Presentation
Previous surgery. Now chest pain on right side.
Patient Data
Chest x-ray demonstrates opacification of the right costophrenic angle. There is thickening of the right paratracheal stripe (marginal) and evidence of previous thoracotomy with partial resection of the right posterior 7th rib.
There is a large soft tissue mass in the right base which invades both the chest wall, ipsilateral hemidiaphragm and liver.
Case Discussion
This case illustrates the potentially aggressive behavior of mesotheliomas, not only within the chest but also extending into the chest wall and into the liver.
Histology
The appearances are of thickened pleura some of which at least is parietal. The following changes are seen. Organizing fibrinous pleurisy, epithelioid malignant mesothelioma, sarcomatoid malignant mesothelioma and fibrous pleural plaques.
DIAGNOSIS: malignant mesothelioma.
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