Saved by the Scan: A Case of Early Detection of Sarcomatoid Mesothelioma

Our plain-English summary of Saved by the Scan: A Case of Early Detection of Sarcomatoid Mesothelioma, by H. Choudhury, J. Budde, N. Ahmed, et al (Curēus, 2022).

The study

• Authors: H. Choudhury, J. Budde, N. Ahmed, A. Johnson, C. Adewunmi
• Journal: Curēus
• Published: 2022;14(7):e26793
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

We report a case of localized sarcomesothelioma detected during screening via a low-dose CT (LDCT) scan. The patient is a 71-year-old female, a current 56-pack-year cigarette smoker with a past medical history of myocardial infarction and stroke with a Zubrod score of zero. A screening LDCT revealed a 1.9 cm × 1.8 cm × 1.4 cm right lower lobe lesion with smooth margins and close association with the hemidiaphragm. A wedge resection with biopsy showed high-grade sarcomatoid mesothelioma with extensive desmoplastic morphology and negative margins. The patient opted for imaging surveillance, and at 12 months has shown no evidence of tumor recurrence on positron emission tomography (PET)/CT. The case shows that LDCT screening discovers cancers and saves lives. It also presented a dilemma for the patient and her oncologist because common guidelines do not define a recommended treatment.

Copyright © 2022, Choudhury et al.

In plain English

This article was a case report describing one patient: a 71-year-old woman who was a current cigarette smoker with a 56-pack-year history. According to the authors, the patient did not have occupational exposure to asbestos. A screening low-dose CT scan found a 1.9 cm × 1.8 cm × 1.4 cm lesion in the right lower lobe of the lung, close to the diaphragm. A PET scan showed mild activity in the lesion (maximum SUV of 2.6) without evidence of lymph node involvement. A CT-guided needle biopsy was inconclusive. Surgeons removed the mass by video-assisted thoracoscopic wedge resection, and lymph nodes were not sampled. Final pathology showed a 2 cm high-grade sarcomatoid mesothelioma with extensive desmoplastic morphology and negative margins. The patient was offered adjuvant ipilimumab and nivolumab but chose imaging surveillance. At 12 months, PET/CT showed no evidence of tumor recurrence. The authors noted that guidelines do not define a recommended treatment for resectable sarcomatoid mesothelioma. They concluded that the case highlights the importance of low-dose CT screening for early diagnosis. The report describes a single patient.

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 71-year-old female patient. She was a current 56-pack-year cigarette smoker with a history of myocardial infarction and stroke, and had a Zubrod score of zero. The place and dates of care are not stated.
• Exposure: No asbestos exposure was reported. The authors state the patient did not have occupational exposure to asbestos and describe a lack of any evidence of prior asbestos exposure. She was a current 56-pack-year cigarette smoker.
• Main results:
  • A screening low-dose CT found a 1.9 cm × 1.8 cm × 1.4 cm right lower lobe lesion with smooth margins, closely associated with the hemidiaphragm.
  • PET showed activity within the lesion with a maximum SUV of 2.6 and no evidence of nodal involvement.
  • The CT-guided needle biopsy was inconclusive.
  • The mass was removed by video-assisted thoracoscopic wedge resection. Lymph nodes were not sampled because they were neither enlarged nor active on PET.
  • Final pathology showed a 2 cm high-grade sarcomatoid mesothelioma with extensive desmoplastic morphology and negative margins.
  • The patient was offered adjuvant ipilimumab and nivolumab but chose ongoing imaging surveillance.
  • At 12 months, PET/CT showed no evidence of tumor recurrence.
  • The authors noted that standard guidelines, including the NCCN's, do not define a recommended treatment because resectable sarcomatoid types are rare.
• The authors' conclusion: The authors concluded that the case highlights the importance of low-dose CT scanning for early diagnosis of life-threatening illnesses. They also stated that the case shows LDCT scans discover cancers and save lives, and they hope it adds to the few case reports on sarcomatoid mesothelioma.
• Limitations the authors state:
  • The authors said the patient's prognosis is difficult to estimate. Published survival rates for localized malignant pleural mesothelioma likely reflect larger tumors treated with more invasive surgery.

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Mesothelioma, Biopsy, Desmoplastic Mesothelioma, Low-Dose CT Screening.

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