Immunocytochemistry as a Diagnostic Procedure of Pleural Mesothelioma

Background: Mesothelioma is a primary malignant tumor arising from the mesothelial surface of the pleura, peritoneal, tunica vaginalis, and pericardium. Most cases of mesothelioma originate from the pleura. Most patients have a history of asbestos exposure. A common diagnostic problem is distinguishing mesothelioma from adenocarcinoma since both tumors invade the pleura. Immunocytochemistry of calretinin and TTF-1 can be used to establish the diagnosis of mesothelioma. Case: Male, 56 years old presented with chest pain, shortness of breath, cough, and weight loss since 5 months before hospitalization. The patient had a history of occupational exposure to asbestos for 30 years. The movement and breath sounds were decreased as well as dull upon percussion at the right chest. A chest X-ray revealed a right lung tumor with pleural effusion. Thorax CT scan suggested pleural mass in right hemithorax, infiltration to intercostal muscles, and destruction of the 7th right rib, right perihilar lymphadenopathy, right pleural effusion, and liver nodules according to mesothelioma T4N1M1 Stage IV. Infiltrative stenting of the right and inferior lobe of the right lung, infiltrative and obstructive stenting of the medius lobe suggestive of a chronic malignancy and inflammation were found on FOB. Cytologic examination of pleural fluid, sputum, and Washing-and-brushing of FOB were a class II (no malignant cells). USG-guided transthoracic FNAB revealed adenocarcinoma with differential diagnosis of mesothelioma. Immunocytochemistry with calretinin showed positive results and TTF-1 showed a negative result. These confirmed the diagnosis of pleural mesothelioma T4N1M1 Stage IV. The patient showed a stable response from carboplatin/gemcitabine treatment.

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Unusual Clear Cell Variant of Epithelioid Mesothelioma

Archives of Pathology & Laboratory Medicine ◽

10.5858/2001-125-1588-uccvoe ◽

2001 ◽

Vol 125 (12) ◽

pp. 1588-1590 ◽

Cited By ~ 2

Author(s):

Enrico Dessy ◽

Monica Falleni ◽

Paola Braidotti ◽

Barbara Del Curto ◽

Tiziana Panigalli ◽

...

Keyword(s):

Differential Diagnosis ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Asbestos Exposure ◽

Pleural Mesothelioma ◽

Cytologic Examination ◽

Cell Variant ◽

The Right ◽

Recurrent Pleural Effusion ◽

Clear Cell Variant

Abstract Clear cell mesothelioma is an extremely rare neoplasm of the pleura, which can easily be mistaken for a metastasis of clear cell carcinoma to the pleura. We report here the histochemical, immunohistochemical, and ultrastructural aspects of a new case of clear cell pleural mesothelioma in a 52-year-old man with no known asbestos exposure. He was admitted to the hospital for recurrent pleural effusion, which was negative for neoplastic cells at the cytologic examination. A partial decortication of the right pleura was performed. The morphologic, immunohistochemical, and ultrastructural features reported for this case are consistent with the diagnosis of clear cell mesothelioma. The differential diagnosis and immunohistochemical features in comparison with other clear cell neoplasms are discussed.

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Primary pulmonary epithelioid sarcoma: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02940-0 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Eiki Mizutani ◽

Riichiro Morita ◽

Keiko Abe ◽

Makoto Kodama ◽

Shogo Kasai ◽

...

Keyword(s):

Tumor Cells ◽

Lung Tumor ◽

Smooth Muscle Actin ◽

Asbestos Exposure ◽

Epithelioid Sarcoma ◽

Whole Body ◽

Health Examination ◽

Positron Emission ◽

Primary Lung Tumor ◽

The Right

Abstract Background Epithelioid sarcoma most frequently occurs in the dermal or subcutaneous area of the distal extremities. To date, there have been three cases of primary pulmonary epithelioid sarcoma reported. We report a case of epithelioid sarcoma that is considered a primary lung tumor. Case presentation A 65-year-old asymptomatic Asian male patient underwent chest radiography during a routine health examination, and an abnormal mass was detected. His past medical history was unremarkable. He smoked 40 cigarettes every day and had slightly obstructive impairment on spirometry. He worked as an employee of a company and had no history of asbestos exposure. He underwent partial resection of the right lung by thoracoscopy. A histological examination of the tumor revealed a cellular nodule of epithelioid and spindle-shaped cells. Some of the tumor cells displayed rhabdoid features and reticular arrangement in a myxomatous stroma. Immunohistochemically, the tumor cells were positive for vimentin, smooth muscle actin (SMA), CD34, and epithelial membrane antigen (EMA); loss of the BAF47/INI1 protein in the tumor cells was also confirmed. A diagnosis of epithelioid sarcoma was established. Careful screening by whole-body positron emission tomography for another primary lesion after surgery did not detect any possible lesion. He had no cutaneous disease. Conclusion To our knowledge, this is the fourth case of a proximal-type epithelioid sarcoma considered as a primary lung tumor.

