A patient with a localized malignant pleural mesothelioma and 15-year disease-free survival

Nina Reig-Oussedik, Ramón Rami-Porta, Luis Antonio Luizaga, Josep Lloreta, Mireia Serra-Mitjans, Carme Obiols, Sergi Call, José Belda-Sanchis

Abstract

Localized malignant pleural mesothelioma (LMPM) is rare and its natural history is not well known. There is not enough evidence to allow the physician to follow a clear therapeutic plan in everyday clinical practice. This case report is about a 40-year-old female who was being studied because of right scapular pain, neck swelling and shortness of breath that led to identify a mass in the right upper lobe. Because of the rapid growth of the mass, the patient presented acute severe respiratory insufficiency and hypoxaemia resulting in haemodynamic instability that required intubation, mechanical ventilation and vasoactive drug support. With no definitive histo-pathological diagnosis, the patient underwent emergency thoracotomy for en bloc resection of the right upper lobe, the second to fourth ribs and pericostal tissue extending to the paravertebral muscle. The patient had a favourable postoperative course. Routine pathological study of the resected specimen revealed a highly undifferentiated tumour with no further characterization. Electron microscopy revealed a malignant pleural mesothelioma (MPM). In view of the diagnosis, the patient received adjuvant chemo-radiotherapy. The patient remains disease-free 15 years after the operation. The LMPM needs to be differentiated from the diffuse form of MPM. While the latter can rarely be cured, the former can be eradicated with tumour resection en bloc with the involved structures and adjuvant therapy. The purpose of this case report is to draw attention to this localized form of MPM and to the fact that an emergency operation was required with no certain preoperative diagnosis because of the rapid growth of the tumour.