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Challenging and Unusual Cases

CASE 4. MALIGNANT MESOTHELIOMA PRESENTING AS AN ANTERIOR MEDIASTINAL MASS

Royal Prince Alfred Hospital and Concord Repatriation General Hospital, Sydney, Australia

A 51-year-old nonsmoker was investigated for an abnormal preoperative chest x-ray. Symptoms were of intermittent right-sided chest pain, a dry cough, and hoarseness. The patient had no known exposure to asbestos.

Chest x-ray revealed a mediastinal mass (Fig 1). A computed tompgraphy scan confirmed the presence of a large anterior mediastinal mass (Fig 2).

View larger version (153K): [in this window] [in a new window]   Fig 1. Chest x-ray.

View larger version (106K): [in this window] [in a new window]   Fig 2. Computed tomagraphy, chest.

View larger version (119K): [in this window] [in a new window]   Fig 3. (A) Core biopsy showing glands lined by cytologically malignant epithelioid cells (hematoxylin and eosin; original magnification, 400x). (B) Calretinin immunohistochemical stain showing nuclear and cytoplasmic positivity of the tumor cells (immunohistochemical section; original magnification, 400x).

Malignant mesothelioma typically presents with diffuse pleural thickening and recurrent pleural effusions.³ Rare cases of mesothelioma presenting as a localized pedunculated pleural-based lesion or sessile mass with broad-based pleural attachment have been described previously;⁴ however, mesothelioma has never to our knowledge presented as a mediastinal mass.⁵ The relationship of localized mesothelioma to its more common diffuse counterpart and clinical behavior remain unknown.

REFERENCES

1. Leong AS-Y, Stevens MW, Mukherjee TM: Malignant mesothelioma: Cytological diagnosis with histologic, immunohistochemical and ultrastructural correlation. Semin Diagn Pathol 9:141–150, 1992[Medline]

2. Okamura H, Kamei T, Mitsuno A, et al: Localized malignant mesothelioma of the pleura. Pathol Int 51:654–660, 2001[CrossRef][Medline]

3. Kawashima A, Libshitz HI: Malignant pleural mesothelioma: CT manifestations in 50 cases. Am J Roetgenol 155:965–969, 1990

4. Crotty TB, Myers JL, Katzenstein AA, et al: Localized malignant Mesothelioma: A clinicopathologic and flow cytometric study. Am J Surg Pathol 18:357–363, 1994[Medline]

5. Mullen B, Richardson JD: Primary anterior mediastinal tumors in children and adults. Ann Thorac Surg 42:338, 1986[Abstract]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Featherstone, C. Articles by Hendel, P.N. Search for Related Content PubMed PubMed Citation Articles by Featherstone, C. Articles by Hendel, P.N. Social Bookmarking                            What's this?