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  Table of Contents    
LETTERS TO EDITOR  
Year : 2019  |  Volume : 62  |  Issue : 4  |  Page : 636-638
Localized intrapulmonary mesothelioma presenting with a pulmonary mass


1 Department of Respiratory Medicine, Xi'an No. 4 Hospital, Xi'an 710004, P.R. China
2 Department of Internal and Critical Care Medicine, Life Guard Hospital; Department of Chest Diseases, Nepal Anti Tuberculosis Association, Morang, Biratnagar, Nepal

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Date of Web Publication14-Oct-2019
 

How to cite this article:
Wang T, Cui M, Thakur A. Localized intrapulmonary mesothelioma presenting with a pulmonary mass. Indian J Pathol Microbiol 2019;62:636-8

How to cite this URL:
Wang T, Cui M, Thakur A. Localized intrapulmonary mesothelioma presenting with a pulmonary mass. Indian J Pathol Microbiol [serial online] 2019 [cited 2019 Nov 22];62:636-8. Available from: http://www.ijpmonline.org/text.asp?2019/62/4/636/269075




Editor,

Malignant mesothelioma (MM) is an insidious and aggressive tumor of the mesothelial surfaces, which commonly involves pleura, peritoneal cavities, pericardium, and tunica vaginalis. Approximately 80% of all cases are pleural in origin. This kind of neoplasm is considered as a rare form of cancer, and exposure to asbestos is the predominant cause of it.[1] Mesothelioma can be classified into diffuse and localized types. Localized malignant mesothelioma (LMM) is extremely rare and cases have been described that it occasionally occurs in solid organs. In this article, we report a case of localized epithelioid malignant mesothelioma that developed in lung.

A 71-year-old man, who lacked any known history of asbestos exposure, was referred to the gastrointestinal department of our hospital on 21st May 2018 with a history of progressive weakness, nausea and poor appetite. Abdomen CT demonstrated no evident abnormity and further gastroscopy showed mild gastritis. Unusual results of laboratory tests were as follows: leukocyte = 11.2*109/L, neutrophils = 10.38*109/L, hemoglobin = 62 g/L, hematocrit = 22.9%, platelet = 430*109/L, albumin = 18.9 g/L (normal range 35-55), creatinine = 42 umol/L (normal range 53-97), C-reactive protein = 148.4 mg/L (normal range 0.068-8.2). The rest of the laboratory examinations, including all tumor markers, were unremarkable.

The routine inspection of chest CT-scan inadvertently revealed a palpable, irregular and inhomogeneous mass with lobule in his right lung (size: 75mm*71mm, CT value: 29-38Hu), together with the corresponding superior lobe's stenosis, obstructive pneumonia and adjacent pleura thickening [Figure 1]. Radiologists believed that the pulmonary mass showed on CT scan had a great possibility to be lung cancer, and suggested for further biopsy. The tumor displayed abnormal enhancement following intravenous administration of contrast material, with a CT value of 49Hu [Figure 2]. The CT-guided percutaneous lung biopsy was then performed, leading to an initial pathological diagnosis of allotypic epithelioid cells with indeterminate source. Subsequently, immunohistochemical analysis showed that the tumor cells were positive for CK, CR and Vim, suspicious positive for D-2-40, Ki67, negative for thyroid transcription factor-1 (TTF-1), Wilms tumor-1 (WT-1), CK7, NapsinA, CK5/6, P40, which were compatible with mesothelioma [Figure 3]. Unfortunately, our patient did not agree for any treatments and was discharged upon request. We learned that the patient passed away on Oct 15th during our regular follow-up.
Figure 1: Chest CT showed an irregular mass with lobule in the right lung, as indicated by the arrows, together with the corresponding superior lobe's obstructive pneumonia and adjacent pleura thickening. (a) pulmonary window; (b) mediastinal window

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Figure 2: Enhanced chest CT showed the tumor displayed abnormal enhancement, as indicated by the arrow

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Figure 3: CT-guided percutaneous lung biopsy demonstrated epithelioid malignant mesothelioma (a), which is positive for CK (b), CR (c) and Vim (d)

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Concerning about the intrapulmonary MM in the absence of widespread pleural involvement, so far, there are seven reports in the English literature study. Radiologically, the majority of these cases showed diffuse intrapulmonary lesions, and one of them had a lung mass near the pleura.[2],[3] Our present report, firstly, demonstrated a case of epithelioid mesothelioma, which had an imaging appearance of central mass with obstructive pneumonia in the right lung. The positive immunohistochemical stains in this case were CK, CR and Vim, which are also recommended as good markers for mesothelioma.[4] Cumulatively, localized intrapulmonary mesothelioma is difficult to be diagnosed, and it is necessary to consider the possibility of this malignancy in patients with unusual laboratory test results and pathological presentations.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This study was supported by Key Research and Development Program of Shaanxi Province (Grant No. 2018SF-219), Xi'an Municipal Science and Technology Project (Grant No. 201805093YX1SF27 (4)).

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Henley SJ, Larson TC, Wu M, Antao VC, Lewis M, Pinheiro GA, et al. Mesothelioma incidence in 50 states and the district of Columbia, United States, 2003-2008. Int J Occup Environ Health 2013;19:1-10.  Back to cited text no. 1
    
2.
Hasegawa M, Sakai F, Sato A, Tsubomizu S, Arimura K, Katsura H, et al. FISH analysis of intrapulmonary malignant mesothelioma without a clinically detectable primary pleural lesion: An autopsy case. Jpn J Clin Oncol 2014;44:1239-42.  Back to cited text no. 2
    
3.
Livasy CA, Tishko DJ, Maygarden SJ. Miliary pulmonary metastases from a clinically occult pleural mesothelioma. Ann Diagn Pathol 2003;7:249-53.  Back to cited text no. 3
    
4.
Doglioni C, Dei Tos AP, Laurino L, Iuzzolino P, Chiarelli C, Celio MR, et al. Calretinin: A novel immunocytochemical marker for mesothelioma. Am J Surg Pathol 1996;20:1037-46.  Back to cited text no. 4
    

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Correspondence Address:
Asmitananda Thakur
Department of Internal and Critical Care Medicine, Life Guard Hospital and Nepal Anti Tuberculosis Association, Biratnagar
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_538_18

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  [Figure 1], [Figure 2], [Figure 3]



 

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