya, S. Deepa, P.L. Jayalakshmy (Journal of Cytology, 2017).

The study

• Authors: P.V. Priya, S. Deepa, P.L. Jayalakshmy
• Journal: Journal of Cytology
• Published: 2017;34(4):224-226
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma of pleura is a locally aggressive rare neoplasm of mesothelial cells, which produces distant metastasis in advanced stages of its course. It is exceptional for patients to present with metastasis prior to the detection of primary tumor in the pleura. Here, we report a case of malignant mesothelioma of pleura in a 65-year-old quarry worker where the initial diagnosis was offered by fine needle aspiration of an enlarged supraclavicular lymph node. Subsequent pleural fine needle aspiration cytology (FNAC), tumor biopsy, and immunohistochemical analysis confirmed the diagnosis.

In plain English

This case report came from the Department of Pathology, Government Medical College, Kottayam, Kerala, India. It described a man who had worked in a quarry for 25 years and smoked beedis for 30 years. He was admitted with right-sided chest pain and breathlessness lasting one year, and had a hard lymph node above the right collarbone measuring 3 by 2 cm. The case history gives his age as 50, but the abstract says 65. The article does not state whether this patient had asbestos exposure. A needle sample from the neck node showed cancer cells. The authors thought these could have spread from pleural mesothelioma or from lung adenocarcinoma. A CT scan showed fluid around the right lung and thickened, nodular pleura. A needle sample from a pleural nodule showed similar cells. Biopsy staining was negative for mucicarmine and positive for calretinin and epithelial membrane antigen, which confirmed malignant mesothelioma of the pleura. The authors concluded that this cancer rarely first appears as spread to a lymph node outside the chest, and that extra material for staining is needed to confirm the 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
• Who was studied: One male patient seen at the Department of Pathology, Government Medical College, Kottayam, Kerala, India. The case history gives his age as 50 years; the abstract gives 65 years.
• Exposure: Quarry work for 25 years and beedi smoking for 30 years. The article does not state whether this patient had asbestos exposure.
• Main results:
  • The patient had a hard right supraclavicular lymph node measuring 3 by 2 cm.
  • Fine needle aspiration of the supraclavicular lymph node showed malignant cells consistent with metastasis. The authors suggested spread from malignant mesothelioma of pleura or from adenocarcinoma of the lung.
  • CT of the thorax showed pleural effusion and right parietal pleural thickening with nodularity. The radiological differential diagnoses were sequelae of empyema, silicosis, and malignancy.
  • Fine needle aspiration of a pleural nodule showed cells similar to those in the lymph node.
  • In the transbronchial biopsy, the tumor cells were negative for mucicarmine and positive for calretinin and epithelial membrane antigen, which confirmed malignant mesothelioma of pleura.
• The authors' conclusion: The authors concluded that it is exceptional for malignant mesothelioma to present with extrathoracic lymph node metastasis before the primary pleural tumor is detected. They also concluded that diagnosing it by needle aspiration of a lymph node is a challenge without an earlier mesothelioma diagnosis, and that material for cell block, cytochemistry or immunohistochemistry is mandatory to confirm the diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleura, Metastasis, Neoplasm, Mesothelial Cells, Cytology, Biopsy.

Related studies

• Peritoneal malignant mesothelioma metastatic to supraclavicular lymph nodes — S. Zannella, M.A. Testi, et al. (2014)
• Malignant pleural mesothelioma without asbestos exposure with distant metastasis in a peripheral lymph node: a case report — S. Kant, S.K. Verma, et al. (2008)
• Malignant peritoneal mesothelioma with lymph node metastasis that originated in the transverse colon — Y. Takehara, S. Endo, et al. (2014)
• Asbestos content of lung tissue, lymph nodes, and pleural plaques from former shipyard workers — R.F. Dodson, M.G. Williams, et al. (1990)
• Intrapulmonary lymph nodes. Clinical, radiologic, and pathologic features — R.L. Kradin, P.W. Spirn, et al. (1985)
• Lymph node metastases in diffuse malignant peritoneal mesothelioma — D. Baratti, S. Kusamura, et al. (2010)

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