Localised malignant mesothelioma presenting as an esophageal mass: An unusual manifestation

Our plain-English summary of Localised malignant mesothelioma presenting as an esophageal mass: An unusual manifestation, by K.L. Yaxley, T. Rutland, T. Jayawardena, et al (Radiology Case Reports, 2026).

The study

• Authors: K.L. Yaxley, T. Rutland, T. Jayawardena, D. Law, Y. Weerakkody
• Journal: Radiology Case Reports
• Published: 2026;21(8):3313-3318
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is an aggressive neoplasm arising from mesothelial cells, typically presenting with pleural thickening, pleural effusions, or respiratory symptoms. Dysphagia as a presenting symptom is extremely uncommon, and esophageal involvement is rare. We report a 71-year-old male with an 18-month history of progressive dysphagia and significant weight loss. Initial gastroscopy was unremarkable, but repeat endoscopy revealed a smooth lower esophageal stricture. Contrast-enhanced CT demonstrated a well-circumscribed esophageal mass with minimal pleural thickening, and PET-CT confirmed high FDG uptake in the mass and subtle anterior and posterior mediastinal pleural foci. Endoscopic ultrasound-guided fine-needle aspiration of the esophageal lesion revealed epithelioid cells positive for mesothelial markers (CK5, D2-40, WT1, Calretinin, CK7) with loss of BAP1 and MTAP, consistent with epithelioid mesothelioma. The patient was commenced on immunotherapy but lost to follow-up. This case represents an unusual manifestation of localized malignant mesothelioma presenting primarily as an esophageal mass, with minimal pleural disease. The diagnosis was established via endoscopic ultrasound-guided fine-needle aspiration, highlighting the utility of minimally invasive techniques in atypical presentations. It underscores the importance of considering mesothelioma in the differential diagnosis of unexplained esophageal or mediastinal masses, even in the absence of classic pleural findings. Mesothelioma can rarely present with dominant esophageal involvement. Awareness of this atypical presentation facilitates timely diagnosis, appropriate management, and may prevent diagnostic delays in patients presenting with dysphagia.

© 2026 The Authors.

In plain English

This case report described one patient, a 71-year-old man who had worked as an engineer and gave an occupational history of possible asbestos exposure. No fiber type was reported. The patient had an 18-month history of worsening difficulty swallowing and 10 kg of weight loss over the last year. An earlier gastroscopy had found no cause, and a biopsy of a narrowed part of the esophagus showed only benign tissue. CT showed a smooth lower-esophageal mass up to 59 mm across, with minimal pleural thickening and no pleural effusion or calcified pleural plaques. PET-CT showed high uptake in the mass and a few small spots in the pleura. A needle sample taken through an endoscope showed cells whose staining pattern, including loss of BAP1 and MTAP, supported a diagnosis of epithelioid mesothelioma. The patient began immunotherapy but was lost to follow-up. The authors concluded this was a rare presentation of malignant pleural mesothelioma appearing mainly as an esophageal mass. They noted that the pleural origin was surmised from imaging only, because the pleural disease was not biopsied.

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 71-year-old man with an 18-month history of dysphagia (difficulty swallowing) and 10 kg weight loss over the previous year; a former engineer with a 10-pack-year smoking history who had stopped smoking 30 years earlier. The authors are from hospitals in Western Australia.
• Exposure: Possible occupational asbestos exposure reported by the patient, who had worked as an engineer; no fiber type, product or dose was described
• Main results:
  • A gastroscopy in August 2024 found no cause for the dysphagia. At this presentation, a biopsy of the esophageal stricture showed only benign tissue.
  • CT showed a smoothly marginated mass in the lower third of the esophagus measuring up to 59 mm in diameter and approximately 61 mm in height.
  • Minimal nodular pleural thickening was recognized on CT only on retrospective review after PET. There was no pleural effusion and there were no calcified pleural plaques.
  • PET-CT showed high-grade uptake in the esophageal mass and a few small areas of uptake in the right mediastinal pleura. No FDG-avid lymph nodes or disease outside the chest were seen.
  • Endoscopic ultrasound showed a 4-5 cm lesion that appeared to compress the esophagus from outside, so it was felt to be extrinsic rather than intrinsic to the esophagus.
  • On the fine-needle aspiration sample, the tumor cells expressed mesothelial markers (CK5, D2-40, WT1, Calretinin, CK7), were negative for carcinoma markers including p40 and CK20, and showed loss of MTAP and BAP1. The authors stated this was supportive of a diagnosis of epithelioid mesothelioma.
  • The patient started first-line immunotherapy (nivolumab and ipilimumab) and was then lost to follow-up.
• The authors' conclusion: The authors concluded that this case illustrates a rare presentation of malignant pleural mesothelioma manifesting primarily as an esophageal mass, with minimal pleural disease, diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Elsewhere in the article they describe it as likely a form of localized malignant mesothelioma.
• Limitations the authors state:
  • Because the patient was lost to follow-up, the pleural disease was not biopsied and no further invasive investigations were done. The pleural origin of the mass was surmised from imaging findings only.

Topics

Medical terms in this study, explained in our Lexicon: Localized Malignant Mesothelioma, Mesothelioma, Neoplasm, Mesothelial Cells, Pleural Thickening, Pleural Effusion, Dysphagia, Endoscopy.

Related studies

• Epithelioid malignant mesothelioma presenting with features of esophageal tumor — M.W. Khalil, A.P. Campbell, et al. (2011)
• Abdominal mass as a manifestation of mesothelioma — A.J. Martín-Jiménez, V. Aragón-Domínguez, et al. (2018)
• Unusual region for pericardial malignant mesothelioma: cutaneous manifestation in a Turkish woman — M. Günday, H. Erinanç, et al. (2013)
• Calcified plaque in the superior portion of the major fissure. An unusual manifestation of asbestos exposure — S.B. Rupp, H. Jolles (1989)
• An unusual liver mass: primary malignant mesothelioma of the liver : CT and MRI findings and literature review — A. Serter, N. Buyukpinarbasili, et al. (2015)
• An unusual cause of an anterior mediastinal mass — I. Hassan, A. Goolam-Mahomed (2014)

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