Primary Malignant Neuroendocrine Tumour of Pleura: First Case Report

Our plain-English summary of Primary Malignant Neuroendocrine Tumour of Pleura: First Case Report, by A. Das, A. Pratap (Case Reports in Oncological Medicine, 2016).

The study

• Authors: A. Das, A. Pratap
• Journal: Case Reports in Oncological Medicine
• Published: 2016;2016:5462380
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Metastatic tumours of pleura are the most common malignant tumours causing malignant pleural effusion. Lungs are the most common primary sites. Primary pleural tumours are rarely seen and diffuse malignant mesothelioma is the most common malignant tumour of pleura. Primary malignant neuroendocrine tumour of pleura is not reported in the literature. Here, we report a rare case of primary malignant neuroendocrine tumour of pleura in a fifty-two-year-old, nonsmoker female who presented with right-sided pleural effusion and ipsilateral, dull aching chest pain. Clinical presentations of inflammatory lesions like tuberculous pleuritis and benign and malignant neoplasms of pleura are indistinguishable; hence, fluid cytology, pleural biopsy, and immunohistochemistry are necessary for exact tissue diagnosis of the tumours, which is mandatory for correct treatment and prognostic assessment.

In plain English

This article was a case report about one patient, a fifty-two-year-old nonsmoker woman in India who had four months of right-sided chest pain, dry cough and breathlessness on exertion. Fluid from around her right lung contained no malignant cells, and a chest CT scan showed fluid but no mass. A needle biopsy of the pleura (the lining around the lung) showed a malignant tumour whose cells were mostly positive for synaptophysin, a marker of neuroendocrine cells. Tests of other organs found no tumour elsewhere, so the authors diagnosed a primary malignant neuroendocrine tumour of the pleura, which they described as the first reported case. She received six cycles of carboplatin and etoposide chemotherapy, a chest drain, and pleurodesis with povidone-iodine. At one-year follow-up the fluid had regressed and her chest pain had eased. Elsewhere the authors reported that she had no symptoms at two years. The authors noted that PET-CT scanning and thoracoscopic biopsy could not be done because of cost and lack of facilities. The article does not mention asbestos.

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 fifty-two-year-old nonsmoking woman, reported by authors from pulmonary medicine departments of medical colleges in West Bengal, India. The article does not give the dates of her care.
• Main results:
  • In this patient, fluid aspirated from the right side of the chest showed no malignant cells and no acid fast bacilli.
  • In this patient, contrast CT of the chest showed only right-sided pleural effusion, with no mass and no enlarged mediastinal lymph nodes.
  • In this patient's pleural biopsy, immunohistochemistry showed tumour cells positive for synaptophysin and occasionally for Ki-67, and negative for CEA, CD 56, calretinin, desmin, pan-cytokeratin, TTF1 and WT1.
  • The patient was treated with six cycles of carboplatin and etoposide chemotherapy, intercostal tube drainage, and chemical pleurodesis with 20 mL of 10% povidone-iodine.
  • At one-year follow-up, the patient's pleural effusion had progressively regressed and her chest pain had eased.
  • In the Discussion, the authors reported that at two-year follow-up the patient had no symptoms and had developed pleural fibrosis on the affected side.
• The authors' conclusion: The authors concluded that the patient had a primary malignant neuroendocrine tumour of the pleura, which they described as the first such case reported. They also stated that inflammatory conditions and benign and malignant pleural tumours look alike clinically, so fluid cytology, pleural biopsy and immunohistochemistry are needed for an exact tissue diagnosis.
• Limitations the authors state:
  • PET-CT scanning (with Ga68-SSA or octreoscan) to look for a hidden primary tumour elsewhere was not done, because of cost and because the facility was not available at the authors' institution.
  • Thoracoscopic biopsy, which the authors considered better, was not done for the same reasons.
  • Closed pleural biopsy, the method used here, has a poor diagnostic yield in malignant pleural effusion.

Topics

Medical terms in this study, explained in our Lexicon: Pleura, Pleural Effusion, Mesothelioma, Neoplasm, Fluid Cytology, Pleural Biopsy, Immunohistochemistry.

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