Presentation
Shortness of breath, left pleuritic pain.
Patient Data
Large left pleural effusion, partially loculated, most probably accompanied by substantial atelectasis.
Large lobulated left pleural-subpleural mass. Large left pleural effusion with substantial passive atelectasis of the basal lower left lobe (LLL) and lingula.
Numerous extrapleural nodules of various sizes at posterior aspect of left hemithorax. Numerous nonenlarged anterior superior mediastinal lymph nodes, most probably metastatic. Small posterior mediastinal and retrocrural lymph nodes. Left supradiaphragmatic nodes.
Several infradiaphragmatic rounded lymph nodes.
Status post bariatric surgery.
Impression of mesothelioma in left hemithorax.
Case Discussion
Ultrasound-guided biopsy was performed.
9 slides received from percutaneous needle biopsy of the pleural lesion:
The H&E slide shows mesothelial proliferation with epitheloid feature of the cells. The slide also contains striated muscle and fibrofatty tissue from the pleural membranes not infiltrated or invaded by the proliferated tissue.
Mild nuclear atypia; score 1. Low mitotic count / 2 mm2; score 1. Sum = score 2.
Nuclear Grade I. No necrosis seen. Overall tumor grade = low. No necrosis seen. Immunohistochemical study positive for CK7, CK5/6, D2-40 and Calretinin. Ki67 positive in less than 2%. Negative for P40, P63, TTF1, CEA, WT1, GATA3. HBME1 non-contributory.
In conclusion:
Mesothelioma, epithelioid type.