대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Localized malignant mesothelioma

Radiologic Findings

Chest PA shows bulging contour of right suprahilar area and chest lateral radiograph demonstrates space-occupying lesion in anterior mediastinum.
Chest CT images show about 4.6 cm sized enhancing lobulating mass with internal septa involving anterior mediastinum and RUL central lung with invasion of the left brachiocephatlic vein and SVC.
PET-CT scan with F-18 FDG shows increased uptake in anterior mediastinal mass.

Brief Review

Malignant mesotheliomas are a rare malignant tumor derivd from mesothelial cells of pleura and peritoneum. Localized malignant mesothelioma(LMM) is 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 located in the mediastium is extremely rare and only a few cases have been reported.
Patient are usually asymptomatic and occasionally vitsit medical center with coughing, pain, dyspnea and pulmonary osteoarthropathy. In contrast to diffuse malignant mesothelioma, the differential diagnosis of mediastinal LMM includes lymphoma and thymic carcinoma. However, the radiologic and clinical findings are usually not useful to make differential diagnoses and tumors may only be differentiated by histopathological and immunohistochemical examinations. Tumor cells in malignant mesothelioma have been reported to be positive for calretinin, vimentim, keratin and epithelial membrane antigen (EMA), while negative for markers suggesting adenocarcinoma such as and thyroid transcription factor 1 (TTF 1) and CEA. Calretinin is the most sensitive of the positive mesothelial markers.
Malignant mesothelioma are usually treated by wide resection of the border, chemotherapy and combined therapy. Prognosis is extremely poor.

Please refer to

Case 815, Case 788,

References

1. Nakas A, Martin-Ucar AE, Edwards JG, and Waller DA. Localised malignant pleural mesothelioma: a separate clinical entity requiring aggressive local surgery. Eur J Cardiothorac Surg. 2008;33:303-306
2. Tanzi S, Tiseo M, Internullo E, Cacciani G, Capra R, and Carbognani P, et al. Localized malignant pleural mesothelioma: report of two cases. J Thorac Oncol 2009;4:1038-40
3. Zhang S, Song P, and Zhang B. Giant malignant mesothelioma in the upper mediastinum: a case report. Oncol Lett. 2013;6:181-184

Please refer to

Case 815 Case 788

Keywords

Pleura, malignant tumor,