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P046 Pointing the finger: an unusual presentation of dactylitis

Rheumatology ◽

10.1093/rheumatology/keab247.043 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Natalia Cernovschi - Feasey ◽

Julekha Wajed

Keyword(s):

Pleural Effusion ◽

Soft Tissue ◽

Middle Finger ◽

Joint Involvement ◽

Long Bones ◽

History Of ◽

Systemic Symptoms ◽

The Right ◽

Hands And Feet ◽

Radiographic Changes

Abstract Background/Aims Dactylitis is commonly associated with psoriatic arthritis, and regularly presents at Rheumatology clinics. We discuss a case where progressive systemic symptoms lead to the consideration of alternate diagnoses. Methods A 46-year-old Nepalese woman presented to the Rheumatology department with a 3 month history of diffuse swelling of the right middle finger proximal interphalangeal joint, with the appearance of dactylitis. There was pain on movement, but no other joint involvement. Simultaneously she noticed blurred and decreased vision, which on review by the ophthalmologists, was diagnosed with bilateral uveitis. There was no history of psoriasis, inflammatory bowel disease, or other past medical history of note. There was no travel history in the past 12 months. A diagnosis of a presumed inflammatory arthritis was made. Results Blood tests showed elevated c-reactive protein 55 (normal <4 mg/l), erythrocyte sedimentation rate 138 (normal 0-22 mm/hr) and an iron deficiency anaemia. Rheumatoid factor and Anti-CCP antibody were negative. Hand radiographs were reported as normal. MRI of the third digit confirmed an enhancing soft tissue collection at the proximal phalanx of the right middle finger. She was referred for a biopsy of this lesion. Interestingly over the subsequent few months, she developed progressive breathlessness. Chest radiograph showed a left pleural effusion. Further tests showed negative serum ACE, Lyme and Toxoplasma screen. Quantiferon test was negative. Pleural aspirate showed a transudate with negative Acid-fast bacillus (AFB) test and culture. CT chest and abdomen showed a persistent pleural effusion, inflammatory changes in the small bowel and thickening of the peritoneum and omentum. In view of the systemic involvement, a peritoneal tissue biopsy was performed. This confirmed chronic granulomatous inflammation with positive AFB stain for mycobacterium tuberculosis. Our patient was started on quadruple anti- TB antibiotics for 6 months. Her systemic symptoms and dactylitis have improved, although there is on-going treatment for her ocular involvement. Conclusion Approximately 10% of all cases of extrapulmonary TB have osteoarticular involvement. Dactylitis is a variant of tuberculous osteomyelitis affecting the long bones of the hands and feet. It occurs mainly in young children; however adults may be affected also. The first manifestation is usually painless swelling of the diaphysis of the affected bone followed by trophic changes in the skin. The radiographic changes are known as spina ventosa, because of the ballooned out appearance of the bone, although this was not seen in our case. Fibrous dysplasia, congenital syphilis, sarcoidosis and sickle cell anaemia may induce similar radiographic changes in the metaphysis of long bones of hands and feet, but do not cause soft tissue swelling or periosteal reaction. This case highlights the importance of testing for TB, especially in atypical cases of dactylitis, with other systemic features. Disclosure N. Cernovschi - Feasey: None. J. Wajed: None.

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A hematologic condition expressed as a lung disease

F1000Research ◽

10.12688/f1000research.1-28.v1 ◽

2012 ◽

Vol 1 ◽

pp. 28 ◽

Cited By ~ 1

Author(s):

Mónica Egozcue-Dionisi ◽

José Nieves-Nieves ◽

Ricardo Fernández-Gonzalez ◽

Rosángela Fernández-Medero ◽

Raúl Reyes-Sosa ◽

...

