Diffuse Pleural Mesothelioma Initially Presenting as Cervical Lymphadenopathy: A Report of a Rare Case

Our plain-English summary of Diffuse Pleural Mesothelioma Initially Presenting as Cervical Lymphadenopathy: A Report of a Rare Case, by K. Saha, S. Ghosh, S. Poddar (Curēus, 2026).

The study

• Authors: K. Saha, S. Ghosh, S. Poddar
• Journal: Curēus
• Published: 2026;18(8):e114875
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Diffuse mesothelioma is a rare malignant tumor arising from mesothelial cells, showing diffuse involvement of the pleura and having a strong association with asbestos exposure. Cervical lymphadenopathy as the initial presentation of pleural mesothelioma is very unusual to date. We report here such a rare case of diffuse pleural mesothelioma in a 42-year-old male patient who primarily presented with left-sided lower cervical lymphadenopathy. Fine-needle aspiration cytology (FNAC) from the lymph nodes demonstrated hypercellular smears with polygonal epithelioid cells arranged mostly as singly scattered cells, loosely cohesive clusters, monolayered pavement-like sheets, and spheroid groups. Many cells displayed binucleation, multilobed nuclei, cytoplasmic vacuoles, fuzzy cell borders, and mitotic figures. Guided tru-cut biopsy from the lymph node revealed diffuse sheets of atypical epithelioid cells with abundant eosinophilic cytoplasm, with large nuclei and prominent nucleoli in places. The tumor cells were immunopositive for pancytokeratin, CK5/6, EMA, Calretinin, D2-40, and WT1 while negative for all other relevant markers. Diffuse, irregular thickening and nodularity of left-sided pleura and mediastinal lymphadenopathy were identified on contrast-enhanced computed tomography (CECT). It is very important to consider metastatic pleural mesothelioma in the differential diagnosis of lymph node mass on FNAC, especially in the cervical region, to avoid misdiagnosis or delay in the correct diagnosis of this strikingly unusual presentation.

Copyright © 2026, Saha et al.

In plain English

This article is a case report about one patient, a 42-year-old male construction worker, whose diffuse pleural mesothelioma was first noticed as enlarged lymph nodes in the lower left side of the neck. He had no other complaints, such as breathing difficulty or chest pain. A fine-needle sample from the neck nodes favored an epithelioid malignant tumor. A needle biopsy showed sheets of abnormal epithelioid cells that stained positive for markers including calretinin, WT1, CK5/6 and D2-40, and negative for many markers used to rule out other cancers. A CT scan showed diffuse, irregular thickening and nodules of the left pleura (the lining around the lung), mild fluid on that side, and enlarged lymph nodes in the chest. The article does not say whether the patient had been exposed to asbestos, and it does not describe treatment or outcome. The authors concluded that pathologists should consider mesothelioma when they find a metastatic epithelioid tumor in a lymph node with no known primary site.

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 (single patient)
• Who was studied: One 42-year-old male construction worker. The authors are from pathology and radiotherapy departments in Berhampore, India. The article does not give the date the patient was seen.
• Exposure: The article gives the patient's job as construction worker but reports no asbestos exposure history, no fiber type and no exposure measurement for this patient.
• Main results:
  • The patient's only complaint was enlarged lymph nodes in the lower left neck. He had no breathing difficulty or chest pain.
  • Fine-needle aspiration cytology of the neck lymph node favored an epithelioid malignant tumor, and lymphoid malignancies were almost excluded.
  • An ultrasound-guided tru-cut biopsy of the lymph node showed diffuse sheets of atypical epithelioid cells.
  • The tumor cells were positive for pancytokeratin, CK5/6, EMA, calretinin, WT1 and D2-40, and negative for other markers tested to exclude other diagnoses.
  • A contrast-enhanced CT scan showed diffuse, irregular thickening and nodularity of the left pleura, a mild left-sided pleural effusion, and mediastinal lymphadenopathy.
  • A PET/CT scan showed high FDG uptake throughout the pleural lesion and in the lymph nodes.
• The authors' conclusion: The authors concluded that malignant mesothelioma should be on the list of possible diagnoses whenever a pathologist finds a metastatic epithelioid tumor in a lymph node from an unknown primary site. They also concluded that lymph node cytology can give a clue toward a prompt diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Lymphadenopathy, Mesothelioma, Mesothelial Cells, Pleura, Asbestos Exposure, Fine-Needle Aspiration, Cytology.

Related studies

• Diffuse Malignant Peritoneal Mesothelioma Presenting with Psammomatous Calcification on a Cervical Smear — A. Tan, P. Cohen, et al. (2015)
• Pleural mesothelioma with initial presentation as cervical lymphadenopathy — E.J. Wills (1995)
• Malignant pleural mesothelioma initially diagnosed on cervical lymph node biopsy — S. Ogata, S. Hiroi, et al. (2009)
• Metastatic pleural mesothelioma presenting initially as multiple gastric and colonic polyps — A. Alhumidi, A. Alqahtani (2020)
• Benign multicystic peritoneal mesothelioma (BMPM) presenting with ambiguous symptoms: A rare case report — A. Hamza, A. Zazo, et al. (2021)
• Localized biphasic malignant mesothelioma presenting as a giant pelvic wall mass: a rare case report and literature review — Y. Liu, J. Wu, et al. (2020)

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