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CASE REPORT
Year : 2009  |  Volume : 26  |  Issue : 2  |  Page : 53-54 Table of Contents   

Malignant pleural mesothelioma


Department of Tuberculosis and Respiratory Diseases, Yenepoya Medical College, Mangalore-575 018, Karnataka, India

Correspondence Address:
Sukhesh Rao
'Hemadri', 2nd, Cross, Behind S.D.M Law College, Mangalore-575 003, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-2113.48900

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   Abstract 

Malignant mesothelioma is one of the rare tumors of pleura. One such case in a 57-year-old male, who presented with hemorrhagic pleural effusion and had no history of asbestos exposure, is reported here. The rarity, unusual presentation, and implications are discussed.

Keywords: Mesothelioma, pleural effusion, abestos


How to cite this article:
Rao S. Malignant pleural mesothelioma. Lung India 2009;26:53-4

How to cite this URL:
Rao S. Malignant pleural mesothelioma. Lung India [serial online] 2009 [cited 2019 Sep 20];26:53-4. Available from: http://www.lungindia.com/text.asp?2009/26/2/53/48900


   Introduction Top


Malignant pleural mesothelioma (MPM) is the most common neoplasm of pleura. [1] It is a cancerous proliferation of mesothelial cells that involves a large extent of pleural cavity. [2] A strong etiological correlation with asbestos exposure is well proven. [1],[3] Unusual presentations are also reported, though rarely. [4] We report here one such case.


   Case History Top


Mr. P, a 57-year-old male, presented with complaints of dyspnea on exertion and left-sided chest pain for 15 days. History revealed smoking index to be 250. He was a known diabetic under regular treatment. There was no other significant history.

Examination revealed thin built, anemic, dyspneic individual with signs of pleural effusion on the left side. On investigation, chest X-ray revealed left-sided pleural effusion. There was no other pleural or parenchymal abnormality. Diabetes was under adequate control. Other hematological and biochemical parameters were within normal limits.

Pleural aspiration revealed hemorrhagic fluid which was exudative. Fluid examination did not show acid fast bacilli or any malignant or abnormal cells. Hence, CT scan of thorax was perfomed that suggested the lesions to be probably infective, with no evidence of malignancy [Figure 1]. Empirically, he was put on antitubercular treatment. On the fourth day he developed acute severe dyspnea. Examination revealed massive effusion. Intercostal drainage was instituted and the fluid was once again examined; but it did not reveal malignant cells even on three consecutive occasions. Finally, a thoracotomy and open lung biopsy was done which confirmed the diagnosis of mesothelioma [Figure 2].


   Discussion Top


MPM is a rare tumor even in Western world and still rarer in India. The incidence in men ranges from 7-13 per million per year. In population unexposed to asbestos it is still rarer, with reported incidence of 1-2 per million per year. [5],[6]

MPM usually occurs in males with a male to female ratio of 2.6:1. It is usually related to asbestos exposure, though rarely it can occur in patients not exposed to asbestos. In such cases, the postulated correlation is operation of other carcinogens, genetic factors, and viral infections. [7]

Patients usually present with pleural effusions. Radiographic investigations reveal pleural effusion (exudative/hemorrhagic), pleural nodular shadows (diffuse or localized), or involvement of lungs, ribs, spine, etc. [8] Pleural fluid cytology may sometimes reveal the diagnosis, but usually definitive diagnosis is based on histological evidence on examination of pleural tissue.

Histologically, MPM are of three types: (a) sarcomatoid type, appearing as a spindle cell carcinoma resembling fibrosarcoma, (b) epithelial type, consisting of cuboidal, columnar, or flattened cells forming a tubular and papillary structure resembling adenocarcinoma, and (c) biphasic type, containing both epithelial and sarcomatoid (mixed) patterns. The histological picture in this case was suggestive of epithelial type.

A search of literature for reported cases from India confirmed the rarity. In a retrospective study, [9] only 15 cases were reported over a 25-year period. Another study [2] reported only three cases over a 10-year period. Whether this is because of lesser number of cases, or lesser awareness and diagnosis, is difficult to predict.

The rarity of the occurrence, the absence of exposure to asbestos, and the unusual presentation prompted us to report this case.

 
   References Top

1.Patel SN, Kettner NW. Malignant pleural mesothelioma: A case report. J Manipulative Physiol Ther 2005;28:724-9.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Nadgouda UG, Soppimath SS, Datta KS, Shiggaon UN, Babu KR. Malignant pleural mesothelioma. J Assoc Physicians India 2001;49:1208-9.  Back to cited text no. 2    
3.Bruce WS, Robinson MD, Lake RA. Advances in malignant mesothelioma. N Engl J Med 2005;353:1591-601.  Back to cited text no. 3    
4.Kashyap AS, Kashyap S. An elderly man with pleural effusion and abnormal behaviour. Postgrad Med J 2001;77:407-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Miller BH, Rosado-de-Christenson, Mason AC, Fleming MV, White CC, Krasna MJ. Malignant pleural mesothelioma: Radiologic-pathologic correlation. Radiographics 1996;16:613-44.  Back to cited text no. 5    
6.Hansen J, Klerk NH, Musk AW, Hobbs MS. Environmental exposure to crociodolite and mesothelioma: Exposure response relationship. Am J Respir Crit Care Med 1998;157:69-75.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Fraser RC, Colman N, Pare PA. Synopsis of diseases of chest. 3 rd ed. Elsevier India Pvt. Ltd; 2006.  Back to cited text no. 7    
8.Wang ZJ, Reddy GP, Gotway MB, Higgins CB, Jablons DM, Ramaswamy M, et al . Malignant pleural mesothelioma: Evaluation with CT, MR imaging and PET. Radiographics 2004;24:105-19.  Back to cited text no. 8    
9.Kini U, Shariff S, Thomas JA. Primary pleural mesothelioma in S. India: A 25 year study. J Surg Oncol 1992;49:196-201.  Back to cited text no. 9    


    Figures

  [Figure 1], [Figure 2]



 

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