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Weekly Chest CasesArchive of Old Cases

Case No : 815 Date 2013-06-10

  • Courtesy of Jung Myung Kim, Myung Hee Chung / Catholic University Bucheon St. Mary
  • Age/Sex 64 / M
  • Chief ComplaintAbnormal chest radiography
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Localized malignant mesothelioma (epithelioid type)
Radiologic Findings
The patient has been a building dismantler for 7 years.
Initial chest X-ray showed two, well circumscribed, oval opacities in right upper and lower chest.
Three well-demarcated enhancing pleural masses, seen in the right upper and lower posterior regions on chest CT scans were all proved as malignant mesothelioma (figure). PET-CT scan demonstrated four hypermetabolic pleural nodules.
Brief Review
Localized malignant mesothelioma (LMM) is an extremely rare, solitary, and well-circumscribed tumor arising from the serosa. Classified as a separate entity among the pleural tumors in the 2004 World Health Organization (WHO) classification, it is rare and little is known about its behavior. LMM usually has microscopic appearance of malignant mesothelioma, but without any evidence of diffuse spread. The diagnosis of LMM can only be distinguished pathologically in localized pleural mass, showed at CT scan and confirmed as localized uptake at FDG-PET.
Generally approached by aggressive surgery, it follows a better course than diffuse form.
There are relatively few detailed accounts of the histology of localized tumors. Most seem to be predominantly fibrous, but with varying cellularity. Epithelium-type predominates, while biphasic or purely sarcomatous forms are infrequent.
Evidence of a significant association with asbestos exposure has not been recorded.
The small number of reported cases makes it difficult to determine whether LMM is a separate clinical entity or simply a diffuse malignant mesothelioma diagnosed at an early stage or with a different pathologic presentation.
References
1. Nakas A, Martin-Ucar AE, Edwards JG, Waller DA. Localised malignant pleural mesothelioma: a separate clinical entity requiring aggressive local surgery. Eur J Cardiothorac Surg. 2008;33(2):303-306
2. Tanzi S, et al. Localized malignant pleural mesothelioma:report of two cases. J Thorac Oncol 2009;4(8):1038-40
Keywords
Pleura, Malignant tumor,

No. of Applicants : 72

▶ Correct Answer : 11/72,  15.3%
  • - Chernomorska , Bulgaria VLADISLAV RUSINOV
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - Severance hospital , Korea (South) Hyunjoo Shin
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - GATA , Turkey Ersin Ozturk
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - IMSS , Mexico Tlaloc Lopez
  • - CAC Rennes , France nicolas gautier
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
▶ Correct Answer as Differential Diagnosis : 31/72,  43.1%
  • - University of British Columbia , Canada Amr Ajlan
  • - ICD,MCH CALICUT , India rikhy krishnan
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - kasturba medical college , India mugil varman
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - stanley medical college, india , India vanitha gnanasoundran
  • - UWO , Canada S Lee
  • - Kyoto University , Japan Akihiko Sakata
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Severance hospital, Yonsei university , Korea (South) Hanbeom Ji
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Private sector , Greece Vasilios Tzilas
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Erciyes University Medical School , Turkey Afra Y캇ld캇r캇m
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - izmir hospital , Turkey bakhtiar bakhshi
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Eren T캇p Merkezi Istanbul , Turkey Armagan Sarac
  • - All India Institute of medical sciences , India Justin Moses
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
▶ Semi-Correct Answer : 1/72,  1.4%
  • - McGill university , Canada Badriya Al-Qassabi
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