대한흉부영상의학회 Weekly Chest Cases

Case No : 813 Date 2013-05-27

Courtesy of Mi-Jin Kang / Inje Uiversity Sanggye Paik Hospital
Age/Sex 74 / M
Chief ComplaintRight chest wall pain during 5 months

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Diagnosis With Brief Discussion

Diagnosis: Malignant mesothelioma
Radiologic Findings: Chest PA and lateral shows increased opacity in right anterior hemithorax. Chest CT scans demonstrate lobulated mass overlying right anterior hemithorax and right anterior mediastium. Chest CT scans obtained 12 months ago show no evidence of mass in the same location and TB destroyed lung in the RUL.
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.
Please refer to
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 : 71

▶ Correct Answer : 6/71, 8.5%

- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- McGill University - Cairo University , Canada Hisham Mikhael
- All India Institute of medical sciences , India Justin Moses

▶ Correct Answer as Differential Diagnosis : 8/71, 11.3%

- NIMS, HYDERABAD , India bhaskar kakarla
- Radnet Teleradiology , Turkey Murat Ulusoy
- Himeji St.Mary Hospital , Japan Yuichiro Kanie
- Eren T캇p Merkezi Istanbul , Turkey Armagan Sarac
- IRSA La Rochelle France , France Denis Chabassiere
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Onomichi municipal hospital , Japan Hirofumi Mifune

▶ Semi-Correct Answer : 1/71, 1.4%

- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 813 Date 2013-05-27

Discussion

No. of Applicants : 71