Malignant pleural mesothelioma with long-term tumor disappearance of a local relapse after surgery: a case report

Our plain-English summary of Malignant pleural mesothelioma with long-term tumor disappearance of a local relapse after surgery: a case report, by M. Higashiyama, K. Oda, J. Okami, et al (Journal of Medical Case Reports, 2009).

The study

• Authors: M. Higashiyama, K. Oda, J. Okami, J. Maeda, K. Kodama, F. Imamura
• Journal: Journal of Medical Case Reports
• Published: 2009;3:6800
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: There have been few reports of spontaneous regression of malignant pleural mesothelioma, but the mechanism for this is unknown. We present a case report on a patient with malignant pleural mesothelioma showing apparent tumor disappearance in a local relapse after surgery.

Case Presentation: A 73-year-old man presented with malignant pleural mesothelioma in the right thoracic cavity. A pleurectomy was performed, and as expected, the tumor locally relapsed with increasing chest pain. However, the symptoms suddenly improved while the tumor was apparently reduced, and spontaneous tumor regression was initially considered. The patient confessed that he had self-administered a mushroom extract with alternative parasympathetic nerve stimulation therapy thereafter. The complete disappearance of the tumor was clinically achieved during a 29-month follow-up with continuing self-treatment.

Conclusion: This is the first report describing a malignant pleural mesothelioma patient in Japan showing long-term complete disappearance of a local relapse after surgery. This event was a tumor regression possibly due to an immunological effect of combined complementary and alternative therapy.

In plain English

This case report described one man in Japan with malignant pleural mesothelioma of the right pleural cavity. He was 73, had a 75-pack-year smoking history, and had been exposed to asbestos between the ages of 30 and 40. The article did not name the fiber type. In September 2003 surgeons removed only part of the tumor (a cytoreduction pleurectomy). Chemotherapy followed, and the tumor was judged stable. The tumor came back in May 2004. He refused further chemo-radiation and, without telling his doctors, took a mushroom extract (Agaricus blazei Murill Kyowa) and a modified acupuncture treatment. After about 2 weeks of high fever his condition improved. The relapsed tumor shrank and then disappeared on CT scans for 29 months. It returned in August 2007, and he was alive in November 2008 with slowly growing tumor. The authors could not explain the mechanism and said there were no scientific grounds to confirm the treatment's direct effect. They suggested an immune reaction of the host to the tumor was responsible.

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 table comparing three previously published cases of spontaneous regression
• Who was studied: one 73-year-old man in Japan with malignant pleural mesothelioma in the right pleural cavity, treated from 2003 and followed to November 2008
• Exposure: asbestos exposure between ages 30 and 40 (fiber type, job and dose not stated), plus a 75-pack-year cigarette smoking history
• Main results:
  • The tumor was epithelioid type, T4N0, stage IV (IMIG staging)
  • Only a cytoreduction pleurectomy was performed, in September 2003
  • After surgery, intrapleural carboplatin and systemic gemcitabine left the remaining tumor at stable disease
  • In May 2004 the patient had increasing chest pain and the tumor had relapsed in the right pleural cavity
  • From June 2004 the patient took a mushroom extract and a parasympathetic nerve stimulation therapy (a modified acupuncture method) at another hospital
  • After about 2 weeks of high fever, his general condition improved
  • Four months after starting these therapies the relapsed tumor had shrunk, and it then completely disappeared on chest CT
  • The tumor stayed undetectable for 29 months of follow-up
  • The tumor relapsed again in August 2007
  • In November 2008 the patient was alive, with the tumor growing slowly, while continuing the self-treatment
  • Immune blood tests done after the tumor disappeared (serum IL-2, interferon-alpha, interferon-gamma, CD4/CD8 ratio) were all normal
• The authors' conclusion: The authors said the mechanism could not be fully explained, but suggested that some immunological reaction of the host to the tumor was responsible in this patient
• Limitations the authors state:
  • The authors stated there are no scientific grounds to confirm a direct effect of the self-treatment
  • The authors stated it is unknown whether the mushroom extract, the nerve stimulation, or both together produced the effect
  • The authors stated the mechanism of the tumor disappearance could not be sufficiently explained
  • The heavy lymphoid infiltration described in earlier regression cases was not seen in this patient's resected tissue

Topics

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

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