Metastasis of Sarcomatoid Malignant Mesothelioma With p16/CDKN2A Deletion Manifested as a Subcutaneous Mass in the Back: A Case Report and Review of Literature

2021 ◽  
pp. 106689692110050
Author(s):  
Kai-Bo Chen ◽  
Ya-Jing Huang ◽  
Yi Huang ◽  
Zhi-Wei Wu ◽  
Xiao-Li Jin ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Mesothelioma ◽  
Kinase Inhibitor ◽  
Pleural Thickening ◽  
Thyroid Transcription Factor 1 ◽  
Positron Emission ◽  
Systemic Treatments ◽  
Multiple Metastases ◽  
Cdkn2a Deletion ◽  
Subcutaneous Mass

Sarcomatoid malignant mesothelioma (MM) is a rare and aggressive disease, and its diagnosis is challenging. A 60-year-old man presented with a recurrent subcutaneous mass in his right back after the initial resection. A chest computed tomography (CT) scan found right pleural thickening, nodular pleural thickening, pleural effusion, mediastinal, and right infraclavicular lymph nodes enlargement, which indicated a right pleura MM. Immunohistochemical stains of the resected mass showed sarcomatous atypical spindle cells, which were positive for pan-CKs (clone Anti-cytokeratin cocktail AE1/AE3), cytokeratin 5/6 (CK5/6), Wilm’s tumor 1, podoplanin, vimentin and programmed death-ligand 1 (PD-L1), and negative for Napsin A, thyroid transcription factor 1, CDX 2, calretinin and desmin, and fluorescent in situ hybridization detected homozygous p16/cyclin-dependent kinase inhibitor 2A ( p16/CDKN2A) deletion. The association of the chest CT features and the pathological assessment confirmed metastatic MM in the subcutaneous layer of the back. Moreover, positron emission tomography–CT showed multiple metastases in his brain. He developed massive right pleural effusion and chest tightness soon, and the mass kept growing despite local and systemic treatments. The patient die of pulmonary failure in 3 months.

scholarly journals Metastasis of Sarcomatoid Malignant Mesothelioma With p16/CDKN2A Deletion Presented as a Subcutaneous Mass in the Back: a Case Report and Review of Literature

2020 ◽  
Author(s):  
Kai-Bo Chen ◽  
Ya-Jing Huang ◽  
Yi Huang ◽  
Zhi-Wei Wu ◽  
Xiao-Li Jin ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Mesothelioma ◽  
Metastatic Lesion ◽  
Chest Ct ◽  
Pleural Thickening ◽  
Systemic Treatments ◽  
Multiple Metastases ◽  
Cdkn2a Deletion ◽  
Current Therapies ◽  
Subcutaneous Layer

Abstract Background: Sarcomatoid malignant mesothelioma (MM) is a rare and aggressive disease, and its diagnosis is challenging.Case presentation: A 60-year-old man was found a recurrent mass in his right back after the initial resection. A chest CT found right pleural thickening, nodular pleural thickening, pleural effusion, mediastinal and right infraclavicular lymph nodes enlargement, which indicated a right pleura MM. Immunohistochemical (IHC) stains of the resected mass showed sarcomatous atypical spindle cells, which were positive for CK 1/3, CK 5/6, WT1, podoplanin and vimentin, and negative for Napsin A, TTF-1 and CDX2, and fluorescent in situ hybridization (FISH) detected homozygous p16/CDKN2A deletion. The association of the chest CT features and the mass assessment confirmed metastatic MM in the subcutaneous layer of the back. Moreover, PET-CT showed multiple metastases in his brain. He developed massive right pleural effusion and chest tightness soon, and the mass kept growing despite of the local and systemic treatments, and he died from pulmonary failure in 3 months.Conclusion: We described an extremely rare subcutaneous metastasis in the back from sarcomatoid MM. And we made the diagnosis by both histological and molecular analysis of the metastatic lesion. MM patients most likely have subcutaneous metastasis on head, they usually develop pleural effusion, chest pain or dyspnea, and their prognosis is very poor because of late diagnosis and insensitivity to current therapies.

scholarly journals Evaluation of Malignant Mesothelioma in Central Anatolia: A Study of 67 Cases

2004 ◽  
Vol 11 (4) ◽  
pp. 287-290 ◽  
Author(s):  
Inci Gulmez ◽  
Levent Kart ◽  
Hakan Buyukoglan ◽  
Ozlem Er ◽  
Suleyman Balkanli ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Mesothelioma ◽  
Environmental Control ◽  
Public Health Problem ◽  
Central Anatolia ◽  
Major Public Health Problem ◽  
Pleural Thickening ◽  
Chest X Ray ◽  
Fibrous Mineral

