Simultaneous tongue metastasis from malignant pleural mesothelioma: Case report and literature review

Our plain-English summary of Simultaneous tongue metastasis from malignant pleural mesothelioma: Case report and literature review, by C. Huang, X. Yang (Thoracic Cancer, 2020).

The study

• Authors: C. Huang, X. Yang
• Journal: Thoracic Cancer
• Published: 2020;12(3):391-6
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare neoplasm of the serosal membranes. MPM usually manifests as local invasion, rarely with distant haematogenous metastases in different organs. Few cases of tongue metastasis have been documented. Here, we report the case of a 68-year-old man diagnosed with malignant pleural epithelioid mesothelioma together with a simultaneous tongue lesion, which was found to be metastatic malignant mesothelioma. Tongue metastasis from MPM is rare and the oral symptoms it causes could be an early sign of clinical manifestation. For patients with oral symptoms and a newly discovered tongue lesion, clinicians should be aware of the possibility of tongue metastasis and search for a primary malignancy.

© 2020 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This was a case report with a short review of earlier published cases. The authors described a 68-year-old Chinese man who came to their hospital short of breath and with mild difficulty speaking. Both were caused by a firm mass at the back of his tongue. He had no history of significant asbestos exposure in his working life and a past 20 pack-year smoking history. A chest scan showed fluid around both lungs, and pleural thickening that a figure caption placed on the left. A biopsy of a mass in his left chest wall showed epithelioid malignant mesothelioma, and a tongue biopsy matched it. Stains supported mesothelioma and were negative for lung cancer markers. After five cycles of cisplatin and pemetrexed he had a partial response. He died of respiratory failure 17 months after his first symptoms. The authors found nine earlier reported cases of mesothelioma spreading to the tongue, one of them peritoneal; 7 of the 9 were men. The authors concluded that tongue metastasis from pleural mesothelioma is rare. For patients with oral symptoms and a newly found tongue lesion, they said clinicians should consider it and search for a primary cancer.

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 with literature review
• Who was studied: One 68-year-old Chinese man treated at the authors' hospital in Beijing, China, plus nine previously published cases of malignant mesothelioma with tongue metastasis
• Exposure: The patient had no history of significant asbestos exposure in his working life. He had a 20 pack-year smoking history and had not smoked for 20 years. No fiber type was described.
• Main results:
  • The patient's shortness of breath and mild difficulty speaking were caused by a firm, submucosal mass in the back part of his tongue.
  • A chest CT scan showed fluid in the pleural space on both sides, with pleural thickening.
  • The figure caption for the chest CT scan placed the diffuse pleural thickening on the left side of the chest.
  • A CT-guided biopsy of a mass in the left chest wall showed epithelioid-type malignant mesothelioma.
  • The tongue biopsy matched the findings from the left chest wall.
  • Stains were positive for calretinin, cytokeratin 5/6 and WT-1 in both the primary tumor and the tongue metastasis, and negative for the lung cancer markers TTF-1 and CEA.
  • Masses in the muscles of both upper limbs and the jaw were noted at the same time as the tongue lesion but were not biopsied.
  • The patient had a partial response after five cycles of cisplatin and pemetrexed.
  • The patient died of mesothelioma, from respiratory failure, 17 months after the first manifestation.
  • The literature search found nine previously reported cases of malignant mesothelioma with tongue metastasis. One of these (Vazquez et al. 2016) was a peritoneal mesothelioma.
  • Of the nine previously reported cases, 78% (7/9) were men. The median age at diagnosis was 69 years.
  • Where the primary tumor type was stated, 6 of 8 previously reported cases were epithelioid, 1 of 8 was biphasic and 1 of 8 had a well differentiated papillary pattern.
  • In the previously reported cases, the median time between diagnosis of the primary mesothelioma and the tongue metastasis was 19 months (range 5 to 36 months).
  • In the previously reported cases, five patients had the tongue metastasis cut out and two received local radiotherapy. Median survival after tongue metastasis was more than six months (range 19 days to 5 years).
• The authors' conclusion: The authors concluded that, in their literature review, tongue metastasis from malignant pleural mesothelioma was very uncommon. In the abstract they added that the oral symptoms it causes could be an early sign. For patients with oral symptoms and a newly discovered tongue lesion, they said clinicians should be aware of possible tongue metastasis and search for a primary cancer.

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Neoplasm, Epithelioid, Mesothelioma.

Related studies

• Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT: A case report and literature review — P. Delabie, D. Evrard, et al. (2021)
• Tongue metastasis from a malignant diffuse mesothelioma of the pleura: report of a case — A. Piattelli, M. Fioroni, et al. (1999)
• Floor of mouth and tongue metastasis from malignant pleural mesothelioma — D. Kirke, K. Horwood, et al. (2010)
• Peritoneal mesothelioma metastasis to the tongue - Comparison with 8 pleural mesothelioma reports with tongue metastases — M.V. Vazquez, S. Selvendran, et al. (2016)
• Tongue metastasis was the first sign of malignant pleural mesothelioma detected by PET/CT — P. Xie, W. Wang, et al. (2020)
• Metastatic pleural mesothelioma presenting with solitary involvement of the tongue: report of a new case and review of the literature — F. Zanconati, A. DelConte, et al. (2003)

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