Giant malignant mesothelioma in the upper mediastinum: A case report

Our plain-English summary of Giant malignant mesothelioma in the upper mediastinum: A case report, by S. Zhang, P. Song, B. Zhang (Oncology Letters, 2013).

The study

• Authors: S. Zhang, P. Song, B. Zhang
• Journal: Oncology Letters
• Published: 2013;6(1):181-184
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma in the mediastinum is rare and the majority of known cases have been reported as 'localized mesothelioma'. The present study reports a case of an upper mediastinal tumor, which was diagnosed through thoracoscopic surgery and surgical biopsies of the mass. A computed tomography scan revealed a giant upper mediastinal tumor, adjacent to the aortic arch, trachea, superior vena cava and left pulmonary artery. The vessels in the mediastinum were compressed and were shifted to the lower right. The trachea became stenotic and a small amount of bilateral pleural effusion was observed. The mass was relatively well encapsulated. There was no pleural thickening or clearly swollen lymph nodes in the mediastinum. The histopathological and immunohistochemical examinations of the tumor verified the diagnosis of a malignant mesothelioma. The tumor was demonstrated to be derived from the mediastinal pleural mesothelium cells. The patient received pemetrexed disodium and cisplatin combination chemotherapy for four cycles. At present, the patient is undergoing follow-up.

In plain English

This article is a case report of one patient treated at Shandong Tumor Hospital in Jinan, China. A 29-year-old woman was admitted in July 2012 with a cough lasting one month and a fever of seven days. The report states she had no history of any remarkable asbestos exposure. A CT scan showed a 9.0 by 10.0 cm tumor in the upper mediastinum, the space in the middle of the chest. It pressed on nearby blood vessels and narrowed the windpipe without signs of invasion, and there was a small amount of fluid around both lungs. A CT-guided needle biopsy gave no diagnosis, so tissue was taken during thoracoscopic (keyhole chest) surgery. Microscope and immunohistochemical tests led to a diagnosis of malignant mesothelioma arising from the mediastinal mesothelial cells. The authors judged it came from the mediastinal pleura rather than the pericardium. The patient received four cycles of pemetrexed and cisplatin chemotherapy and, when the report was written, had no symptoms and was under follow-up. The authors concluded this mesothelioma is hard to diagnose early and extremely difficult to treat at an advanced stage.

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 29-year-old female patient admitted to Shandong Tumor Hospital and Institute, Jinan, China, on July 17, 2012, with a one-month cough and a seven-day fever
• Exposure: No asbestos exposure was reported. The case section says the patient had no history of any remarkable asbestos exposure.
• Main results:
  • A contrast-enhanced CT scan showed an upper mediastinal tumor 9.0x10.0 cm in size, next to the aortic arch, trachea, superior vena cava and left pulmonary artery.
  • The trachea was narrowed but not invaded. There was a small amount of fluid around both lungs and no fluid around the heart.
  • A CT-guided needle biopsy failed to give a diagnosis. Thoracoscopic surgery with surgical biopsies was then performed, and the mass measured 8.0x9.0 cm at surgery.
  • Tumor cells were positive for CK, CAM5.2, SMA, CK19, calretinin and CD34. They were negative for CEA, bcl-2, PLAP, CD117, S-100, CD20, CD79a, CD45RO, CD15 and CD30.
  • The tumor was diagnosed as a malignant mesothelioma arising from the mediastinal mesothelial cells.
  • The authors judged that the tumor may have originated from the mediastinal pleura rather than the pericardium, because there was only a small amount of pleural fluid and no fluid around the heart.
  • The patient received pemetrexed (500 mg/m2) and cisplatin (75 mg/m2) for four cycles of 21 days each. At the time of the report the patient had no symptoms and was under follow-up.
• The authors' conclusion: The authors concluded that this type of mesothelioma is extremely difficult to treat at an advanced stage, even with comprehensive treatment, and difficult to diagnose at an early stage.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Mediastinum, Localized Malignant Mesothelioma, Bilateral, Pleural Effusion, Pleural Thickening, Mesothelium, Pemetrexed (Alimta).

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