Diagnostic pitfall in a large cell lung cancer with testicular metastasis synchronous malignant pleural mesothelioma patient: A case report

Our plain-English summary of Diagnostic pitfall in a large cell lung cancer with testicular metastasis synchronous malignant pleural mesothelioma patient: A case report, by L. Jiang, V.A. De Souza, N.M. George, et al (Thoracic Cancer, 2022).

The study

• Authors: L. Jiang, V.A. De Souza, N.M. George, N.P. Rai, M. Shi, G. Che
• Journal: Thoracic Cancer
• Published: 2022;13(15):2253-2256
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Large cell lung cancer metastases to the testis are scarce, although it is the most common malignancy and the most common site of metastases for breast, colorectal and kidney cancers. We hereby report a 28-year-old male patient admitted to our hospital with a chief complaint of scrotal enlargement, accompanied by chest pain and progressive dyspnea. The definite diagnosis was malignant pleural mesothelioma with the synchronous occurrence of large cell lung cancer with testicular metastasis. Sophisticated clinical manifestation of symptoms led to a time-consuming diagnosis, while the patient's condition deteriorated rapidly. Herein, we present this case to share our hard-learnt experience to increase clinician awareness and contribute to the information in the literature.

© 2022 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This case report described one patient treated at Sichuan University West China Hospital in Chengdu, China. He was a 28-year-old man who came to the urology clinic with enlargement and discomfort of the right scrotum for 6 months, along with chest pain and shortness of breath. His shortness of breath had worsened during a one-month trial of tuberculosis treatment, and he had no history of smoking. A chest CT scan showed fluid around both lungs, partly collapsed lung, and enlarged lymph nodes in the chest. Tests on cells from the chest fluid led to a diagnosis of malignant pleural mesothelioma. Because the right testicular mass was growing quickly, the testicle was removed. Its examination showed large cell lung cancer that had spread to the testis. The patient died of respiratory failure. The authors wrote that his first complaint was limited to the scrotum, which held back a full examination and an early diagnosis. They concluded that physicians should be aware that young and adult patients with pleural effusion may have more than one cancer. The article did not mention asbestos or any work-related or environmental exposure.

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 28-year-old man seen at Sichuan University West China Hospital, Chengdu, China; dates of care not given
• Main results:
  • The patient had a right scrotal mass for 6 months, chest pain and shortness of breath. The shortness of breath worsened during a 1-month antituberculosis treatment trial.
  • The patient had no history of smoking.
  • The baseline chest CT showed fluid around both lungs (bilateral hydrothorax), segmental atelectasis and enlarged mediastinal lymph nodes. Ultrasound showed an enlarged right testis.
  • Cells from the pleural fluid stained positive for markers including calretinin, D2-40, WT1 and pancytokeratin, and malignant pleural mesothelioma was diagnosed.
  • Because the right testicular mass was growing rapidly, an orchiectomy was performed. Pathology of the testis showed large cell lung cancer with testicular metastasis.
  • The patient died of respiratory failure, which the authors attributed to cancer-related atelectasis, pneumonia and hydrothorax.
  • The authors wrote that the patient's first complaint was limited to the scrotum and testicles. In their view, this restricted a thorough investigation and led to a missed chance of early diagnosis.
• The authors' conclusion: The authors concluded that physicians should be aware of the possibility of multiple malignant tumors in young and adult patients who present with pleural effusion.
• Limitations the authors state:
  • The authors noted that the possibility of a mixed tumor of both types should be considered.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Metastasis, Pleural Mesothelioma, Dyspnea.

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