Pseudomesotheliomatous Carcinoma with a High Pleural Hyaluronic Acid Concentration Arising from a Primary Esophageal Squamous Cell Carcinoma

Our plain-English summary of Pseudomesotheliomatous Carcinoma with a High Pleural Hyaluronic Acid Concentration Arising from a Primary Esophageal Squamous Cell Carcinoma, by T. Shirahata, T. Takeshita, Y. Maeda, et al (The American Journal of Case Reports, 2019).

The study

• Authors: T. Shirahata, T. Takeshita, Y. Maeda, K. Shimizu
• Journal: The American Journal of Case Reports
• Published: 2019;20:447-452
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

BACKGROUND Pseudomesotheliomatous carcinomas are rare tumors that develop like malignant pleural mesothelioma (MPM). These tumors have similar features, and thus pseudomesotheliomatous carcinomas can sometimes be misdiagnosed as MPM. Most pseudomesotheliomatous carcinomas develop from primary lung cancers, although there have been some reports involving other malignancies; however, there has been no report describing a pseudomesotheliomatous carcinoma developing from an esophageal squamous cell carcinoma (ESCC). To the best of our knowledge, this is the first case report describing pseudomesotheliomatous carcinoma originating from primary ESCC. CASE REPORT A 65-year-old man was admitted to our hospital because of persistent cough and right chest pain. Radiological examination suggested MPM, and a high concentration of pleural hyaluronic acid was also observed. Cytological examination of pleural effusion confirmed metastatic squamous cell carcinoma, and ESCC was confirmed by upper-gastrointestinal endoscopy. The patient received cisplatin and 5-FU combination chemotherapy as first-line treatment, and docetaxel chemotherapy as second-line treatment. However, the patient's condition deteriorated, and he died 6 months after the diagnosis was established. We performed an autopsy and found that ESCC had invaded the lung, pleura, peritoneum, liver, stomach, ureter, bladder, spine, and lymph nodes. CONCLUSIONS We demonstrated that primary ESCC can give rise to a pseudomesotheliomatous carcinoma. This report describes the clinical features and outcome of such a patient, with an emphasis on differential diagnosis of MPM.

In plain English

This case report from Saitama, Japan, described a 65-year-old man who sought care in May 2015 for persistent cough and low fever, later with right chest pain. He had a 68-pack-year smoking history and had worked for a construction company, which the authors described as occupational asbestos exposure. Chest CT showed fluid around the right lung and multiple pleural nodules, but no lung nodules. Because of his past occupation and these findings, the doctors first suspected malignant pleural mesothelioma. His pleural fluid had a high hyaluronic acid concentration of 168 mg/L, which the authors said also suggested mesothelioma. However, the fluid contained metastatic squamous cell carcinoma, and endoscopy then found a tumor in the lower esophagus that biopsy showed was squamous cell carcinoma. Two lines of chemotherapy brought no improvement, and he died 6 months after admission. At autopsy the esophageal cancer had spread to the lung, pleura, peritoneum and other organs, and no signs of lung asbestosis, such as asbestos corpuscles, were found. The authors concluded that esophageal squamous cell carcinoma should be suspected as a primary tumor for pseudomesotheliomatous carcinoma, a cancer that mimics mesothelioma.

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 65-year-old Japanese man seen in 2015 at the Japan Community Health Care Organization (JCHO) Saitama Medical Center, Saitama City, Japan
• Exposure: Former work for a construction company, which the authors described as occupational asbestos exposure (fiber type not stated). He also had a 68-pack-year smoking history.
• Main results:
  • Doctors initially suspected malignant pleural mesothelioma because of the patient's past occupation, pleural effusion and pleural nodules.
  • Chest CT showed no nodules in the lung, alongside pleural effusion and multiple pleural nodules.
  • The patient's pleural fluid had a high hyaluronic acid concentration of 168 mg/L, which the authors described as also suggestive of mesothelioma.
  • Cytology of the patient's pleural fluid showed metastatic squamous cell carcinoma.
  • Upper-gastrointestinal endoscopy found a tumor in the patient's lower esophagus. Biopsy of that tumor showed a poorly differentiated squamous cell carcinoma.
  • Tissue from the esophagus and pleural fluid tested positive for p63 and p40 and negative for calretinin and D2-40. The authors said these results were consistent with esophageal squamous cell carcinoma.
  • Cisplatin and 5-FU chemotherapy, followed by docetaxel, gave no symptomatic or radiographic improvement.
  • The patient died in November, 6 months after he was first admitted.
  • At autopsy, tumor invasion was seen extensively in the pleura of the lungs.
  • At autopsy, the esophageal squamous cell carcinoma had invaded the lung, pleura, peritoneum, liver, stomach, ureter, bladder, spine and lymph nodes.
  • At autopsy, no signs suggestive of lung asbestosis, such as asbestos corpuscles, were detected.
• The authors' conclusion: The authors concluded that the esophageal squamous cell carcinoma spread diffusely to the pleura and produced mesothelioma-like findings with high pleural hyaluronic acid. They said esophageal squamous cell carcinoma should be suspected as the primary tumor for pseudomesotheliomatous carcinoma.

Topics

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

Medical terms in this study, explained in our Lexicon: Pseudomesotheliomatous Adenocarcinoma, Hyaluronic Acid, Squamous Cell Carcinoma, Pleural Mesothelioma, Lung Cancer, Pleural Effusion, Endoscopy, Cisplatin.

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