Malignant pleural mesothelioma in a 17-year old boy: A case report and literature review

Our plain-English summary of Malignant pleural mesothelioma in a 17-year old boy: A case report and literature review, by C. Pérez-Guzmán, R. Barrera-Rodríguez, J. Portilla-Segura (Respiratory Medicine Case Reports, 2016).

The study

• Authors: C. Pérez-Guzmán, R. Barrera-Rodríguez, J. Portilla-Segura
• Journal: Respiratory Medicine Case Reports
• Published: 2016;17:57-60
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma is a rare, invasive and often fatal neoplasm that develops in the thin layer of tissue surrounding the lungs known as the pleura. Although rare, mesotheliomas do occur in the young; their characteristics are distinct from those of older patients.

Case Presentation: This is a case report of a 17-year-old boy who had moderate dyspnea, cough, right-sided pleuritic chest pain, fever, headache and no weight loss. Physical examination showed a right pleural effusion and chest roentgenograms revealed a homogenous opacity on lower right hemithorax. Biochemical analysis of pleural fluid showed hemorrhagic/turbid effusion compatible with exudate. It was initially treated as an empyema. The pleural fluid culture was negative. Adenosine deaminase level was 34.3 U/L (admission) and 19.02 U/L (two weeks after). Pleural fluid smear and culture for Mtb were negative. During the open pleural biopsy, thickened pleura and multiple pale yellow nodules in the lung were observed. The histopathological report was compatible with malignant pleural mesothelioma. With this diagnosis, a chemotherapy regimen with cisplatin was initiated. After two cycles, the patient had no clinical and radiological improvement. The patient is currently under regular follow up.

Conclusion: MPM is rare in young adults and its clinical presentation makes it different from mesothelioma in elderly patients, so it will be necessary to identify the new risk factors that can identify these patients.

In plain English

This article was a case report, with a literature discussion, of a 17-year-old boy admitted to a hospital in Aguascalientes, Mexico, in June 2015. He had seven days of moderate breathlessness, fever, right-sided chest pain, headache and cough, without weight loss. An X-ray showed fluid around the lower right lung, and 1600 ml of bloody, cloudy fluid was drained. He was first treated with antibiotics and later for tuberculosis, but fluid cultures and tuberculosis tests were negative and the fluid kept draining. An open biopsy found thickened pleura and multiple pale yellow nodules, and tissue tests led to a diagnosis of malignant pleural mesothelioma. After two cycles of cisplatin chemotherapy there was no clinical or X-ray improvement, and he remained under follow-up. The article did not report whether he had ever been exposed to asbestos. The authors concluded that this case and others in the literature suggest mesotheliomas of young people are a different disease from those of elderly patients and should be treated differently, and that more studies are needed to identify new risk factors.

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 discussion of published literature
• Who was studied: One 17-year-old male patient admitted to a hospital in Aguascalientes, Mexico, in June 2015
• Exposure: The article does not report any asbestos exposure history for the patient. The case history notes that he smoked tobacco and marijuana cigarettes for three months the previous year and had moderate alcohol consumption.
• Main results:
  • At admission, a chest tube was inserted into the patient's chest and 1600 ml of bloody, cloudy pleural fluid was drained.
  • The patient's adenosine deaminase level in the pleural fluid was 34.3 U/L at admission and 19.02 U/L two weeks later.
  • A closed pleural biopsy in the patient was negative for tuberculosis and for malignancy.
  • During the open pleural biopsy, the surgeons saw pleural thickening and multiple pale yellow nodules in the lung.
  • On the basis of immunohistochemistry (tumor cells reactive for calretinin and cytokeratin 7, negative for WT1 and Napsin A), the cause of the patient's pleural effusion was diagnosed as malignant pleural mesothelioma.
  • Pleurodesis with povidone-iodine was done twice in the patient without decreasing the fluid drainage.
  • After two cycles of cisplatin chemotherapy, the patient showed no clinical or radiological improvement.
• The authors' conclusion: The authors concluded that this case, together with others reported in the literature, suggests that mesotheliomas of young people are a different disease from those of elderly patients and should be treated differently. They also concluded that further studies are needed to identify new risk factors.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Neoplasm, Pleura, Mesothelioma, Dyspnea, Pleuritic Chest Pain, Pleural Effusion, Hemithorax.

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