Primary pleural malignant mesothelioma with delayed metastasis to the piriform sinus: report of a case

Our plain-English summary of Primary pleural malignant mesothelioma with delayed metastasis to the piriform sinus: report of a case, by U. Taskin, O. Yigit, M. Aricigil, et al (Ear, Nose, & Throat Journal, 2013).

The study

• Authors: U. Taskin, O. Yigit, M. Aricigil, G. Huq
• Journal: Ear, Nose, & Throat Journal
• Published: 2013;92(6):E55
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Piriform sinus tumors are uncommon and silent lesions. Their prognosis is poor because these tumors are usually not detected until they have reached an advanced stage. Almost all piriform sinus cancers are primary squamous cell carcinomas; other primary and metastatic tumors of the hypopharynx are exceedingly rare. One of the rare tumors in the laryngopharyngeal area is sarcomatoid carcinoma, which is an unusual type of squamous cell carcinoma. Another uncommon malignant tumor that is histologically similar to sarcomatoid carcinoma is malignant mesothelioma, which is a rare form of lung carcinoma. The macroscopic appearance and histologic characteristics of sarcomatoid carcinoma and malignant mesothelioma are so similar that differentiation is usually achieved by immunohistochemical examination. To the best of our knowledge, no case of primary or metastatic laryngohypopharyngeal malignant mesothelioma has been previously reported in the literature. In this article, we describe a case of isolated malignant mesothelioma of the piriform sinus that resembled a sarcomatoid carcinoma in a 50-year-old man with a history of lung mesothelioma.

In plain English

This article reported a single case from the Istanbul Education and Research Hospital in Turkey. A 50-year-old man came to the emergency department with worsening breathlessness and hoarseness. Two years earlier his left lung had been removed to treat biphasic malignant mesothelioma, which the case description places in the lung parenchyma, followed by 3 months of chemotherapy. A scan now showed a 6 × 5-cm mass filling the left piriform sinus, part of the lower throat. He had an emergency tracheotomy and later surgery to remove the larynx and lymph nodes on both sides of the neck. The authors described the nodes as reactive. The tumor measured 7 × 6 × 5 cm. The authors diagnosed malignant mesothelioma of the piriform sinus based on three things: his history, the tumor's appearance, and focal staining for calretinin and CK-5/6. They noted that some features resembled a different cancer, sarcomatoid carcinoma. He had no recurrence during 3 years of follow-up. The article does not mention asbestos exposure. The authors concluded that clinicians should consider throat tumors in patients with a history of cancer.

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) from Istanbul, Turkey
• Who was studied: one 50-year-old man with progressively worsening breathlessness and hoarseness of 2 weeks' duration
• Exposure: The article does not report any asbestos exposure, occupation or fiber type for the patient.
• Main results:
  • Two years before, the patient had a left pneumonectomy (lung removal) for biphasic malignant mesothelioma of the lung parenchyma, followed by 3 months of chemotherapy.
  • CT of the neck showed a 6 × 5-cm solid mass filling the left piriform sinus.
  • He underwent total laryngectomy with bilateral functional neck dissection.
  • The neck dissection found multiple reactive lymph nodes in the left jugulodigastric chain.
  • The removed tumor was a nodular, necrotic mass of 7 × 6 × 5 cm.
  • Tumor staining was negative for HBME-1, CK-17, Ber-EP4, Leu-M1, bcl-2 and CD99.
  • The tumor was diagnosed as malignant mesothelioma of the piriform sinus based on the patient's history of lung mesothelioma, the tumor's appearance, and focal positive staining for calretinin and CK-5/6.
  • After surgery the patient showed no recurrence during 3 years of follow-up.
• The authors' conclusion: The authors concluded that clinicians should be aware of the possibility of tumors of the hypopharynx in patients with a history of malignancy.
• Limitations the authors state:
  • The authors acknowledged that the tumor's location and its cytokeratin (CK) positivity resembled sarcomatoid carcinoma, a different cancer.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Metastasis, Prognosis, Squamous Cell Carcinoma, Sarcomatoid, Carcinoma.

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