BACKROUND:Malignant mesothelioma (MM) is a fatal neoplasm which frequently results from exposure to asbestos or erionite.METHOD:Sixty-seven patients with MM were seen between 1990 and 2001. Their clinical and radiological features, as well as the therapy, were retrospectively evaluated.RESULTS:In 51 patients (76.1%), the MM was confined to the pleura, in 14 patients it was exclusively peritoneal and in two patients, it involved both areas. Of the 67 cases, 35 (52.2%) were women. The mean (± SD) age for all cases was 57.6±11.5 years. Dyspnea (67.2%), cough (55.2%) and chest pain (50.7%) were the most frequent symptoms of onset. Pleural effusion (92.4%) was the most common chest x-ray finding, whereas pleural effusion (60.8%), pleural nodules (34.7%) and pleural thickening (34.7%) were the most common computed tomography findings in pleural MM patients. The histological subtypes of MM were determined as epithelial in 60 patients (89.5%), sarcomatous in four patients (5.9%) and mixed in three patients (4.4%). Although 50.7% and 25.4% of the cases were exposed to erionite and asbestos, respectively, 23.9% of the cases recalled no exposure to asbestos or erionite. Exposures were environmental as opposed to occupational. Thirty-five patients (52.2%) were administered chemotherapy, and follow-up data were available for 22 patients. For these patients, the two-year survival rate was 22% and the two-year progression-free interval was 15.7%. There were no differences between patients with asbestos and erionite exposure.CONCLUSION:MM should be considered when exudative pleural effusion is detected in a patient who has been exposed to asbestos or erionite. MM is a major public health problem in parts of Turkey and compulsory environmental control of fibrous mineral should be considered.

Small orangiophilic squamous-like cells: An underrecognized and useful morphological feature for the diagnosis of malignant mesothelioma in pleural effusion cytology

2013 ◽  
Vol 122 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Longwen Chen ◽  
Sonia Gatius Caldero ◽  
Stephen Gmitro ◽  
Maxwell L. Smith ◽  
Giovanni De Petris ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Mesothelioma ◽  
Morphological Feature

scholarly journals Pleural Effusion of Patients with Malignant Mesothelioma Induces Macrophage-Mediated T Cell Suppression

2016 ◽  
Vol 11 (10) ◽  
pp. 1755-1764 ◽  
Author(s):  
Lysanne A. Lievense ◽  
Robin Cornelissen ◽  
Koen Bezemer ◽  
Margaretha E.H. Kaijen-Lambers ◽  
Joost P.J.J. Hegmans ◽  
...  
Keyword(s):  
T Cell ◽  
Pleural Effusion ◽  
Malignant Mesothelioma ◽  
T Cell Suppression ◽  
Cell Suppression

scholarly journals The relation of the pleural thickening in tuberculosis pleurisy with the activity of adenosine deaminase

2005 ◽  
Vol 63 (2) ◽  
Author(s):  
B. Uskul ◽  
H. Turker ◽  
C. Ulman ◽  
M. Ertugrul ◽  
A. Selvi ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Clinical Findings ◽  
X Rays ◽  
Biochemical Tests ◽  
Pleural Thickening ◽  
Group I ◽  
Immunological Mechanisms ◽  
Tuberculosis Pleurisy

Selvi, A. Kant, S. Arslan, M. Ozgel. Background: Residual pleural thickening (RPT) still occurs in most patients with tuberculosis pleurisy despite advances in the treatment of tuberculosis. The aim of this study was to evaluate the significance of RPT in tuberculosis pleurisy with the patients clinical findings, biochemical and microbiological properties of pleural effusion and with the total adenosine deaminase (ADA) and isoenzymes levels. Methods: 121 tuberculosis pleurisy patients were evaluated retrospectively. According to posteroanterior chest x-rays, the 63 (52%) cases with the thickness 2 mm or more in lower lateral hemithorax were grouped as I and the 58 (48%) cases without pleural thickness were grouped as II. The amount of pleural effusion was classified into small, medium or massive according to their chest x-rays. In both groups; sex, age, symptoms score, bacteriological and biochemical tests and ADA levels were recorded. Results: 81 (67%) male and 40 (33%) female, overall 121 patients were enrolled into the study. RPT was found higher in males (p=0.014) and the increase ran parallel with the amount of cigarette smoking (p=0.014). RPT was found to be lower in small effusions (p=0.001). The group with RPT, the serum albumin was found lower (p=0.002), pleural fluid total protein (p=0.047) and the ratio of pleural fluid protein to serum protein (p=0.002) were found higher. In group I, total ADA: 69.5±38.9 IU/L and ADA2: 41.3±31.6 IU/L were higher than the cases without RPT (p=0.032, p=0.017, respectively). Conclusions: We suggest that the immunological mechanisms are effective in the development of pleural thickening.

