Malignant mesothelioma presenting as a gradually enlarging pneumothorax

Our plain-English summary of Malignant mesothelioma presenting as a gradually enlarging pneumothorax, by A. Prasad, D. Olsen, P.S. Sriram (Case Reports in Pulmonology, 2013).

The study

• Authors: A. Prasad, D. Olsen, P.S. Sriram
• Journal: Case Reports in Pulmonology
• Published: 2013;2013:374960
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is an extremely aggressive tumor arising from the pleura with median survival of approximately 9-12 months. It can rarely present as a spontaneous pneumothorax. Less than 35 cases of malignant mesothelioma presenting as spontaneous pneumothorax have been reported in the literature. Pathology may show florid mesothelial hyperplasia. We herein report a case of mesothelioma presenting as a pneumothorax that gradually enlarged over a one-year period and also review the relevant literature.

In plain English

This was a case report of one patient, with a brief review of earlier published reports. A 69-year-old man was referred to a lung clinic for a right-sided pneumothorax (air in the space around the lung) that was slowly growing. He had been exposed to asbestos during 4 years in the navy, later worked as a truck driver, and was a 75 pack year smoker who had quit. Chest CT scans over a 1-year period showed the pneumothorax gradually enlarging. At surgery, doctors found and closed a bronchopleural fistula, an abnormal opening between an airway and the space around the lung. The removed tissue was first read as exuberant mesothelial hyperplasia, an overgrowth of lining cells. Further review and special staining led to a final diagnosis of low-grade mesothelioma. The authors believed the tumor began in the visceral pleura, the lining covering the lung. The patient declined further treatment and died 3 years later from disease progression. The authors concluded that patients with asbestos exposure and recurrent or persistent spontaneous pneumothorax should have pleurectomy samples examined to rule out malignant 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 of a single patient, with a brief review of the relevant literature
• Who was studied: one 69-year-old man referred to a pulmonary clinic in the United States (University of Florida / VA Medical Center, Gainesville) for a gradually enlarging right-sided pneumothorax; CT scans dated September 2007 to August 2008
• Exposure: asbestos exposure during 4 years of navy service, followed by work as a truck driver; fiber type not stated. He was also a 75 pack year smoker who quit 3 years earlier.
• Main results:
  • Serial chest CT scans over a 1-year period showed gradual enlargement of the right-sided pneumothorax
  • At thoracotomy, a cyst-like sac near the bronchus intermedius contained a bronchopleural fistula; the cyst was removed and the fistula closed
  • Pathology was initially read as exuberant mesothelial hyperplasia
  • Epithelioid cells stained positive for pancytokeratin, calretinin, D2-40 and keratin 5/6, confirming mesothelial origin, and negative for CD15, CEA and TTF-1; final diagnosis was low-grade mesothelioma
  • The authors believed the mesothelioma originated in the visceral pleura and eroded inwards to cause a small bronchopleural fistula
  • The patient declined further treatment including surgery and chemotherapy and died 3 years later due to disease progression
• The authors' conclusion: The authors concluded that patients with asbestos exposure who present with recurrent or persistent spontaneous pneumothorax should have pleurectomy samples sent for histology to rule out malignant mesothelioma. They also stated that if pleural pathology in such patients with strong occupational exposure shows marked mesothelial hyperplasia, mesothelioma must be considered.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pneumothorax, Pleura, Median Overall Survival, Pathology, Reactive Mesothelial Hyperplasia.

Related studies

• Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review — S. Alkhuja, A. Miller, et al. (2000)
• Malignant pleural mesothelioma presenting as a spontaneous pneumothorax — A. Mitsui, H. Saji, et al. (2015)
• Malignant mesothelioma presenting as recurrent hydro-pneumothorax: An atypical case presentation and literature review — N. Sattar, R. Durrance, et al. (2018)
• [Pleural Well-differentiated Papillary Mesothelial Tumor Presenting with Recurrent Pneumothorax and Pleural Effusion: A Case Report] — Z. Li, F. Kong, et al. (2026)
• Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage — P. Lange, J. Mortensen, et al. (1988)
• Spontaneous pneumothorax and pulmonary malignant disease--a syndrome sometimes associated with cavitating tumours. Report of nine new cases, four with metastases and five with primary bronchial tumours — F.W. Wright (1976)

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