Pleural mesothelioma presenting as periumbilical metastasis: the first clinical documentation

Our plain-English summary of Pleural mesothelioma presenting as periumbilical metastasis: the first clinical documentation, by R.F. Falkenstern-Ge, M. Kimmich, S. Bode-Erdmann, et al (Case Reports in Oncological Medicine, 2013).

The study

• Authors: R.F. Falkenstern-Ge, M. Kimmich, S. Bode-Erdmann, G. Friedel, G. Ott, M. Kohlhäufl
• Journal: Case Reports in Oncological Medicine
• Published: 2013;2013:198729
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction. Pleural mesothelioma with metastasis to the subcutaneous tissue of the abdominal wall at first diagnosis and without penetration into the peritoneum is an extremely rare clinical presentation. Methods. Patients with pleural mesothelioma have low survival rate. Usually, the disease at presentation is confined to its site of origin (most often the pleural cavity). A 55-year-old man was referred to our center due to increasing dyspnea and a painful periumbilical mass in the anterior abdominal wall. CT scan revealed both advanced mesothelioma of the pleura and a tumor mass confined to the subcutaneous fatty tissue without penetration through the peritoneum. Results. Video-assisted thoracoscopy confirmed the diagnosis of epithelioid pleural mesothelioma, which was also confirmed by a biopsy of the periumbilical mass. Systemic chemotherapy with cisplatin and pemetrexed was initiated. Under the ongoing systemic chemotherapy, the evaluation revealed partial remission of pleura mesothelioma and its subcutaneous manifestation of the abdominal wall. Conclusion. Mesothelioma of the pleura with a simultaneous metastasis to the subcutaneous fatty tissue of the abdominal wall at presentation without penetration of peritoneum is a rare clinical presentation of mesothelioma disease. The knowledge of its natural history is very limited. This is the first ever clinical documentation of a patient with pleura mesothelioma and simultaneous subcutaneous manifestation of abdominal wall.

In plain English

This was a case report of one patient at a lung and thoracic surgery center in Stuttgart, Germany. The patient was a 55-year-old man who did not smoke. He had worked for a long time as a construction worker in the shipbuilding industry with asbestos exposure; the fiber type was not stated. He arrived with fluid around the right lung, worsening breathlessness, severe abdominal pain and a lump near the navel. A CT scan showed pleural mesothelioma and a 10 cm by 7 cm tumor in the fatty tissue under the skin of the abdominal wall that had not grown into the peritoneum (the abdominal lining). Biopsies confirmed epithelioid pleural mesothelioma, and the abdominal tumor matched the pleural one. Surgery was not considered an option because of the spread. After 6 cycles of cisplatin and pemetrexed, CT showed partial remission of the pleural tumor and remission of the abdominal wall tumor, and he was described as partially employable again. The authors concluded that, to their knowledge, this was the first reported case of pleural mesothelioma with such spread present at diagnosis.

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 55-year-old male nonsmoker with a large right-sided pleural effusion, referred to the authors' center (Klinik Schillerhoehe, Stuttgart, Germany); dates not given
• Exposure: Long-term work as a construction worker in the shipbuilding industry with asbestos exposure; fiber type and dose not reported
• Main results:
  • Initial CT showed pleural mesothelioma with right-sided effusion and a tumor mass in the abdominal subcutaneous fatty tissue measuring 10 cm by 7 cm, without penetration through the peritoneum
  • Thoracoscopy biopsies and biopsy of the periumbilical mass confirmed epithelioid pleural mesothelioma (staged cT3N1 M1)
  • A punch biopsy of the abdominal mass showed a tumor identical to the one in the pleural biopsies
  • Because of the abdominal wall metastasis, surgery was not indicated
  • Systemic chemotherapy with cisplatin and pemetrexed was well tolerated; after 6 cycles, CT showed partial remission of the pleural mesothelioma
  • After 6 cycles of chemotherapy, the subcutaneous abdominal wall metastasis showed remission
  • The patient's clinical condition improved under chemotherapy and he was again partially employable
• The authors' conclusion: The authors concluded that, to their knowledge of the literature, this was the first reported clinical documentation of pleural mesothelioma with a simultaneous solitary subcutaneous metastasis of the abdominal wall, without peritoneal penetration, at the time of diagnosis

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Metastasis, Peritoneum, Pleural Cavity, Dyspnea, CT Scan, Mesothelioma, Pleura.

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