Malignant Mesothelioma Diagnosed by Bronchoscopic Biopsy

Our plain-English summary of Malignant Mesothelioma Diagnosed by Bronchoscopic Biopsy, by Y.H. Park, J.W. Choi, S.O. Jung, et al (Tuberculosis and Respiratory Diseases, 2015).

The study

• Authors: Y.H. Park, J.W. Choi, S.O. Jung, M.J. Cho, D.H. Kang, C.U. Chung, D.I. Park, J.Y. Moon, H.S. Park, S.S. Jung, J.O. Kim, S.Y. Kim, J.E. Lee
• Journal: Tuberculosis and Respiratory Diseases
• Published: 2015;78(3):297-301
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a rare malignant neoplasm that arises from mesothelial surfaces of the pleural cavity, peritoneal cavity, tunica vaginalis, or pericardium. Typically, pleural fluid cytology or closed pleural biopsy, surgical intervention (video thoracoscopic biopsy or open thoracotomy) is conducted to obtain pleural tissue specimens. However, endobronchial lesions are rarely seen and cases diagnosed from bronchoscopic biopsy are also rarely reported. We reported the case of a 77-year-old male who was diagnosed as malignant mesothelioma on bronchoscopic biopsy from obstructing masses of the endobronchial lesion.

In plain English

This case report from Korea describes one 77-year-old man with malignant pleural mesothelioma. He first had shortness of breath and a large fluid collection around the right lung. Fluid testing and a closed pleural biopsy suggested cancer, but its origin was unclear. Chest CT showed thickened tissue around the airways of the right middle and lower lobes but no definite pleural thickening. In March 2014, bronchoscopy found masses inside the airways. Biopsy of these masses and staining tests showed malignant mesothelioma, and review of the earlier pleural biopsy slides showed the same. The patient had worked in construction from 1991 to 2003, and the authors presumed he had a lot of asbestos exposure then; no fiber type was named. After cisplatin and pemetrexed chemotherapy, the fluid and breathlessness lessened. A repeat airway biopsy showed mesothelioma with squamous differentiation. After four cycles, the thickened tissue around the airways shrank from 4.0 by 2.3 cm to 3.3 by 1.3 cm. The authors concluded that bronchoscopy could be considered as a way to obtain tissue in malignant pleural mesothelioma.

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 77-year-old man with shortness of breath, a past history of rectal cancer and about 55 pack-years of smoking. He was transferred to Chungnam National University Hospital in Daejeon, Korea, where bronchoscopy was done on 12 March 2014.
• Exposure: Construction work from 1991 to 2003. The authors presumed heavy asbestos exposure during those years. No fiber type, product or dose was reported.
• Main results:
  • Chest CT showed thickened tissue around the airways of the right middle and lower lobes, with bronchial narrowing and collapse and a large pleural effusion, but no definite pleural thickening.
  • The bronchoscopic biopsy of the airway masses stained positive for WT-1, calretinin, CK5/6 and p63, and negative for napsin-A and TTF-1. The authors reported this as malignant mesothelioma.
  • Review of the slides from the earlier pleural biopsy done at the other hospital also showed malignant mesothelioma.
  • After 2 cycles of pemetrexed and cisplatin, the patient's pleural effusion decreased and his shortness of breath improved.
  • Because the patient's cough persisted, bronchoscopy was repeated. The repeat biopsy showed malignant mesothelioma with squamous differentiation.
  • After four cycles of chemotherapy, the patient's chest CT showed a partial response. The pleural nodules decreased, and the peribronchial soft tissue thickening (thickened tissue around the airways) decreased from 4.0 by 2.3 cm to 3.3 by 1.3 cm.
• The authors' conclusion: The authors had considered whether squamous cell carcinoma had been misdiagnosed as mesothelioma. Because of the staining results and the tumor shrinkage after pemetrexed and cisplatin, they judged misdiagnosis unlikely. They concluded that bronchoscopy could be considered as a way to obtain tissue in malignant pleural mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Biopsy, Neoplasm, Pleural Cavity, Peritoneal Cavity, Tunica Vaginalis, Pericardium, Fluid Cytology.

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