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A Rare Case of Malignant Mesothelioma Affecting the Major Airways FREE TO VIEW

Babak Eshaghian, MD; Farhad Mazdisnian, MD
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University of California, Irvine, Orange, CA

Chest. 2014;146(4_MeetingAbstracts):626A. doi:10.1378/chest.1990865
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SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Monday, October 27, 2014 at 11:00 AM - 12:00 PM

INTRODUCTION: Malignant mesothelioma is a neoplasm arising from the mesothelial surface of the peritoneum, pericardium, and tunica vaginalis, with majority of cases arising from the pleura. We report a rare case of malignant mesothelioma affecting the major airways.

CASE PRESENTATION: A 64-year-old man with a history of asbestos exposure presented with dyspnea with minimal exertion. Chest X-Ray showed hydropneumothorax. After extensive workup he was found to have Malignant Pleural Mesothelioma (MPM). The patient subsequently underwent pleurectomy and decortication. He had multiple positive margins with tumor infiltrating the lung parenchyma and chest wall muscles. He received adjuvant chemotherapy with partial response. One year later, chest CT demonstrated almost complete opacification of the left lung with extensive infiltration of the left mainstem bronchus. Bronchoscopy showed diffuse mucosal nodularity and endobronchial lesions almost completely obstructing the left lower lobe bronchus. Endobronchial biopsy was consistent with malignant mesothelioma. The histology was identical to the previously diagnosed MPM.

DISCUSSION: MPM has been considered a fatal disease for which there is no standard treatment (1). The gravity of malignant mesothelioma is thought to be secondary to the highly invasive nature of this disease. Malignant mesothelioma is known to spread by direct local invasion and extension (2). Tumor cells have been detected in bronchoalveolar washing and on transbronchial biopsy or open lung biopsy. It has also been observed that malignant mesothelioma can track along sites of surgical incision or chest drain. In our patient, the presence of tumor cells in the bronchi may also be explained by the introduction of the malignant cells through compromised visceral pleura during pleurectomy and decortication and infiltration of the lung parenchyma, thus invasion to the main bronchi via local spread.

CONCLUSIONS: We report a case of malignant mesothelioma involving major airways. Although no other case of airway malignant mesothelioma has been published previously, this presentation of malignant mesothelioma must remain in the differential diagnosis for patients with advanced malignant mesothelioma post pleurectomy with signs of airway compromise.

Reference #1: Malignant pleural mesothelioma: an update on biomarkers and treatment. Chest. 2009 Sep;136(3):888-96

Reference #2: Unusual intraparenchymal growth patterns of malignant pleural mesothelioma. Histopathology. 2003 Feb;42(2):150-5

DISCLOSURE: The following authors have nothing to disclose: Babak Eshaghian, Farhad Mazdisnian

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