Long-term survival of nonoccupational pleural mesothelioma: a case report and review of the literature

Our plain-English summary of Long-term survival of nonoccupational pleural mesothelioma: a case report and review of the literature, by L. Tobia, E. Tolli, A.I. Sedile, et al (Journal of Medical Case Reports, 2025).

The study

• Authors: L. Tobia, E. Tolli, A.I. Sedile, V. Cofini, S. Necozione, L. Fabiani
• Journal: Journal of Medical Case Reports
• Published: 2025;19(1):528
• Type of article: Case report, Review
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Malignant mesothelioma is an aggressive cancer that arises from the mesothelial cells lining the pleura, peritoneum, pericardium, or tunica vaginalis. While occupational exposure accounts for most cases, nonoccupational exposures (to ionizing radiation, carbon nanotubes, and different natural fibers) remain important and under-recognized. The rarity of nonoccupational pleural mesothelioma cases with prolonged survival substantiates a detailed analysis of the presented clinical case to increase awareness and review and contribute to the scientific literature.

Case Presentation: We present a clinical case of a 64-year-old Caucasian male patient still alive after a diagnosis in 2017 of epithelial-type pleural mesothelioma and three episodes of pleuritis accompanied by dyspnea, fever, and chest pain. The patient lived near a contaminated area but no other exposure was reported. The diagnosis was established by thoracic computed tomography scan and thoracentesis. The patient subsequently underwent chemotherapy and pneumonectomy, followed by semiannual follow-up visits that showed no evidence of disease recurrence.

Conclusion: This case highlights the importance of considering nonoccupational risk factors in patients with pleural mesothelioma and suggests that long-term survival can be achieved with early diagnosis and multimodal treatment. This literature review supports the need for further studies to improve the understanding and management of nonoccupational pleural mesothelioma.

© 2025. The Author(s).

In plain English

This article was a case report combined with a non-systematic review of 24 published studies. It described a 64-year-old Caucasian man seen at an occupational medicine unit in L'Aquila, Italy. He was diagnosed with epithelioid pleural mesothelioma in 2017 after repeated episodes of right-sided pleuritis. Pleural fluid analysis raised the diagnosis, and tissue examination after thoracoscopy confirmed it. He received three cycles of chemotherapy with cisplatin and pemetrexed. In January 2018 he had pleurectomy and pleural decortication, and the tumor was staged pT1N0. Two more chemotherapy cycles followed, and he did not need radiotherapy. Follow-up scans showed no recurrence, and the authors reported him alive more than 6 years after diagnosis. He also had several squamous cell skin cancers before and after the mesothelioma. No occupational asbestos exposure was identified. He reported living near asbestos-covered structures that had not yet been decontaminated. The authors suggested this environmental exposure was not significant and that genetic susceptibility may have been responsible. They stated that their case had limited generalizability and could not establish cause and effect.

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 with a non-systematic literature review (24 studies included)
• Who was studied: one 64-year-old Caucasian man seen at the occupational medicine unit of the University of L'Aquila, Abruzzo, Italy, diagnosed with pleural mesothelioma in 2017
• Exposure: No occupational asbestos exposure was identified in his work history (assembly work, gardening, four-color printing, transport and green maintenance). He reported living near an area with asbestos-covered structures that had not been decontaminated. The article did not report a fiber type.
• Main results:
  • Before diagnosis, the patient had two episodes of right basal pleuritis in 2015 to 2016 and a recurrent episode in August 2017.
  • Histology confirmed epithelioid mesothelioma.
  • The patient received three cycles of chemotherapy with cisplatin and pemetrexed before surgery.
  • Surgery in January 2018 was pleurectomy and pleural decortication, with tumor staging pT1N0.
  • Two further chemotherapy cycles followed surgery, and no radiotherapy was needed.
  • Follow-up CT and PET scans showed no recurrence, and the patient was alive more than 6 years after diagnosis.
  • The patient also had squamous cell skin cancers in 2009, 2018 and 2021, with a recurrence treated in 2023.
  • The authors described the case as one of the rare exceptions of nonoccupational pleural mesothelioma with long survival.
• The authors' conclusion: The authors considered that the potential environmental asbestos exposure was not significant and that concurrent genetic susceptibility may have been responsible for the disease.
• Limitations the authors state:
  • The authors stated that the findings have limited generalizability and that a cause-and-effect relationship cannot be established.

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, Mesothelioma, Mesothelial Cells, Pleura, Peritoneum, Pericardium, Tunica Vaginalis, Occupational Exposure.

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