Diffuse epithelioid malignant mesothelioma of the pleura presenting as a hydropneumothorax and vertebral body invasion

Abstract

Malignant mesothelioma is an uncommon form of neoplastic transformation of the mesothelial cells that line the serosal surfaces of the body. It most commonly affects the pleura and is often associated with pleural effusions and pleural-based masses. The annual incidence in the United States is only 3300 cases, representing less than 0.3% of all cancers worldwide, although this is likely underestimated. We present a case of diffuse epithelioid malignant pleural mesothelioma in a patient with remote, short-term asbestos exposure complicated by recurrent left-sided hydropneumothoraces and pleural-based invasion of the T12 vertebral body, which represent two rare coexisting complications. This case illustrates the importance of maintaining a broad differential for hydropneumothorax, particularly as the risk factors may be decades removed and the degree of asbestos exposure to induce a malignant mesothelioma may be smaller than has been traditionally thought.

Malignant Pleural Mesothelioma (MPM) Presenting as Hydropneumothorax

“…Since MPMs originate from the parietal pleura and typically result in symptoms such as dyspnea, cough, and chest pain, hydropneumothorax is rarely the primary motive for its detection. In our literature search encompassing studies published from 2000 to the present, including our case, only 18 cases have been reported [ 2 - 5 ].…”

“…Typically, MPM manifests with symptoms such as dyspnea, cough, and chest pain, while hydropneumothorax is an infrequent finding for its detection. Limited reports have described cases of MPM presenting with hydropneumothorax [ 2 - 5 ]. This report presents a similar case and discusses the distinctive clinical characteristics.…”