Keyword(s):

Multiple Myeloma ◽

Pleural Effusion ◽

Plasma Cells ◽

Rare Complication ◽

Disease Stage ◽

Fluid Analysis ◽

Progressive Dyspnea ◽

Breath Sounds ◽

The Right ◽

Pleural Involvement

Pleural involvement secondary to Multiple Myeloma is considered a very rare complication. According to the literature only 1% of these patients develop a myelomatous pleural effusion. We present a case of a 39 year old man with multiple myeloma diagnosed six years prior to our evaluation, which developed progressive dyspnea, dry cough and right pleuritic chest pain two weeks prior to admission. On physical examination the patient had decreased breath sounds over the right posterior hemithorax accompanied by dullness to percussion. The chest radiogram was consistent with a right sided pleural effusion. Pleural fluid analysis revealed the presence of abundant abnormal plasma cells. The patient died four weeks after hospitalization. The presence of myelomatous pleural effusion is considered to be a poor prognostic finding, no matter at what disease stage it develops. So far no definite treatment has been shown to improve survival.

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Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure

BMJ Case Reports ◽

10.1136/bcr-2019-232812 ◽

2020 ◽

Vol 13 (2) ◽

pp. e232812

Author(s):

Syed Tausif Ahmed ◽

Matthew Barvo ◽

Nayana Kamath ◽

Richard Alweis

Keyword(s):

Emergency Department ◽

Asbestos Exposure ◽

Anticoagulation Therapy ◽

Abdominal Distension ◽

High Density ◽

Chemotherapy Treatment ◽

Lower Limb Pain ◽

History Of ◽

The Right ◽

Vague Abdominal Pain

A 75-year-old man presented to the emergency department with 1-day history of right lower limb pain and 3-month history of vague abdominal pain. In the emergency department a thrombus was discovered in the right popliteal artery. CT scan of the abdomen and pelvis revealed high-density material in the pelvis, multiple hypodensities on the liver, ascites with omental nodularity, and high-density material along the stomach wall. He underwent thrombectomy and was started on anticoagulation therapy. The core needle biopsy revealed primary omental mesothelioma. There was no history of any known asbestos exposure. He also had to undergo therapeutic paracentesis twice due to abdominal distension. Mesothelioma treatment of carboplatin and pemetrexed was started, and the patient is currently receiving this chemotherapy treatment regimen.

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Infection of lung cavitations in a young dog owner with Hodgkin’s lymphoma caused by Pasteurella multocida, without a dog bite: confirmed zoonotic transmission by tagmentation microbiome analysis

BMJ Case Reports ◽

10.1136/bcr-2018-226646 ◽

2018 ◽

Vol 11 (1) ◽

pp. bcr-2018-226646 ◽

Cited By ~ 1

Author(s):

Mirek van der Reijden ◽

Lesley F V Riethoff ◽

Wil A van der Reijden ◽

Anita Griffioen-Keijzer

Keyword(s):

Hodgkin’S Lymphoma ◽

Pasteurella Multocida ◽

Stage Iv ◽

Domestic Animal ◽

Hodgkin's Lymphoma ◽

Immunocompromised Patients ◽

Dog Bite ◽

Animal Contact ◽

History Of ◽

The Right

Pasteurella multocida is a known pathogen in humans, mostly reported after animal bite incidents. Atraumatic infections have been described, especially in immunocompromised patients. A 20-year-old patient with a history of stage IV Hodgkin’s lymphoma with cavitating pulmonary lesions presented with a bilateral pneumonia. Shortly after finishing antibiotic treatment, she quickly developed the same symptoms of pneumonia. Bronchoscopy showed a large cavity in the right upper lobe and P. multocida was isolated from all bronchial cultures. The transmission route of P. multocida via the patient’s dog was confirmed by sampling the full genome of the dog’s mouth, which matched the unique P. multocida sequences found in the patient. This case demonstrates the importance of accurately determining the aetiology of the patient’s symptoms, and Pasteurella infection should be considered in all immunocompromised patients with domestic animal contact, even without a bite incident.