Pleural Effusion

Chest Imaging ◽  
2019 ◽  
pp. 165-170
Author(s):  
Christopher M. Walker
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Lateral Displacement ◽  
Pleural Space ◽  
Gravitational Effects ◽  
Pleural Thickening ◽  
Air Bubble ◽  
Fluid Analysis ◽  
Exudative Pleural Effusion

Pleural effusion discusses the radiographic and computed tomography (CT) manifestations of this entity. Pleural effusion is classified based on pleural fluid analysis using Light’s criteria: transudative and exudative. Free pleural fluid collects in the most dependent aspect of the pleural space due to gravitational effects. It exhibits a meniscus configuration on upright chest radiography. Pleural effusion in a supine or semiupright patient is more difficult to identify but may be suspected in cases with a homogeneous or gradient-like opacity over the lower hemithorax, elevation of the hemidiaphragm contour, or an apical cap. Subpulmonic pleural effusion manifests with lateral displacement of the apex of the ipsilateral hemidiaphragm contour and increased distance between the gastric air bubble and pseudodiaphragmatic contour. Exudative pleural effusion should be suspected in cases with CT findings of pleural thickening, enhancement, septations, and/or loculations.

Introduction to Pleural Disease

Chest Imaging ◽  
2019 ◽  
pp. 155-158
Author(s):  
Christopher M. Walker
Keyword(s):  
Pleural Effusion ◽  
Asbestos Exposure ◽  
Pleural Space ◽  
Pulmonary Vasculature ◽  
Pleural Disease ◽  
Pleural Thickening ◽  
Pleural Plaques ◽  
Pleural Surface ◽  
Pleural Neoplasm ◽  
Ct Features

The chapter titled introduction to pleural disease discusses the imaging and clinical features of diseases of the pleura. The pleural space is a potential space located between the visceral and parietal pleural surfaces. Pleural effusion and pneumothorax are the most common manifestations of pleural disease and are caused by a wide variety of disease processes. Pleural thickening may be related to benign or malignant processes. Bilateral discontinuous nodular pleural thickening is characteristic of pleural plaques. Pleural thickening with calcification may also be seen in fibrothorax. Malignant pleural disease may manifest with pleural effusion, pleural nodules or masses, or a combination of the two. There are several CT features suggestive of malignant pleural thickening including circumferential pleural thickening, pleural nodules or masses, involvement of the mediastinal pleural surface, and pleural thickening measuring greater than 1 cm in thickness. Metastatic disease is the most common pleural neoplasm. Mesothelioma is uncommon but remains the most common primary pleural malignancy and is almost always seen in patients with previous asbestos exposure. Pleural abnormalities must be differentiated from pulmonary processes. Pleural masses may exhibit obtuse angles with the adjacent pleural surfaces, displace rather than engulf adjacent pulmonary vasculature, and may exhibit the incomplete border sign.

scholarly journals A Retrospective Study of Ultrasound Characteristics and Macroscopic Findings in Confirmed Malignant Pleural Effusion

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Nevenka Piskac Zivkovic ◽  
Igor Cikara ◽  
Nina Petra Novak ◽  
Boris Brkljacic ◽  
Neven Tudoric
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Diagnostic Significance ◽  
Macroscopic Appearance ◽  
Frequency Distributions ◽  
Thoracic Ultrasound ◽  
Pleural Thickening ◽  
Diagnostic Potential ◽  
Number Of Patients ◽  
Significant Difference

Background. A definitive diagnosis of malignant pleural effusion (MPE) is reached by cytological or histological assessment, but thorough analysis of the ultrasound features of the effusion as well as pleural thickening or nodularity can also be of significant diagnostic help. Objective. To assess the relationship of specific ultrasound characterisctics and macroscopic features of confirmed malignant pleural effusion, thus increasing the diagnostic potential of thoracic ultrasound. Methods. The findings of thoracic ultrasonography performed prior to initial thoracentesis in 104 patients with subsequently confirmed malignant pleural effusion were analyzed with regard to the macroscopic features of the pleural effusion. Results. Distribution in terms of frequency of hemorrhagic/sanguinolent (n=64) in relation to nonhemorrhagic transparent/opaque (n=40) MPE, regardless of their ultrasound characteristics, did not yield a statistically significant correlation (p=0.159). Conversely, the frequency distribution of hemorrhagic pleural effusions (n=8) in relation to nonhemorrhagic effusions (n=1), in the group of septated MPE, showed a statistically significant difference (p<0.001). The least number of patients (0.96%) had a complex septated MPE combined with the macroscopic appearance of a serous/transparent nonhemorrhagic effusion, which suggests that this combination is a sporadic occurrence and may have a diagnostic significance for this patient group. Conclusion. The incidence of specific combinations of the ultrasound characteristics and macroscopic appearance of MPEs showed different frequency distributions, which may improve the diagnostic value of thoracic ultrasound in this patient population.

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