Phrenic nerve paralysis as the initial presentation in pleural sarcomatoid mesothelioma

Our plain-English summary of Phrenic nerve paralysis as the initial presentation in pleural sarcomatoid mesothelioma, by G. Makimoto, K. Fujiwara, N. Fujimoto, et al (Case Reports in Oncology, 2014).

The study

• Authors: G. Makimoto, K. Fujiwara, N. Fujimoto, I. Yamadori, T. Sato, T. Kishimoto
• Journal: Case Reports in Oncology
• Published: 2014;7(2):389-92
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 74-year-old man was referred to our hospital because of persistent cough. A chest radiograph revealed an elevation of the right diaphragm. Computed tomography (CT) images revealed a small nodule localized on the right mediastinum. Five months later, the nodule had grown and was diagnosed as malignant pleural mesothelioma (MPM) by a CT-guided needle biopsy. The patient underwent combined chemotherapy, but the disease progressed rapidly and he passed away. On autopsy, microscopic findings and immunohistological examinations supported the diagnosis of sarcomatoid mesothelioma. Therefore, we diagnosed this rare case as localized sarcomatoid MPM showing phrenic nerve paralysis as an initial presentation.

In plain English

This article is a case report from Japan about one patient. A 74-year-old man was referred to hospital in October 2011 with a persistent cough. He had worked in a shipyard and had been exposed to asbestos for several years in his early twenties. The type of asbestos was not reported. A chest X-ray showed his right diaphragm was raised, and CT scans showed a small nodule on the right side of the mediastinum. Five months later it had become a massive tumor, and a needle biopsy diagnosed malignant pleural mesothelioma. He received chemotherapy with carboplatin and pemetrexed, but the disease progressed rapidly. He died in June 2012 after palliative radiation. At autopsy the tumor had grown into the pleura, diaphragm, pericardial cavity and aorta, and tissue staining confirmed sarcomatoid mesothelioma. The authors suspected that the tumor had involved the right phrenic nerve, causing its paralysis. They stated that, to their knowledge, this was the first such report. The authors concluded that immunohistochemical testing on enough tissue is important for diagnosing sarcomatoid 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, including autopsy findings)
• Who was studied: One 74-year-old man in Okayama, Japan, referred in October 2011 for persistent cough. He was a former smoker of 20 cigarettes per day for 24 years who stopped at age 44.
• Exposure: Shipyard work with asbestos exposure for several years during his early twenties. Fiber type not reported.
• Main results:
  • The first chest radiograph showed elevation of the right diaphragm.
  • A small nodule on the right mediastinum next to the pericardial cavity grew into a massive tumor within five months.
  • The patient was treated with combined chemotherapy with carboplatin and pemetrexed.
  • Despite chemotherapy, the disease progressed rapidly and caused superior vena cava syndrome.
  • After palliative thoracic irradiation, the patient died in June 2012.
  • At autopsy, the tumor had infiltrated the parietal pleura, diaphragm, pericardial cavity and aorta.
  • Under the microscope, the tumor was made of spindle-shaped cells and collagen fibers with areas of necrosis.
  • Tumor cells stained positive for calretinin, WT-1, D2-40 and cytokeratin, and negative for CEA and TTF-1. On this basis, sarcomatoid malignant pleural mesothelioma was confirmed.
  • The authors noted that the radiological findings indicated the primary lesion was apparently not in the lung.
  • The authors suspected, but did not show directly, that the tumor involved the right phrenic nerve and caused right phrenic nerve paralysis.
  • The authors stated that, to their knowledge, this was the first report of malignant pleural mesothelioma presenting with phrenic nerve paralysis as the first sign.
• The authors' conclusion: The authors concluded that this was a case of localized sarcomatoid malignant pleural mesothelioma that first showed itself as phrenic nerve paralysis. They also concluded that immunohistochemical examination with sufficient material is important for diagnosing sarcomatoid mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Mesothelioma, Chest X-Ray, Diaphragm, Mediastinum, Pleural Mesothelioma, Needle Biopsy, Chemotherapy.

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