Mesothelioma: A Case in a Diagnostic Timeline and the Efficiency of Robot-Assisted Surgery

Our plain-English summary of Mesothelioma: A Case in a Diagnostic Timeline and the Efficiency of Robot-Assisted Surgery, by P. Zarogoulidis, K. Tsakiridis, T. Zarampoukas, et al (Case Reports in Oncology, 2022).

The study

• Authors: P. Zarogoulidis, K. Tsakiridis, T. Zarampoukas, K. Zarampouka, D. Hatzibougias, C. Tolis, S. Tryfon, M. Saroglou, A. Ioannidis, D. Matthaios, C. Kosmidis
• Journal: Case Reports in Oncology
• Published: 2022;15(1):149-155
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

We present a case of a 65-year-old male with a difficulty to diagnose mesothelioma. To be specific, three attempts were made to diagnose the disease, and only with a large sample performed with robot-assisted surgery, our pathologists were able to identify the malignancy. The novelty for our case is mostly based on the timeline of the diagnosis along with the tissue samples where we present the course of the transformation from benign to malignancy. All tissue biopsies were checked by two independent pathologists. Conclusively, diagnosis for small local lesions should be performed with an endoscopic method, video-assisted or robot-assisted.

Copyright © 2022 by S. Karger AG, Basel.

In plain English

This was a case report about one 65-year-old man with known exposure to asbestos. The article does not say how he was exposed or to which fiber type. He was seen for a cough lasting 6 months and mild back pain on the lower right side of the chest. A CT scan showed thickening of the pleura (the lining around the lungs) of 1 cm, and a first biopsy guided by ultrasound did not show cancer. A year later the article reports the thickening as 1.7 mm. A second, CT-guided needle biopsy then showed atypia, which the authors called a precancerous condition. Eight months later the lesion measured 2.5 cm. Surgery that took a larger tissue sample found mesothelioma, probably of the desmoplastic type. The authors presented this sequence as the course from benign to malignant. The patient had bone metastasis and received chemotherapy and radiotherapy. After 6 months he had a good quality of life and was still under treatment. The authors concluded that small local lesions should be diagnosed with an endoscopic method, video-assisted or robot-assisted.

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 65-year-old man seen for a 6-month persistent cough and mild back pain on the lower right side of the chest, treated by authors based in Greece; dates of care not given
• Exposure: Asbestos exposure, stated only as 'known'; no job, product, fiber type, duration or dose given
• Main results:
  • The first CT scan showed pleural thickening of 1 cm
  • The first biopsy, guided by ultrasound, did not show cancer; the findings were attributed to an old infection
  • At follow-up after 1 year the article reports the thickening as 1.7 mm (width), and a CT-guided needle biopsy was done
  • The second biopsy showed atypia, which the authors called a precancerous condition; only follow-up was proposed
  • About 8 months later the lesion measured 2.5 cm (width), and surgery was performed
  • The surgical sample was diagnosed as mesothelioma, probably desmoplastic type, with Ki-67 positivity of about 20%
  • The authors presented the sequence of biopsies as showing the course of transformation from benign to malignancy
  • The patient had bone metastasis and received chemotherapy with radiotherapy; after 6 months he had a good quality of life and was under treatment
• The authors' conclusion: The authors concluded that diagnosis of small local lesions should be performed with an endoscopic method, video-assisted or robot-assisted

Topics

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

Related studies

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• Should all patients who have mesothelioma diagnosed by video-assisted thoracoscopic surgery have their intervention sites irradiated? — M. Nagendran, A. Pallis, et al. (2011)
• Comparison of video-assisted pleurectomy/decortication surgery plus hyperthermic intrathoracic chemotherapy with VATS talc pleurodesis for the treatment of malignant pleural mesothelioma: A pilot study — M. Migliore, M. Fiore, et al. (2023)
• The MesoVATS trial: is there a future for video-assisted thoracoscopic surgery partial pleurectomy? — R.C. Rintoul (2015)
• Video assisted thoracoscopic and open chest surgery in diagnosis and treatment of malignant pleural diseases — P. Perikleous, D.A. Waller (2017)
• Value of autofluorescence in video-assisted thoracoscopic surgery in pleural diseases — S.T. Liman, A. Elicora, et al. (2013)

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