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Malignant Peritoneal Mesothelioma: Clinicopathological Characteristics of Two Cases

Case Reports in Surgery ◽

10.1155/2014/748469 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Mustafa Cem Algın ◽

Faik Yaylak ◽

Zülfü Bayhan ◽

Figen Aslan ◽

Nilüfer Araz Bayhan

Keyword(s):

Abdominal Pain ◽

Asbestos Exposure ◽

Final Diagnosis ◽

Clinicopathological Characteristics ◽

Clinical Findings ◽

Peritoneal Mesothelioma ◽

Abdominal Masses ◽

History Of ◽

The Right ◽

Specific Symptoms

Introduction. Peritoneal mesothelioma is a rare tumor, presenting difficulties in diagnosis and treatment. Peritoneum is the second most common area of the mesothelioma after pleura, and even synchronous pleural and peritoneal mesotheliomas are observed in 30–45% of all cases. The diagnosis may be difficult due to lack of specific symptoms and clinical findings. In addition, a delay in the diagnosis is not rare especially in the absence of previous asbestos exposure. Here we report two cases of malignant peritoneal mesotheliomas. The diagnostic and therapeutic approaches for these rare neoplasms are discussed.Case Presentation. The cases were two men (one aged 54 years old and the other 40 years old). Prolonged abdominal pain and swelling were the primary presentation symptoms and findings. The mesotheliomas were developed in the right upper quadrant of abdomen in both of the cases. Both cases were treated with surgical resection. Final diagnosis were possible with histological and immunohistochemical documentation of tumor characteristics, which were consistent with dictating a mesothelial origin. No history of asbestos exposure was reported.Conclusion. Peritoneal mesotheliomas are rare clinical entities. However, patients with prolonged abdominal pain and abdominal masses should be considered to have atypical pathologies such as peritoneal mesotheliomas.

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Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor

Case Reports in Pulmonology ◽

10.1155/2016/7560929 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5

Author(s):

James Benjamin Gleason ◽

Basheer Tashtoush ◽

Maria Julia Diacovo

Keyword(s):

Computed Tomography ◽

Malignant Pleural Mesothelioma ◽

Asbestos Exposure ◽

Pleural Mesothelioma ◽

Ct Guided ◽

Core Needle ◽

Chest Computed Tomography ◽

History Of ◽

Sarcomatoid Mesothelioma ◽

Histologic Component

Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT) scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma), with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid), supporting the diagnosis of biphasic malignant mesothelioma.

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Lifelong Idiopathic Unilateral Diaphragmatic Paralysis With Recurrent Pneumonia: A Case Report

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v9i4.26743 ◽

2020 ◽

Vol 10 (1) ◽

pp. 26743

Author(s):

Khosrow Agin ◽

Akram Sabkara ◽

Farzaneh Sadat Mirsafai Rizi ‎ ◽

Bita Dadpour ◽

Maryam Vahabzadeh ◽

...

Keyword(s):

Primary Diagnosis ◽

Diaphragmatic Paralysis ◽

Recurrent Pneumonia ◽

Emergency Center ◽

Diabetes Mellitus Type Ii ◽

X Ray ◽

Breath Sounds ◽

History Of ◽

Chest X Ray ◽

The Right

A 50-year-old woman was admitted to the emergency center with dyspnea, cough, and fever symptoms. She had a medical history of diabetes mellitus type II, rheumatoid arthritis, as well as several admission records due to aspiration pneumonia. The primary diagnosis was diabetic ketoacidosis and pneumonia. Normal breath sounds were reduced on the lower posterior right side of the thorax. A standard chest x-ray and lung Computed Tomography (CT) scan revealed collapse consolidation in the Right Lower Lobes (RLL) and Right Middle Lobes (RML). We here presented a case of unilateral diaphragmatic paralysis with a history of recurrent pneumonia.

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Benign Pleural Multicystic Mesothelioma: A Rare Case Report

10.21203/rs.3.rs-165790/v1 ◽

2021 ◽

Author(s):

Alireza Rezvani ◽

SeyedehMaryam Pishva ◽

Amirhossein Erfani ◽

Ahmad Monabati ◽

Bizhan Ziaian ◽

...

Keyword(s):

Case Report ◽

Chronic Cough ◽

Rare Case ◽

Pleural Mesothelioma ◽

Case Presentation ◽

Rare Case Report ◽

History Of ◽

The Right ◽

Lateral Thoracotomy ◽

Pleural Involvement

Abstract Background: Fewer than 200 benign multicystic peritoneal mesothelioma cases were reported worldwide till 2017, while its pleural involvement has rarely been reported. Case presentation: We report a 70-year-old man who presented with three months history of chronic cough. Surgical resection was performed, and the pathology confirmed benign multicystic pleural mesothelioma. The patient underwent right lateral thoracotomy, wedges resection of the right upper lobe, and parietal pleurectomy and was discharged with an uneventful postop course.Conclusion: Based on published literature to date, this is the second reported case of pleural involvement of this disease.

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