Malignant mesothelioma presenting as dysphagia diagnosed by endoscopic ultrasound

Our plain-English summary of Malignant mesothelioma presenting as dysphagia diagnosed by endoscopic ultrasound, by B. Al-Bawardy, E.C. Gorospe, C. Leggett (Annals of Gastroenterology, 2014).

The study

• Authors: B. Al-Bawardy, E.C. Gorospe, C. Leggett
• Journal: Annals of Gastroenterology
• Published: 2014;27(4):409
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

In plain English

This "Image of the Month" item from the Mayo Clinic in Rochester, Minnesota, was a case report about one patient. An 81-year-old man with severe chronic obstructive lung disease and congestive heart failure was referred for worsening difficulty swallowing (dysphagia) and had lost 22 lbs (10 kg) in 3 months. A barium X-ray showed narrowing in the middle of the esophagus, and a chest CT scan showed a 7 cm mass in the mediastinum. Upper endoscopy showed the esophagus was pressed on from outside, with no mass inside it. Endoscopic ultrasound found a mass outside the esophagus, below where the windpipe divides, and a fine needle sample was taken. The cells were consistent with malignant mesothelioma, and immunostaining was positive for calretinin, CK5/6, D2-40 and WT1. Because of other illnesses, the patient chose palliative treatment and received a stomach feeding tube. The authors wrote that their literature review found fewer than 10 published cases first presenting with dysphagia and diagnosed this way. The article did not mention asbestos or any other exposure.

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 (a one-page "Image of the Month" item describing a single patient)
• Who was studied: One 81-year-old man referred to the Mayo Clinic, Rochester, Minnesota, USA, for worsening dysphagia. He had severe chronic obstructive lung disease and congestive heart failure. The dates of care are not given; the article was received in April 2014.
• Exposure: Not reported: the article does not mention asbestos, any fiber type, occupation, or any other exposure history for the patient.
• Main results:
  • The patient had worsening dysphagia with an unintentional weight loss of 22 lbs (10 kg) over the previous 3 months.
  • A barium esophagogram showed narrowing in the middle of the esophagus.
  • A chest CT scan showed a 7 cm mediastinal mass.
  • Esophagogastroduodenoscopy showed the esophagus compressed from outside, with no esophageal mass.
  • Endoscopic ultrasound showed a subcarinal mass outside the esophagus, which was sampled by fine needle aspiration.
  • Cytology was consistent with malignant mesothelioma. Immunostaining was positive for calretinin, CK5/6, D2-40 and WT1.
  • Because of his multiple other medical conditions, the patient chose palliative treatment. A percutaneous endoscopic gastrostomy (feeding) tube was placed because of ongoing dysphagia.
• The authors' conclusion: The authors did not state a separate conclusion. They presented the case as uncommon, writing that their literature review found fewer than 10 published cases of malignant mesothelioma first presenting as dysphagia and diagnosed by endoscopic ultrasound with fine needle aspiration.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Dysphagia, Ultrasound.

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