Online Images in the Medical Sciences| Volume 364, ISSUE 4, e2-e3, October 2022

Desmoplastic malignant mesothelioma of the pleura

      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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