Localized malignant pleural mesothelioma of the interlobar fissure mimicking a lung cancer

Our plain-English summary of Localized malignant pleural mesothelioma of the interlobar fissure mimicking a lung cancer, by P. Ciriaco, S. Viscardi, F. Filipello, et al (Interactive Cardiovascular and Thoracic Surgery, 2022).

The study

• Authors: P. Ciriaco, S. Viscardi, F. Filipello, G. Negri
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2022;34(4):700-702
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

We report a case of localized malignant pleural mesothelioma (LMPM) of the interlobar fissure mimicking lung cancer. A 74-year-old woman presented with dyspnoea and a left pleural effusion. Chest computed tomography revealed a bulky mass, arising from the left lower lobe with intense uptake at the 18F-FDG PET. A left lower lobectomy was performed after thoracoscopic pleural biopsies. The final histology revealed an LMPM epithelioid like. We describe the diagnostic and curative path of the disease, speculating on the differential diagnosis and treatment of LMPM.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

In plain English

This case report described one patient, a 74-year-old woman with no history of asbestos exposure, whose localized malignant pleural mesothelioma looked like lung cancer. The patient had shortness of breath, fluid around the left lung, and a raised blood level of the marker CA-125 (357 IU/ml; normal below 35). A CT scan showed a bulky mass arising from the lower lobe of the lung. Tests on the fluid and biopsies of the pleura (the lining of the lung) did not find cancer. Surgeons then removed the left lower lobe. The 9 cm by 8 cm by 7 cm mass was firmly attached to the fissure between lung lobes. Tissue staining confirmed that the tumour started in the mesothelium, the lining tissue. The type was epithelioid-like. The resection margins and lymph nodes were negative. CA-125 fell to 7 IU/ml at 6 months, and the patient was alive and well at 9 months. The authors concluded that this tumour may resemble solitary lung cancer. They noted that a biopsy of the main tumour, done at the time of the pleural biopsies, would have been advisable.

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 74-year-old woman with no history of asbestos exposure, reported by thoracic surgeons and pathologists at IRCCS San Raffaele Scientific Institute, Milan, Italy; dates of care not given
• Exposure: No history of asbestos exposure was reported for the patient; no fiber type or job is described
• Main results:
  • At presentation the patient had dyspnoea, a left pleural effusion and a CA-125 level of 357 IU/ml (normal below 35)
  • Chest CT showed a bulky mass arising from the lower lobe
  • Pleural fluid cytology and the thoracoscopic pleural biopsies were negative for malignancy
  • At left lower lobectomy the mass was firmly adherent to the interlobar fissure
  • The mass measured 9 cm by 8 cm by 7 cm
  • The final diagnosis was localized malignant pleural mesothelioma, epithelioid like
  • The tumour was TTF-1 negative and stained strongly for calretinin and focally for WT-1, which the authors said confirmed mesothelial origin
  • The tumour infiltrated the visceral pleura without evidence of lung invasion; resection margins and lymph nodes were negative
  • CA-125 dropped to 141 IU/ml before discharge
  • CA-125 was 7 IU/ml at 6 months, and the patient was alive and well at 9-month follow-up
• The authors' conclusion: The authors concluded that localized malignant pleural mesothelioma may resemble solitary lung cancer, as this case showed, and that the diagnostic and treatment process proved correct for this case
• Limitations the authors state:
  • The authors stated that it would have been advisable to biopsy the primary tumour at the time of the pleural biopsies

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: Pleural Mesothelioma, Lung Cancer, Pleural Effusion, Histology, Epithelioid, Differential Diagnosis.

Related studies

• Localized malignant pleural mesothelioma arising in the interlobar fissure: a unique surgical case masquerading clinicopathologically as primary lung adenocarcinoma — X. Guo, J. Watanabe, et al. (2019)
• Thickening of pulmonary interlobar fissures: exposure-response relationship in crocidolite and amosite miners — A. Solomon, L.M. Irwig, et al. (1979)
• CT demonstration of interlobar fissure calcification due to asbestos exposure — S.D. Rockoff (1987)
• Visceral pleural thickening in asbestos exposure: the occurrence and implications of thickened interlobar fissures — S.D. Rockoff, E. Kagan, et al. (1987)
• Nodular thickening of interlobar fissures: an early manifestation of malignant mesothelioma: a case report — S. Bandoh, J. Fujita, et al. (2001)
• Interlobar pleural plaque mimicking a lung nodule in a patient with asbestos exposure — W.R. Webb, C. Cooper, et al. (1983)

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