Radiotherapy-Induced Pleural Mesothelioma in a Childhood Leukaemia Survivor: A Case Report

Our plain-English summary of Radiotherapy-Induced Pleural Mesothelioma in a Childhood Leukaemia Survivor: A Case Report, by S. Saeki, R. Kurosawa, A. Yamada, et al (Respirology Case Reports, 2025).

The study

• Authors: S. Saeki, R. Kurosawa, A. Yamada, M. Shimamura, M. Inaba, T. Tashiro, A. Sakagami, N. Hirata, Y. Jodai, S. Iyama, Y. Tomita, T. Sakagami
• Journal: Respirology Case Reports
• Published: 2025;13(9):e70342
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We report the case of a 41-year-old woman who developed an epithelioid-type pleural mesothelioma (PM) decades after treatment for childhood acute myeloid leukaemia (AML), who was treated with chemotherapy and total body irradiation (TBI). The diagnosis was confirmed by thoracoscopic pleural biopsy and immunohistochemical staining. Although PM is classically associated with asbestos exposure, the patient had no known history of exposure. This case report highlights the fact that PM can occur as a late-onset secondary malignancy following radiation therapy in childhood cancer survivors. Although radiation-induced PM has been reported primarily in survivors of Hodgkin lymphoma or breast cancer, incidences following treatment for leukaemia are exceptionally rare. This case report highlights the importance of considering prior therapeutic irradiation, including total-body irradiation, as a potential etiological factor for non-asbestos-related PM. It also emphasises the need for the long-term surveillance and monitoring of childhood cancer survivors, particularly those who have received radiation therapy.

© 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This was a case report about one patient in Japan. A 41-year-old woman, treated for acute myeloid leukaemia (AML) at age 8, developed worsening breathlessness and a large fluid collection around the right lung. Fluid tests suggested tumour cells. Biopsies of pleural nodules taken during thoracoscopic surgery, with immunohistochemical staining, confirmed epithelioid-type pleural mesothelioma. A detailed interview did not confirm any history of asbestos exposure. Records showed the childhood treatment had included chemotherapy, total body irradiation and an autologous bone marrow transplant. Based on family history, the authors considered an inherited BAP1 syndrome less likely. The patient was referred to another hospital for treatment. The authors concluded that prior therapeutic irradiation, including total body irradiation, should be considered as a potential cause of mesothelioma not linked to asbestos, and called for long-term follow-up of childhood cancer survivors. A single case shows what happened to one person, not how often this occurs.

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 41-year-old woman, seen at a respiratory medicine department in Kumamoto, Japan, who had been treated for acute myeloid leukaemia (AML) at age 8
• Exposure: Childhood AML treatment with chemotherapy, total body irradiation (TBI) and an autologous bone marrow transplant. A detailed interview did not confirm a history of asbestos exposure.
• Main results:
  • Pleural fluid cytology in this patient suggested tumour cells consistent with pleural mesothelioma
  • Thoracoscopy showed multiple nodular lesions on the visceral and parietal pleura
  • The tumour cells stained positive for calretinin, D2-40 and WT-1 and negative for TTF-1 and CEA, confirming epithelioid-type pleural mesothelioma
  • A detailed interview did not confirm a history of asbestos exposure
  • Family history included bile duct cancer in the paternal grandfather and gastric cancer in the maternal grandfather. The authors considered BAP1 tumour predisposition syndrome less likely.
  • The patient was referred to a tertiary care hospital for multidisciplinary treatment. No treatment outcome was reported.
• The authors' conclusion: The authors concluded that the case highlights the importance of considering prior therapeutic irradiation, including total body irradiation, as a potential etiological factor for non-asbestos-related pleural mesothelioma. They also emphasised long-term follow-up of childhood cancer survivors who received radiation.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Epithelioid, Chemotherapy, Pleural Biopsy, Immunohistochemistry, Asbestos Exposure.

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• Anti-cancer therapy using dendritic cells and apoptotic tumour cells: pre-clinical data in human mesothelioma and acute myeloid leukaemia — M. Grégoire, C. Ligeza-Poisson, et al. (2003)
• Clinical and pathological features of three-year survivors of malignant pleural mesothelioma following extrapleural pneumonectomy — D.J. Sugarbaker, A.S. Wolf, et al. (2011)
• Molecular resistance fingerprint of pemetrexed and platinum in a long-term survivor of mesothelioma — O.D. Røe, A. Szulkin, et al. (2012)
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