Rapid diffuse pleural thickening due to metastatic meningioma

Our plain-English summary of Rapid diffuse pleural thickening due to metastatic meningioma, by F. Kobayashi, T. Saraya, K. Ohkuma, et al (Respirology Case Reports, 2018).

The study

• Authors: F. Kobayashi, T. Saraya, K. Ohkuma, M. Fujiwara, H. Takizawa
• Journal: Respirology Case Reports
• Published: 2018;6(4):e00313
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 64-year-old man was referred to our hospital because of persistent dyspnoea for the past 1 month. He had recurrent brain anaplastic meningioma after two operations and irradiation. He suffered from right pleural effusion in the previous few months and was diagnosed with malignant mesothelioma via pleural biopsy 1 month prior to coming to our hospital. At his first visit to our hospital, thoracic computed tomography demonstrated rapidly developed large inhomogeneously enhancing pleural thickening up to 3 cm, which surrounded the right hemithorax, together with left-sided pleural effusion. After re-evaluation of the pathological specimens retrieved from the local hospital, he was finally diagnosed with pleural metastasis secondary to anaplastic meningioma (WHO classification, grade 3). Generally, brain meningiomas are believed to be benign and seldom metastasize to other organs. However, the present case clearly demonstrated the unique clinical presentation of anaplastic meningioma, also known as malignant meningioma, which mimicked the pathological and radiological findings of a malignant mesothelioma.

In plain English

This case report from Japan described one 64-year-old man. He was a former smoker (42 pack-years) who denied any dust exposure; the article did not study asbestos. His brain tumour, anaplastic meningioma (WHO grade 3), recurred one year after surgery and was treated with a second operation and brain irradiation. A local hospital had diagnosed biphasic malignant mesothelioma from pleural tissue taken during chest surgery. A chest X-ray four months before referral appeared normal. At his first visit, chest CT showed pleural thickening of approximately 3 cm (up to 3.4 cm in a figure legend) surrounding the right chest, with left-sided fluid. The authors' re-examination of the tissue pointed to meningioma rather than mesothelioma: the cells were positive for vimentin, epithelial membrane antigen and progesterone receptor, weakly positive for cytokeratin 5/6, WT-1 and D2-40, and negative for calretinin, keratin CAM 5.2, CK AE1/AE3 and oestrogen receptor. He was finally diagnosed with pleural metastasis from anaplastic meningioma and died of respiratory failure one month later. The authors concluded that brain meningiomas, generally considered benign, could rapidly and aggressively spread to the pleura.

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 64-year-old man referred to the Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka City, Japan, with one month of shortness of breath. His anaplastic meningioma of the brain (WHO grade 3) had been resected two years before referral and recurred one year later, leading to a second operation and brain irradiation.
• Exposure: No asbestos exposure was studied or reported. The patient was an ex-smoker with 42 pack-years who denied any dust exposure.
• Main results:
  • One month before referral, the patient's local hospital had diagnosed biphasic malignant mesothelioma based on pleural pathology after video-assisted thoracic surgery.
  • A chest X-ray 4 months before referral appeared normal. At the first visit, thoracic CT showed a large inhomogeneously enhancing pleural thickening of approximately 3 cm surrounding the right hemithorax, with left-sided pleural effusion. The figure legend gives up to 3.4 cm.
  • On re-evaluation of the local hospital's pleural samples, H-E staining showed abundant atypical epithelioid cells and many fusiform cells, indicating the possibility of meningioma rather than malignant mesothelioma.
  • Staining of the atypical pleural cells was positive for vimentin, epithelial membrane antigen and progesterone receptor. It was weakly positive for CK 5/6, WT-1 and D2-40, and negative for calretinin, keratin CAM 5.2, CK AE1/AE3 and oestrogen receptor. Ki-67-positive cells made up over 50% of the atypical cells.
  • The authors stated that the negative calretinin and cytokeratin staining excluded epithelial or biphasic malignant mesothelioma.
  • The patient was finally diagnosed with pleural metastasis secondary to anaplastic meningioma (WHO grade 3). He died of respiratory failure one month after the diagnosis.
• The authors' conclusion: The authors concluded that brain meningiomas, generally considered benign tumours, could rapidly and aggressively metastasize to the pleura, as in this case. They also concluded that metastatic pleural meningioma can resemble malignant mesothelioma radiologically and pathologically.

Topics

Medical terms in this study, explained in our Lexicon: Diffuse Pleural Thickening, Pleural Effusion, Mesothelioma, Pleural Biopsy, Pleural Thickening, Hemithorax, Metastasis, WHO Classification.

Related studies

• Amelanotic Malignant Melanoma with Dense Pleural Thickening Mimicking Malignant Mesothelioma — T. Saraya, M. Fujiwara, et al. (2019)
• Asbestosis, pleural plaques and diffuse pleural thickening: three distinct benign responses to asbestos exposure — P.A. Gevenois, V. de Maertelaer, et al. (1998)
• Diffuse pleural thickening in asbestos workers: disability and lung function abnormalities — C.R. McGavin, G. Sheers (1984)
• Causes of pulmonary impairment in asbestos-exposed individuals with diffuse pleural thickening — S.T. Kee, G. Gamsu, et al. (1996)
• Clinical consequences of asbestos-related diffuse pleural thickening: A review — S.E. Miles, A. Sandrini, et al. (2008)
• Asbestos-related lesions of the pleura: parietal plaques compared to diffuse thickening studied with chest roentgenography, computed tomography, lung function, and gas exchange — G. Hillerdal, P. Malmberg, et al. (1990)

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