Systemic lymphadenopathy as the initial presentation of malignant mesothelioma: a report of three cases

Our plain-English summary of Systemic lymphadenopathy as the initial presentation of malignant mesothelioma: a report of three cases, by Y. Zhang, Z.M. Taheri, M. Jorda (Pathology Research International, 2010).

The study

• Authors: Y. Zhang, Z.M. Taheri, M. Jorda
• Journal: Pathology Research International
• Published: 2010;2010:846571
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Systemic lymph node metastasis is a rare event in malignant mesothelioma. It is even more exceptional when systemic lymph node metastasis is the initial clinical presentation. Review of literature discloses only four cases in which metastatic lymphadenopathy was the only symptom of malignant mesothelioma. We, herewith, report three cases where the initial diagnosis of malignant mesothelioma was made by biopsy of enlarged lymph nodes, which were the only clinical presentation. Immunohistochemistry played a pivotal role in elucidating the mesothelial origin of their unusual systemic lymph node metastasis.

In plain English

This article was a case report from the Department of Pathology at the University of Miami-Miller School of Medicine/Jackson Memorial Hospital. It described three men, aged 50, 61 and 69, whose malignant mesothelioma was first diagnosed by biopsy of enlarged lymph nodes, which the authors described as the only clinical presentation. In the 50-year-old, scans first suggested lymphoma, but needle aspiration ruled that out. A neck-area node biopsy was then diagnosed as metastatic malignant mesothelioma, later traced to the peritoneum near the liver. In the 61-year-old, a neck node biopsy led to the same diagnosis, and earlier CT scans showed origin in the pelvic peritoneum. In the 69-year-old, an armpit node biopsy suggested mesothelioma, and a pleural biopsy confirmed epithelioid malignant mesothelioma. In all three, immunohistochemistry (special stains such as calretinin) supported the diagnosis. The authors concluded that this staining is the most helpful extra test, especially for telling mesothelioma apart from adenocarcinoma. The article did not report asbestos or any other exposure history for these patients.

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 (three cases)
• Who was studied: Three male patients aged 50, 61 and 69, reported from the Department of Pathology, University of Miami-Miller School of Medicine/Jackson Memorial Hospital, Miami; two mesotheliomas arose in the peritoneum and one in the pleura; dates of care not given
• Main results:
  • Case one: a 50-year-old man had progressively enlarging lymph nodes in the left groin and right lower neck over 6 months
  • Case one: imaging first suggested probable malignant lymphoma, but fine needle aspiration of a left groin node ruled lymphoma out
  • Case one: tumor cells in the supraclavicular node biopsy stained positive for cytokeratin and calretinin, among other markers
  • Case one: on review, the tumor was found to have arisen from the peritoneum in the perihepatic region
  • Case two: a 61-year-old man presented with left neck lymphadenopathy
  • Case two: tumor cells were positive for cytokeratin and calretinin
  • Case two: on review of earlier CT scans, the tumor was found to have originated in the pelvic peritoneum
  • Case three: a 69-year-old man with mediastinal and left axillary lymphadenopathy had an axillary node biopsy suggesting mesothelioma; a pleural biopsy confirmed epithelioid malignant mesothelioma
• The authors' conclusion: The authors concluded that immunohistochemistry is the most helpful ancillary test for confirming the diagnosis, particularly for separating malignant mesothelioma from adenocarcinoma. In their experience the most useful findings were positive calretinin and D2-40 with negative CEA, MOC-31 and TTF-1.

Topics

Medical terms in this study, explained in our Lexicon: Lymphadenopathy, Mesothelioma, Metastasis, Biopsy, Immunohistochemistry.

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