Malignant pleural mesothelioma associated with recurrent pneumothorax

Our plain-English summary of Malignant pleural mesothelioma associated with recurrent pneumothorax, by L. Gumber, C.H. Lim, M.H. Naseer, et al (Breathe, 2025).

The study

• Authors: L. Gumber, C.H. Lim, M.H. Naseer, H. Wallace, L. Taylor, S. Parker, D. Cooper, K. Jackson, J. Thekkudan, A. Keng, A. Aujayeb
• Journal: Breathe
• Published: 2025;21(1):240226
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Secondary pneumothoraces can be the first presentation of pleural malignancies and may also complicate their course. They are often associated with prolonged air leaks, and cardiothoracic intervention can be required. https://bit.ly/3DEvPem.

Copyright ©ERS 2025.

In plain English

This case report described one patient: an 84-year-old man, a never-smoker, who had significant asbestos exposure 40 years earlier while working in local shipyards. The article did not name a fiber type. He came to hospital with worsening breathlessness, and a chest X-ray showed a left-sided pneumothorax (air around the lung). A chest drain was placed, but air kept leaking. A CT scan showed subtle changes at the lung bases that the authors said could signify early asbestosis. After 4 weeks of leaking, he had keyhole surgery to remove air blisters (bullae), with talc used to seal the lung lining. Tissue from the operation was consistent with epithelioid malignant pleural mesothelioma. He started carboplatin and pemetrexed chemotherapy. Just before the fifth cycle, the air and fluid around the lung returned. An indwelling catheter and suction did not resolve it. A second operation found early mesothelioma and a lung able to re-expand fully, and talc was applied again. He remained well afterwards. The authors wrote that the pneumothorax was due either to his bullae or to the cancer. Because it recurred despite removal of the bullae, they said they thought it was all due to the 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 (single patient)
• Who was studied: One 84-year-old man, a never-smoker, treated by respiratory and cardiothoracic departments in Newcastle upon Tyne, UK
• Exposure: Significant asbestos exposure about 40 years earlier from work in local shipyards; fiber type not specified
• Main results:
  • At presentation, a chest radiograph showed a left-sided pneumothorax with a very small pleural effusion
  • CT showed subtle reticulation at the lung bases, which the authors said could signify early asbestosis
  • The air leak was still present 4 weeks after presentation. Video-assisted thoracoscopy, bullectomy and talc pleurodesis were then performed.
  • Pathology of the surgical tissue was consistent with epithelioid malignant pleural mesothelioma, with loss of BAP1 on staining
  • While he was on carboplatin and pemetrexed, just before the fifth cycle, a large left basal hydropneumothorax developed
  • An indwelling pleural catheter was placed and later capped. The pneumothorax recurred 5 days after capping, with surgical emphysema.
  • At redo surgery there was early mesothelioma. The left lung was not entrapped and could fully re-expand, and further talc poudrage was performed.
  • After the second surgery the patient remained well, with plans to restart chemotherapy
• The authors' conclusion: The authors wrote that the pneumothorax was due either to his bullous disease or to his pleural malignancy. Because it recurred despite bullectomy, they said they thought it was all due to his mesothelioma. They also stated that an individualised approach to the timing of surgery should be taken.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pneumothorax.

Related studies

• Intrapleural talc for the prevention of recurrent pneumothorax — J.R. Milanez, F.S. Vargas, et al. (1994)
• Malignant mesothelioma presenting as recurrent hydro-pneumothorax: An atypical case presentation and literature review — N. Sattar, R. Durrance, et al. (2018)
• Recurrent pneumothorax: an unusual presentation of malignant mesothelioma — S.I. Handa, A.G. Wilkinson (1989)
• [Pleural Well-differentiated Papillary Mesothelial Tumor Presenting with Recurrent Pneumothorax and Pleural Effusion: A Case Report] — Z. Li, F. Kong, et al. (2026)
• Recurrent pneumothorax following abdominal paracentesis — P.J. Stafford (1990)
• Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage — P. Lange, J. Mortensen, et al. (1988)

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