A 71-year-old male, of Russian origin, construction worker, with usual exposure to asbestos and for 3 years in a mine for two months, who came to the emergency department of our hospital for epipnea.
His personal history included hypertension, treatment with an angiotensin converting enzyme (ACE) inhibitor, and diagnosis of a gastroduodenal ulcer.
A chest X-ray performed in another center showed pleural effusion in the middle of the right hemithorax with mediastinal widening.
He also reported a constitutional syndrome, with a quantified loss of 12 kg in the last 4 months.
Physical examination revealed preserved vesicular murmur and abolition of vocal vibrations in the lower half of the right hemithorax
With clinical suspicion of pleural neoplasia, he was admitted to Pneumology for study where the following diagnostic tests were performed: Analytical: Hb 12 gr/dl, leukocytes 10,000/mm3 (.8%), platelets 535.2%, E 10000
General biochemistry and tumor markers were normal.
Chest CT: massive pleural effusion, nodular thickening with formation of masses in points and involvement of both the parietal, mediastinal and diaphragmatic walls.
Bronchoscopy: compression of the right bronchial tree with bronchoaspiration without malignancy criteria and negative microbiology.
1.
The leukocyte count showed: leukocyte count 3,800/mm3 (PMN 12%, L 88%) and neutrophil count 53,000/mm3.
Glucose: 36 mg/dl; proteins: 4.2 g/dl; cholesterol: 56 mg/dl; LDH: 1570 U/L; pH: 7.242; ADA: 27 U/L negative Microbiology.
Pleural fluid cytology: extended with cytoarchitecture criteria that favor the diagnosis of mesothelioma.
Pleural biopsy was reported as: fragment with morphological and phenotypic criteria that favor the diagnosis of diffuse epithelial malignant mesothelioma of non- glandular architecture (solid).
Immunohistochemical result: positive zone pancytokeratin AE1/AE3.
diffuse positive CK18.
35BH11 positive zone.
CEA-P negative.
Zone positive vimentin.
CD15 negative.
Ki-67, high proliferative fraction (70%). p53 (46%).
Pleural drainage tube was placed during admission and after stent placement, pleurodesis was placed.
With the diagnosis of stage IV MPM, the patient was admitted to our radiology service, where the patient received radiotherapy 15 days after healing all wounds in the right hemithorax.
The patient was irradiated in the linear accelerator, using electrons of 10 MeV, with a dose of 21 Gy administered to all the therapeutic procedures in the right pleural cavity, in which the diagnostic procedures were performed in 7 Gy.
Tolerance to treatment was good but unfortunately the patient died 24 weeks later due to irreversible respiratory failure, with no evidence of cutaneous metastases.
