Rapidly progressive sarcomatoid malignant mesothelioma of the pleura mimicking pulmonary empyema

Our plain-English summary of Rapidly progressive sarcomatoid malignant mesothelioma of the pleura mimicking pulmonary empyema, by K. Fujita, Y.H. Kim, K. Nakatani, et al (Clinical Case Reports, 2015).

The study

• Authors: K. Fujita, Y.H. Kim, K. Nakatani, T. Mio
• Journal: Clinical Case Reports
• Published: 2015;3(10):875-8
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Refractory empyema occasionally reflects hidden malignant disease. We presented a rare case of rapidly progressive malignant mesothelioma of the pleura (MPM) mimicking empyema. Physicians should be aware of MPM when patients with empyema are refractory to the standard treatment, and PET-CT may be helpful in establishing a precise diagnosis in such cases.

In plain English

This article is a case report from a hospital in Kyoto, Japan, describing one patient. An 82-year-old man came to the hospital with a long-lasting cough and shortness of breath. Chest imaging showed a large, walled-off collection of fluid around his right lung. A CT scan showed neither pleural thickening nor pleural plaques. The authors reported that he had no obvious history of environmental or occupational asbestos exposure. Doctors drained 1200 mL of pus-like fluid. He was first diagnosed with empyema (an infected fluid collection around the lung) and given antibiotics. Repeated tests of the fluid found no cancer cells. After brief improvement, his condition worsened rapidly. A biopsy was not done because he was too unstable, so a PET-CT scan was used. It showed intense uptake along his entire right pleura, which the authors said strongly suggested mesothelioma. He died one month after his first visit. Autopsy findings suggested sarcomatoid malignant pleural mesothelioma. The authors concluded that physicians should be aware of this cancer when empyema does not respond to standard treatment, and that PET-CT may help in diagnosis.

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 82-year-old man seen at a hospital in Kyoto, Japan (National Hospital Organisation Kyoto Medical Centre); dates of care not stated
• Exposure: The authors reported no obvious history of environmental or occupational asbestos exposure; no fiber type was identified
• Main results:
  • At presentation, a chest CT scan showed neither pleural thickening nor pleural plaque
  • Chest drainage released 1200 mL of purulent (pus-like) pleural fluid
  • Repeated testing of the pleural fluid showed no cancer cells
  • Despite drainage and antibiotics, the patient's condition declined rapidly about two weeks after starting therapy
  • A thoracoscopic biopsy was not done because the patient's vital signs were unstable
  • PET-CT showed intense tracer uptake throughout the entire right pleura, which the authors said strongly suggested malignant mesothelioma
  • The patient died one month after his first visit
  • Autopsy tissue showed dense tumor made of spindle-shaped cells with abnormal nuclei, and the findings suggested sarcomatoid malignant pleural mesothelioma
• The authors' conclusion: The authors concluded that physicians should be aware of malignant pleural mesothelioma when empyema does not respond to standard treatment, and that PET-CT may help establish a precise diagnosis in such cases

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Mesothelioma, Pleura, Empyema, PET-CT.

Related studies

• Melanoma of the pleura mimicking malignant mesothelioma: a rare and rapidly progressive pleural disease — B. Edland, C. Stanley, et al. (2025)
• A retired shipyard worker with rapidly progressive pulmonary interstitial fibrosis — E.V. Moy, H. Hu, et al. (1999)
• Empyema necessitans mimicking mesothelioma; unusual presentation of active pulmonary TB in immuno-competent state — A.M.H. Dirie, H. Özdemir, et al. (2022)
• Pulmonary sarcomatoid carcinoma mimicking pleural mesothelioma: A case report — L. Wang, J. Zhang, et al. (2021)
• Malignant Pleural Mesothelioma, Biphasic Type: An Unusual and Insidious Case of Rapidly Progressive Small Blue Cell Tumor — C. Salazar, N. Kanter Md, et al. (2018)
• Asymmetric rapidly progressive lung fibrosis: a cause of pseudotumour in asbestosis — W.O. Cookson, J.J. Glancy, et al. (1985)

Browse more research in Clinical Case Reports, or return to medical research.