Massive localized malignant pleural mesothelioma (LMPM): manifestations on computed tomography in 6 cases

Abstract

Objective: Our study analyzed the clinical symptoms and computed tomography (CT) manifestations of massive localized malignant pleural mesothelioma (LMPM) patients to improve the knowledge and diagnosis of this disease.

Methods: Our study collected 6 massive LMPM patients pathologically confirmed by CT in the department of Radiology of the People's Hospital of Yuyao, Zhejiang Province, from January, 2007 to June, 2013; data of patients were also collected. The clinical symptoms, clinicopathological characteristics, CT manifestations, treatments and prognosis of enrolled patients were analyzed.

Results: Our study enrolled 6 LMPM patients (2 males; 4 females) classified to epitheliated type (n = 4) and sarcomatous type (n = 2) with mean age of 62.7 ± 7.4, and 5 of them had a history of asbestos exposure. CT manifestations revealed that large soft-tissue mass close to pleura, which was smooth and lobulated, was discovered in all patients with maximum diameter of 10~15 cm and mean diameter of 13.67 ± 1.15 cm; The mean value of CT was 36.29 ± 2.62 HU; after enhancement, the mean value was increased to 76.36 ± 7.73 HU; patients showed zones of small patchy necrosis and large patchy necrosis. The following presentations were founded: enlargement of tumor vessel which showed arborization (2 patients), mass wrap around the descending aorta in left lower chest (1 patient), strips of fat density in mediastinum superior (1 patient), pleural tail sign (3 patients). Among 6 patients, pleural effusion (n = 4), mediastinal lymph node enlargement (n = 3), invasion and destruction of local ribs (n = 2). Median survival time of patients were 20 months (2 cases conducted operation), 24 (2 cases chose combined radiotherapy and chemotherapy) and less than 6 months (2 cases underwent chemotherapy).

Conclusion: To sum up, CT showed important diagnostic values on massive LMPM patients; patients with a history of asbestos exposure, large soft-tissue mass of pleura with an abundant blood supply and wrap around large vessels might increase the risk of massive LMPM.

Keywords: Localized malignant pleural mesothelioma; asbestos exposure; biomarker levels; computed tomography; diagnosis; malignant pleural mesothelioma; mass-type; median survival time; prognosis.

Figure 1

Large mass in Left chest wall; after enhancement, the outcomes showed vast necrotic area and enlargement of tumor vessel which showed arborization. (A: Computed tomography (CT) enhancement; B: Coronal recombination).

Figure 2

Large soft-tissue mass in left lower chest; after enhancement, patchy necrotic area wrap around aorta descendens and indistinct development were discovered. (A: Computed tomography (CT) enhancement; B: Coronal recombination).

Figure 3

Large soft-tissue mass in anterior superior mediastinum; after enhancement, irregularly shape and strips of fat density were founded. (A: Computed tomography (CT) enhancement; B: Coronal recombination).