Pleural Mesothelioma with No Asbestos Exposure: A Case Report

Our plain-English summary of Pleural Mesothelioma with No Asbestos Exposure: A Case Report, by S.A. Batahar, O. Ouradi, S. Elidrissi, et al (Journal of Clinical and Diagnostic Research, 2016).

The study

• Authors: S.A. Batahar, O. Ouradi, S. Elidrissi, L. Amro
• Journal: Journal of Clinical and Diagnostic Research
• Published: 2016;10(11):OD07-OD08
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant Pleural Mesothelioma (MPM) is the primary malignant tumour of the pleura. It is highly aggressive and linked to the exposure to asbestos fibers. The prognosis of this cancer is bad with a median of survival around 12 months. The diagnosis of pleural mesothelioma is often done at an advanced stage of the disease because of the lack of specific clinical and radiological signs differentiating it from any malignant pleural effusion. The absence of an explicit asbestos exposure is another diagnosis problem. We report the case of a 60-year-old patient without any prior exposure to asbestos who presented for pleural effusion and a nodular thickening of the pleura on the CT scan. The diagnosis of MPM was confirmed after pathology study of the biopsies obtained by video assisted thoracoscopy.

In plain English

This was a case report about one patient, a 60-year-old man seen in the pulmonology department of the authors' hospital in Morocco. He had lower right chest pain, a dry cough and shortness of breath for one month. The authors reported that he had never smoked and had no past asbestos exposure. He was a traditional farmer who had never used chemical substances, worked in a factory or dug wells. Tests showed fluid around the right lung and, on CT, nodular thickening of the pleura (the lining around the lung). Scans also showed sclerotic bone lesions at D1 and in the right iliac bone. These first raised suspicion of a prostate or digestive cancer that had spread. Video-assisted thoracoscopy found multiple pleural nodules, and biopsy with immunohistochemistry confirmed epithelioid pleural mesothelioma at stage IV. He received cisplatin and pemetrexed and died during treatment. The authors concluded that when pleural effusion occurs with nodular pleural thickening, malignant pleural mesothelioma should be suspected and thoracoscopy performed, even if asbestos exposure is not reported. A single case report describes one person and does not give rates.

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 (one patient)
• Who was studied: One 60-year-old man who presented to the pulmonology department of the authors' hospital (the authors are affiliated with Mohamed VI University Hospital, Morocco); dates of care not given
• Exposure: No asbestos exposure reported. The patient had never smoked and was described as a traditional farmer who had never used chemical substances, never worked in a factory and never dug wells.
• Main results:
  • The pleural fluid was a lymphocytic exudate. Hyaluronan analysis could not be completed because the fluid was too thick.
  • Chest CT showed a right pleural effusion with nodular thickening of the pleura.
  • Abdominal and pelvic CT showed sclerotic lesions of D1 and the right iliac bone. Prostate or digestive cancer with pleural and bone metastasis was suspected, but abdominal CT showed no abnormality.
  • Video-assisted thoracoscopy revealed multiple pleural nodules.
  • The pleural biopsy showed round cell malignant tumour infiltration with a myxoid stroma reaction. Immunohistochemistry was positive for CK7 and anti-ACE and negative for anti-CK20 and anti-CK5/6. Epithelioid pleural mesothelioma was confirmed.
  • The mesothelioma was stage IV. The patient was given chemotherapy with cisplatin and pemetrexed and died while on treatment.
  • The authors noted that the absence of asbestos exposure, or of any other exposure linked to mesothelioma, made mesothelioma seem less probable than metastatic pleural effusion.
• The authors' conclusion: The authors concluded that in a case of pleural effusion with nodular pleural thickening, malignant pleural mesothelioma should be suspected and a thoracoscopy performed, even if asbestos exposure is not reported.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Pleura, Prognosis, Pleural Effusion, CT Scan, Pathology, Thoracoscopy.

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