Sarcomatoid mesothelioma

Case contributed by Dr Maxime St-Amant

Presentation

Cough. Known asbestos exposure.

Patient Data

Age: 65
Gender: Female
Modality: X-ray

On the frontal chest X-ray, there is an extra-pulmonary (pleural) rounded & well-defined mass in projection of the right upper lobe, which is possibly calcified, and associated with a diaphragmatic peak sign. On the lateral view, there is actually possibly three calcified pleural mass. The findings are atypical for mesothelioma, but this diagnosis should be excluded in the presence of asbestos exposure. Pleural metastases would be an alternate diagnosis. Loculated pleural effusion is less probable.

R/o pulmonary embolism & evaluation of the pleural masses.

Modality: CT

CT-scan confirms the chest x-ray findings of three rounded, well defined calcified pleural masses involving the right upper lobe (two masses) and superior segment of the right lower lobe (one mass). There are other pleural calcifications (pleural plaque), highly suggestive of asbestos exposure.

Mesothelioma remains the most probable diagnosis, although this is an atypical presentation. Metastases are less probable. Biopsy is recommended.

Case Discussion

Biopsy revealed a sarcomatoid mesothelioma, the rarest subtype of mesothelioma (the others being epithelioid and biphasic). Spindle-cell mesothelioma, sarcomatous and diffuse malignant fibrous mesothelioma are other names for sarcomatoid mesothelioma. It accounts for approximately 10 % of pulmonary mesothelioma. Histologically, the findings are similar to histiocytoma. It contains spindle cells and must be differentiated from sarcoma.

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Case Information

rID: 20730
Case created: 9th Dec 2012
Last edited: 6th Mar 2017
System: Chest
Tag: senior
Inclusion in quiz mode: Included

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