Disorders of the Pleura: Fellow Case Report Poster - Disorders of the Pleura |

Malignant Mesothelioma Without Occupational Asbestos Exposure FREE TO VIEW

Sarah Kung, DO; Viral Gandhi, MBBS; Jianwu Xie, MD; Tariq Cheema, MD
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Allegheny General Hospital, Pittsburgh, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):573A. doi:10.1016/j.chest.2016.08.662
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SESSION TITLE: Fellow Case Report Poster - Disorders of the Pleura

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Malignant mesothelioma (MM) is classically associated with occupational asbestos exposure. Herein, we report a case of MM without occupational exposure.

CASE PRESENTATION: 85 year old female was seen in office for left sided pleural effusion. It was found incidentally during preoperative evaluation. She had a history of follicular lymphoma of right breast treated with excisional biopsy, adjuvant chemotherapy and radiation. The cancer was in remission. She endorsed 8 pounds of unintentional weight loss. She denies cough, fatigue or shortness of breath. She worked as a secretary with no occupational exposures. However, her husband was an electrician and was exposed with asbestos. Computerised tomography (CT) of chest demonstrated a large pleural effusion with thickened pleura. (Figure1) Surveillance CT 2 years prior showed undefined pleural based plaques. Left thoracoscopy was performed for drainage of effusion along with pleural biopsy and pleurodesis. Biopsy showed malignant mesothelioma. (Figure 2)

DISCUSSION: Malignant mesothelioma is an aggressive tumor of serosal surfaces. It is a male predominant disease with increasing incidence worldwide due to widespread occupational asbestos exposure. Unexplained pleural effusion is the most common clinical presentation. MM develops covertly in body and thereby results in extensive tumor burden before the patient seek care. Only 20% of patients have radiographic signs of asbestosis, although most patients will have pleural plaques or calcification. Our patient was found to have pleural plaques 2 years prior to presentation. Mesothelioma has a direct causal relationship with asbestos. Simian virus 40 and radiation therapy to supradiaphragmatic fields have also been implicated as risk factors. However, there have been some reports of MM with minimal household exposure. The indirect exposure in form of husband’s occupation has been described in literature and seems to be the likely cause for MM in our case. The median survival after diagnosis is 12 months with poor prognosis for male sex and patients with poor performance status. Surgery is useful only for palliation and is performed in combination of chemotherapy and radiotherapy. Recurrent pleural effusion is managed by draining the fluid followed by pleurodesis.

CONCLUSIONS: Our patient had a low performance score and thereby decided to not pursue aggressive therapy. She underwent pleurodesis with thoracoscopy.

Reference #1: Robinson BW, Lake RA. Advances in malignant mesothelioma. N Engl J Med. 2005 Oct 13;353(15):1591-603.

DISCLOSURE: The following authors have nothing to disclose: Sarah Kung, Viral Gandhi, Jianwu Xie, Tariq Cheema

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