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Weekly Chest CasesArchive of Old Cases

Case No : 788 Date 2012-12-03

  • Courtesy of So Won Lee, Sung Shine Shim, Yookyung Kim / Ewha Womans University Mokdong Hospital, Seoul, Korea
  • Age/Sex 62 / F
  • Chief Complaintleft chest pain for 1 month
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Figure 1. Initial.

Diagnosis With Brief Discussion

Diagnosis
Localized malignant mesothelioma
Radiologic Findings
Initial chest PA shows a round opacity in left lower lung zone which is adjacent to the pleura. There is a large recurrent mass at the same site on chest PA obtained 7 months after previous mass excision. Initial CT shows a well-defined, homogenously enhancing pleural lesion in left lower lobe. Chest CT which is obtained 7 months after excision shows a large, well enhancing pleural mass which invades lateral arc of left 8th rib and adjacent chest wall with bulging-out through intercostal space.
Brief Review
Localized malignant mesothelioma (LMM) is rare, solitary, circumscribed, nodular tumors, which are attached to the surface of the pleura, peritoneum, or pericardium. The criteria used to diagnose LMM is (i) radiological, surgical, or pathological evidence of a localized serosal/subserosal tumor mass without evidence of diffuse serosal spread; and (ii) a microscopic pattern identical to that found in ordinary diffuse malignant mesothelioma.
The chest CT findings of LMM, consisting of a small localized subpleural nodule or mass, shows overlapping features with solitary fibrous tumor of the pleura. Therefore, the diagnosis of LMM should be distinguished pathologically. LMM is classified as a separate entity among the pleural tumors in the 2004 World Health Organization classification and has epithelioid, sarcomatoid, or biphasic pattern. Epithelioid-type predominates, while biphasic or purely sarcomatoid forms are infrequent.
LMM should be distinguished from the diffuse malignant mesothelioma because of different biologic behavior and better prognosis; many cases, in fact, can apparently be cured with early surgical radical intervention. When these tumors recur, they tend to metastasize in the fashion of sarcomas.
References
1. Khan AM, Tlemcani K, Shanmugam N, Y D, Keller S, Berman AR. A localized pleural based mass with intense uptake on positron emission tomography scan. Chest 2007;131:294-299.
2. Dimarakis I, Rehman S, Machaal A, Shah R. PET-CT in the diagnosis of localized malignant pleural mesothelioma. Clin Imaging 2011;35(6):476-477.
3. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. World Health Organization Classification of Tumours 2004
Keywords
pleura, malignant tumor,

No. of Applicants : 95

▶ Correct Answer : 11/95,  11.6%
  • - McGill university , Canada Badriya Al-qassabi
  • - Hanam sungshim hospital , Korea (South) CHANG IL KIM
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - blue hosptial , Turkey sukru sahin
  • - Saga University , Japan Ryoko Egashira
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - CBNUH , Korea (South) jihyung lee
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
▶ Correct Answer as Differential Diagnosis : 29/95,  30.5%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - MITOYO GENERAL HOSPITAL , Japan Mototsugu Saeki
  • - Columbia Asia , India John Joseph
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - , Korea (South) Chan Park
  • - GHICL , France manuel toledano
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - SCGH , Australia Yuranga Weerakkody
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - XiangYa hospital , China Xia Yu
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Suncheon Plus Medicine , Korea (South) Park Sang Hyun
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - chp st martin , France Mariotte benoit
  • - Okayama University , Japan Satoko Kogawa
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - CAC Rennes , France nicolas gautier
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - All India Institute of medical sciences , India Justin Moses
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