A 91-year-old man with hypertension presented with a 6-month history of poor appetite,
malaise, chest pain, and body weight loss from 55 to 50 kg. He was a nonsmoker and
had no past history of asbestos exposure. Physical examination revealed a cachexia
appearance, palpable mass with tenderness in the left chest (Figure A, arrowheads), and pale conjunctiva. Laboratory analysis revealed a hemoglobin level
of 8.2 g/dL and serum sodium level of 127 mmol/L. Chest radiography (CXR) revealed
opacities in the left lung field. Computed tomography (CT) of the chest revealed a
left-sided heterogeneously pleural-based mass (6.5 × 7.5 × 9 cm) with left second
rib destruction and chest wall invasion, pleural thickening, and encasement of the
left hemithorax (Figure B). The biopsy specimen indicated desmoplastic malignant mesothelioma (DMM) with hyperchromatic
nuclei-containing spindle cells (Figure C). Immunohistochemistry (IHC) demonstrated positivity for CAM 5.2, vimentin, and GATA-3
and negativity for epithelial membrane antigen, cytokeratin 7, and thyroid transcription
factor-1. The diagnosis of T4N0M0 stage IIIB DMM was made. The patient refused further
chemotherapy or surgery, and he opted for palliative treatment.
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References
- Advances in malignant mesothelioma.N Engl J Med. 2005; 353: 1591-1603
- Malignant mesothelioma of the pleura with desmoplastic histology: a case series and literature review.BMC Cancer. 2016; 16: 1-6
- Desmoplastic diffuse mesothelioma.Am J Surg Pathol. 1982; 6: 215-222
Article info
Publication history
Published online: May 10, 2022
Accepted:
May 2,
2022
Received:
April 22,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
