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Case Reports
. 2024 Sep 5;16(9):e68718.
doi: 10.7759/cureus.68718. eCollection 2024 Sep.

Malignant Mesothelioma: Overcoming Diagnostic Hurdles

Priya Dharshini R  1 , Sarah Grace Priyadarshini  1 , Jayaganesh P  1
Affiliations
Case Reports

Malignant Mesothelioma: Overcoming Diagnostic Hurdles

Priya Dharshini R et al. Cureus. .

Abstract

Malignant pleural mesothelioma, an aggressive neoplasm frequently linked to asbestos exposure, is often detected at an advanced stage. This report details the case of a 58-year-old mason who presented with left-sided chest pain, and shortness of breath, accompanied by weight loss for a month. A positron emission tomography (PET) scan revealed increased uptake along the pleural surface, as well as in several mediastinal lymph nodes and the left supraclavicular lymph node. Thoracoscopy revealed the presence of multiple nodules on the costal pleura. Despite repeated negative results from pleural effusion cytology, cell block analysis, and pleural biopsies, the diagnosis of malignant mesothelioma (MM) was ultimately established through an ultrasound-guided (USG) biopsy of the left supraclavicular lymph node, with immunohistochemical confirmation using calretinin.

Keywords: asbestos exposure; calretinin positive; malignant pleural mesothelioma (mpm); massive pleural effusion; pleural neoplasm.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CECT and PET scan.
(A) CECT showing few enlarged lymph nodes. (B) CECT showing nodular pleural thickening (red arrows) and few enlarged lymph nodes in the pre-tracheal region. (C) PET showing uptake in the left supraclavicular lymph node. (D) PET showing uptake along the pleural surface (yellow arrow) and multiple mediastinal lymph nodes (red arrow). CECT: contrast-enhanced computed tomography; PET: positron emission tomography
Figure 2
Figure 2. Microscopy of the USG FNAC of the left supraclavicular lymph node on high-power magnification showing features of metastatic carcinomatous deposits (H&E).
USG: ultrasound-guided; H&E: hematoxylin and eosin; FNAC: fine needle aspiration cytology
Figure 3
Figure 3. Microscopy of USG tru-cut biopsy of the left supraclavicular lymph node. (A) Low-power magnification showing tissue fragments with pleomorphic cells arranged in cords and vague glandular formation (H&E). (B) High-power magnification showing pleomorphic cells with marked nuclear atypia (H&E).
USG: ultrasound-guided; H&E: hematoxylin and eosin
Figure 4
Figure 4. IHC of USG tru-cut biopsy of the left supraclavicular lymph node on high-power magnification. (A) Calretinin: tumor cells showing diffuse positivity. (B) TTF-1: tumor cells showing negativity.
USG: ultrasound-guided; IHC: immunohistochemistry; TTF-1: thyroid transcription factor-1
See this image and copyright information in PMC

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