Malignant Pleural Mesothelioma with Marked Lymphatic Involvement: A Report of Two Autopsy Cases

We herein report two cases of malignant pleural mesothelioma with marked lymphangiosis. The patients included a 68-year-old man and a 67-year-old man who both had a history of exposure to asbestos. Computed tomography (CT) on admission showed pleural effusion with pleural thickening. In both cases, a histopathological examination of the pleura confirmed the diagnosis of epithelioid malignant mesothelioma. They received chemotherapy, but the treatment was only palliative. The chest CT assessments during admission revealed marked pleural effusion and mediastinal lymphadenopathy. CT also showed a consolidative mass with bronchovascular bundle and septal thickening in the lungs suggesting pulmonary parenchymal involvement and the lymphangitic spread of the tumor. These CT findings mimicked lung cancer with pleuritis and lymphangitic carcinomatosis. Autopsy was performed in both cases. Macroscopically, the tumor cells infiltrated the lung with the marked lymphatic spread of the tumor. Microscopy also revealed that the tumor had invaded the pulmonary parenchyma with the marked lymphatic spread of the tumor. Although this growth pattern is unusual, malignant pleural mesothelioma should be considered as the differential diagnosis, especially in patients with pleural lesions.

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Identification of Pleural Effusion with Low Levels of Adenosine Deaminase but Without Signs of Acute Inflammation or Pleural Thickening to Diagnose Early Malignant Pleural Mesothelioma

Haigan ◽

10.2482/haigan.52.10 ◽

2012 ◽

Vol 52 (1) ◽

pp. 10-16

Author(s):

Satoru Moriyama ◽

Masayuki Tanahashi ◽

Eriko Suzuki ◽

Hiroshi Haneda ◽

Naoko Yoshii ◽

...

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Malignant Pleural Mesothelioma ◽

Acute Inflammation ◽

Pleural Mesothelioma ◽

Pleural Thickening ◽

Low Levels

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A review of malignant pleural mesothelioma in a large North East UK pleural centre

Pleura and Peritoneum ◽

10.1515/pp-2020-0144 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Declan C. Murphy ◽

Alexander Mount ◽

Fiona Starkie ◽

Leah Taylor ◽

Avinash Aujayeb

Keyword(s):

Malignant Pleural Mesothelioma ◽

Survival Rates ◽

Case Series ◽

Pleural Mesothelioma ◽

Retrospective Case ◽

Pleural Thickening ◽

North East ◽

Total Cohort ◽

Anti Cancer ◽

One Year

AbstractObjectivesThe National Mesothelioma Audit 2020 showed Northumbria to have low rates of histopathological confirmation, treatment and one-year survival rates for malignant pleural mesothelioma (MPM). We hypothesized that an internal analysis over a 10-year period provides valuable insights into presentation, diagnosis, treatment and outcomes.MethodsA single-centre retrospective case series of all confirmed MPM patients between 1 January 2009 and 31 December 2019 was performed. Demographics, clinical, radiological and histopathological characteristics and outcomes were collected. Statistical analysis was performed using SPSS V26.0.ResultsA total of 247 patients had MPM. About 86% were male, mean age 75.7 years. Dyspnoea (77.4%) and chest pain (38.5%) were commonest symptoms. 64.9 and 71.4% had pleural thickening and effusion, respectively. About 86.8% had at least one attempt to obtain a tissue biopsy, but histopathological confirmation in only 108 (43.7%). About 66.3% with PS 0 and 1 (62.7% of total cohort) had at least one anti-cancer therapy. Death within 12 months was associated with disease progression within 6 months (p≤0.001). Chemotherapy (p≤0.001) and epithelioid histological subtype (p=0.01) were protective.ConclusionsThis study confirms known epidemiology of MPM, demonstrates variability in practices and highlights how some NMA recommendations are not met. This provides the incentive for a regional mesothelioma multi-disciplinary meeting.

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