Pleural amyloidosis imitating pleural malignancy

Our plain-English summary of Pleural amyloidosis imitating pleural malignancy, by F. Coolbear, A.M. Bilawich, J. Tongson, et al (Respiratory Medicine Case Reports, 2017).

The study

• Authors: F. Coolbear, A.M. Bilawich, J. Tongson, J. Adamo, A. Churg
• Journal: Respiratory Medicine Case Reports
• Published: 2017;20:195-197
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

CT chest performed to investigate dyspnea and malaise in an 83 year old man demonstrated bilateral circumferential pleural thickening highly suspicious for pleural mesothelioma or metastatic pleural malignancy. Histopathology of a subsequent pleural biopsy returned a diagnosis of pleural amyloid. This case identifies pleural amyloid as a rare differential consideration for diffuse pleural thickening; the difficulties in distinguishing pleural amyloid from pleural malignancy are highlighted.

In plain English

This case report described one 83-year-old man admitted to hospital with shortness of breath and general malaise. His recorded prior exposures were tobacco smoking and unspecified fumes from work as an exterminator. The article does not mention asbestos. A chest CT scan showed irregular thickening of the pleura (the lining around the lungs) all around the right side of the chest, milder thickening on the left, and small collections of fluid. Compared with a scan 14 months earlier, the right-sided fluid had improved. Repeated samples of fluid drawn from the chest did not show cancer or infection. At surgery the pleura looked highly suspicious for mesothelioma. Under the microscope, however, no tumor was found. Instead, amyloid (abnormal protein deposits) had spread diffusely through the chest wall fat and the lung tissue beneath the pleura. The patient's condition worsened after surgery, and active treatment was eventually stopped. The authors concluded that pleural amyloid that looks like mesothelioma on imaging is very rare but documented. They said it is an uncommon possibility to consider when pleural thickening looks like a tumor.

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 83-year-old man who presented to hospital with shortness of breath and generalized malaise; the authors' affiliations are in Vancouver, Canada and Zanesville/Columbus, Ohio, USA, and the article does not state where the patient was treated
• Exposure: previous tobacco smoking and extensive exposure to unspecified fumes from work as an exterminator; no asbestos exposure is reported in the article
• Main results:
  • Contrast CT of the chest showed irregular circumferential pleural thickening in the right hemithorax, including the mediastinal pleura, and mild thickening of the left mediastinal and posterior costal pleura. It also showed a small loculated effusion on the right and a trace effusion on the left.
  • Compared with a non-contrast CT done 14 months earlier, the right pleural effusion had improved; the other findings were not substantially changed.
  • Multiple thoracocenteses (fluid samples from the chest) were nondiagnostic for malignancy or infection.
  • At surgery the gross appearance of the pleura was highly suspicious for mesothelioma.
  • On microscopic examination no neoplasm was found; instead there was diffuse infiltration of the chest wall fat and subpleural lung tissue by amyloid.
  • After surgery the patient deteriorated. After discussion with the family, active treatment was stopped and the patient was compassionately extubated.
• The authors' conclusion: The authors concluded that pleural amyloid presenting as pleural thickening that radiologically mimics mesothelioma is a very rare but documented form of amyloid disease. They added that this case reaffirms pleural amyloid as an uncommon differential diagnosis for tumor-like pleural thickening.

Topics

Medical terms in this study, explained in our Lexicon: Dyspnea, Bilateral, Pleural Thickening, Pleural Mesothelioma, Histopathology, Pleural Biopsy, Diffuse Pleural Thickening.

Related studies

• Nodular pulmonary amyloidosis associated with asbestos exposure — K. Hiroshima, H. Ohwada, et al. (1996)
• Pleural amyloidosis mimicking mesothelioma: a clinicopathologic study of two cases — A.L. Adams, C.Y. Castro, et al. (2001)
• Asymptomatic localized pleural amyloidosis mimicking malignant pleural mesothelioma: report of a case — T. Nakano, S. Endo, et al. (2016)
• Amyloidosis presenting as bilateral transudative pleural effusions with normal cardiac investigations: a case report — J.H. Briggs, W.G. Singleton, et al. (2009)
• Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases — R. Shibata, T. Ozaki, et al. (2020)
• Organizing Pneumonia in a Patient with Pulmonary Transthyretin Amyloidosis — Y. Tojo, Z. Watanuki, et al. (2026)

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