Pleural metastasis of pulmonary adenocarcinoma mimicking diffuse mesothelioma: A case report and literature study

Our plain-English summary of Pleural metastasis of pulmonary adenocarcinoma mimicking diffuse mesothelioma: A case report and literature study, by E. Shalahuddin, F. Hayati (Radiology Case Reports, 2023).

The study

• Authors: E. Shalahuddin, F. Hayati
• Journal: Radiology Case Reports
• Published: 2023;18(3):818-823
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Conditions on pleura cover a broad range of pathology ranging from benign to malignant, which may potentially carry a poor prognosis and lead to high morbidity and mortality. Radiology plays a pivotal role in the diagnosis of pleural malignancy; however, the diagnostic endeavor can be challenging because of overlapping radiological appearances of one condition to another. This case report presents a 61-year-old male with worsening chronic shortness of breath. Despite early imaging resulting in highly suggested mesothelioma, subsequent biopsy proved the malignancy to be pulmonary adenocarcinoma. The patient underwent Pemetrexed-Cisplatin protocol in accordance with the biopsy result, and follow-up imaging depicted a marked improvement of the pleural condition. This case is a prime example of the challenge radiologists have to face regarding pleural tumors and dictates the necessity of a specialized multidisciplinary team to improve the patient's outcome.

© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

In plain English

This article is a case report from a radiology department in Surabaya, Indonesia, followed by a discussion of published literature. It described a 61-year-old man whose chronic shortness of breath had worsened over two weeks. He had worked as a carpenter for over 30 years and was a non-smoker. The article does not say whether he was exposed to asbestos. A contrast-enhanced chest CT scan showed diffuse nodular thickening of the pleura (the lining around the lung) on the right side only, fluid around the right lung, and several nodules in the left lung. The authors presented this as a case that mimicked mesothelioma on imaging. A biopsy of the pleural nodules, however, showed adenocarcinoma originating from the lung that had spread to the pleura. Testing found the EGFR gene to be wild-type. After four cycles of pemetrexed-cisplatin chemotherapy, a follow-up CT showed marked improvement of the pleural thickening, and the largest left lung nodule shrank from about 1.9 cm to about 1.1 cm. The authors concluded that a specialized multidisciplinary team is needed to establish the 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 of one patient, with a discussion of published literature
• Who was studied: One 61-year-old man seen in an outpatient clinic with chronic shortness of breath that had worsened in the past 2 weeks. The authors are at the Department of Radiology, Universitas Airlangga, Surabaya, East Java, Indonesia, and ethics approval came from Dr. Soetomo General Hospital, Surabaya. The dates of the case are not given.
• Exposure: The article does not describe any asbestos exposure for this patient. It reports that he worked as a carpenter for over 30 years, quit 3 years before, was a non-smoker, and had no history of cancer.
• Main results:
  • In this patient, contrast-enhanced chest CT showed diffuse nodular thickening of the pleura on the right side only, with right pleural effusion, multiple nodules in the left lung, and no discrete mass in either lung. The authors presented these findings as mimicking mesothelioma.
  • A bone survey and abdominal ultrasound showed no evidence of cancer spread to distant sites in this patient.
  • Biopsy of the pleural nodules, with immunohistochemical staining, confirmed adenocarcinoma originating from the lung rather than mesothelioma.
  • Testing of this patient's tumor found the EGFR gene to be wild-type (no EGFR mutation).
  • The patient received four cycles of pemetrexed-cisplatin chemotherapy. Because of a raised blood creatinine level, only a non-contrast follow-up CT was done, and it showed marked improvement of the pleural thickening.
  • On the post-treatment CT, the right lung was fully expanded without pleural effusion. The largest left lung nodule measured approximately 1.1 cm, compared with approximately 1.9 cm before treatment, a reduction of more than 20%.
• The authors' conclusion: The authors concluded that many diseases can arise in the pleura and look alike on imaging, and that a specialized multidisciplinary team is necessary to establish the diagnosis and plan care.

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Adenocarcinoma, Mesothelioma, Pleura, Pathology, Prognosis, Biopsy, Pemetrexed (Alimta).

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