Malignant pleural mesothelioma: epithelial type

Case contributed by Dr Heba Mohamed

Presentation

Dyspnea and cough.

Patient Data

Age: 75 years
Gender: Male

Abnormal circumferential thickening of the pleura on the left side associated with a mild amount of loculated pleural fluid. Ipsilateral shifting of the mediastinum. Abnormal contraction of the hemithorax and narrowed intercostal spaces.

Multiple nodules are demonstrated on the right pulmonary parenchyma.

Multiple lytic lesions involve some of the upper dorsal vertebrae.

Case Discussion

CT findings in a case of mesothelioma include: pleural effusion, nodular pleural thickening, thickening of the fissures and typically the whole lung is encased by the tumor with a rindlike appearance.

Pleural mesothelioma is a locally malignant tumour that may be complicated by the invasion of the chest wall, mediastinum, and diaphragm. 

Signs of invasion of the thoracic wall may include chest wall involvement may manifest as haziness of the extrapleural fat planes, the involvement of the intercostal muscles or invasion and destruction of the rib.

Signs of invasion of vascular or mediastinal structures may include obliteration of surrounding fat planes, and encasing more than 50% of the organ's circumference.

Signs of invasion of the pericardium include nodular pericardial thickening or pericardial effusion. 

Pathology:

Two specimens were received

1- Parietal pleura: 2 pieces of rubbery and flat grayish white tissue 8x4 cm and 4x2 cm.

2- Diaphragmatic nodules: pieces of rubbery grayish tissue 4x3x2 cm.

Microscopic picture:

Examination of sections from both specimens received showed pieces of pleural tissue formed of moderately pleomorphic and cohesive neoplastic epithelioid cells having large hyperchromatic nuclei and adequate cytoplasm. They were displayed in glandular structure. The stromal background was fibrotic and infiltrated by chronic inflammatory cells.

Diagnosis:

Parietal pleural biopsy and free nodules on the diaphragmatic surface: picture is compatible with malignant mesothelioma epithelioid type.

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Case Information

rID: 52018
Diagnostic certainty: Certain
Case created: 18th Mar 2017
Last edited: 21st Mar 2017
Systems: Chest, Oncology
Inclusion in quiz mode: Included

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