Rugilė Mikalčiutė-Ramanauskienė1, Simona Rūta Letautienė1,2
1Vilnius University, Faculty of Medicine
2National Cancer Institute
Background. Malignant pleural mesothelioma – is a rare malignant tumor of the pleura. The most common risk factor is asbestos exposure. It is prognosed that the incidence of the mesothelioma will increase due to intensive use of asbestos in 20th century. This disease has a very poor prognosis. The average survival time after diagnosis is about 1 year. The biggest diagnostic dilemma is – the mesothelioma and benign pleural diseases have the same clinical features. However, our aim is to prove that by using radiological and histological testing it is possible differentiate these diseases and diagnose a mesothelioma earlier. The patient survival time could be prolonged.
Case report. A 74-year-old man with suspected malignancy in the right lung was sent to an oncology institute. After repeated a chest x-ray and the first computer tomography scan a possible pleural mesothelioma with metastases to the right adrenal gland was suspected. A surgeon performed a video-assisted thoracoscopic surgery for diagnostic and treatment purposes. In biopsy of the tumour, loss of BAP-1 expression was found. The pathologist diagnosed an epithelioid malignant pleural mesothelioma. The patient was treated with combination of carboplatin and pemetrexed. After 2 cycles of chemotherapy a computer tomography was repeated. Images showed partial response to the treatment, but overall prognosis was poor.
Conclusion. The patient’s radiological images showed typical signs of the mesothelioma: pleural mass, pleural effusion, thickening of the pleura, involvement of intralobular fissures, ipsilateral volume loss of the lung. Recognizing these features could help differentiate malignant and benign lesions. Loss of BAP1 marker’s expression is the most important indicator for a mesothelioma in histology.
Keywords: malignant, pleural, mesothelioma, diagnosis.