Scientific Letter
Malignant Pleural Mesothelioma In A Young Adult With No Known Exposure To Asbestos
Mesotelioma pleural maligno en adulto joven sin exposición conocida al asbesto
Elena Espinosa Muñoz
, Diego Ramírez Ocaña, Antonio Luis Gutiérrez Cardo
Corresponding author
Unidad de Gestión Clínica de Medicina Nuclear, Hospital Regional Universitario de Málaga, Málaga, Spain
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(a) A large mass is observed occupying almost all the right hemithorax, with heterogeneous density and highly intense peripheral uptake (SUV<span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18.9), in contact with the parietal pleura, posterior mediastinum and right hilum. (b) Reduced metabolic uptake (SUV<span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16.8) seen after chemotherapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary pleural tumors are uncommon, accounting for 3%–3.5% of all chest tumors.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> They most frequently appear as malignant pleural mesothelioma, and occur more often in men (ratio 4:1), with incidence peaking between the ages of 50 and 70 years.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In more than 80% of cases, there is a clear relationship between direct (occupational exposure) and indirect (non-occupational) exposure to asbestos fibers. Environmental exposure has also been described, and the risk is higher in Greece, Cyprus, Turkey and Corsica.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 22-year-old woman with no personal or family history of asbestos contact, who reported a 10-month history of right scapular pain with no other clinical complaints. Around 2 months before presenting, she developed a cyclic febrile pattern, lasting 1 week, coinciding with her menstrual cycles, along with dyspnea on exertion. She was admitted with a suspected diagnosis of pelvic inflammatory disease. Leukocytosis with significant thrombocytosis and CRP 137 were determined, and empirical treatment began with ampicillin and gentamycin, but no improvement was observed. A chest radiograph and chest-abdominal computed tomography (CT) were performed, showing a large right-sided paravertebral mass occupying almost all the ipsilateral hemithorax. The PET-CT with <span class="elsevierStyleSup">18</span>F-FDG revealed a hypermetabolic mass in the right hemithorax, suggestive of malignancy, and diffuse increased reactive uptake in the bone marrow (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). Biopsy found undifferentiated carcinoma in the posterior mediastinum, suggestive of right pleural mesothelioma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Neoadjuvant chemotherapy was started, and some response was seen. Post-treatment PET-CT showed a reduced tumor size with peripheral metabolic uptake (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The case was discussed with the oncological committee and surgical intervention was scheduled. Right pneumonectomy extending to the diaphragm and pericardium was performed, and the pathology report described a deciduoid variant of epithelioid mesothelioma in the right lung, parietal and visceral pleura, pericardium, diaphragmatic muscle, and the diaphragm.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Malignant pleural mesothelioma is a highly aggressive tumor, with a latency period of 20–30 years between exposure and disease onset, making it difficult to identify the “cause–effect” relationship,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and most cases are diagnosed in advanced phases.</p><p id="par0030" class="elsevierStylePara elsevierViewall">PET-CT is useful for correctly differentiating between benign and malignant disease and for quantifying the metabolic activity of the lesion, the presence of metastases, and for evaluating response to treatment.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Sensitivity is greater than 90% and the negative predictive value is 96%.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> Semiquantitative evaluation of FDG-PET tumor uptake, histological subtype, mediastinal lymphadenopathies and extrathoracic metastases are prognostic markers.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In recent years, biomarkers for early diagnosis have emerged, including soluble mesothelin in pleural fluid and fibulin-3 in plasma.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> Currently, microRNA gene expression associated with mesothelioma oncogenesis is under study, and this may be of use as a potential biomarker in the near future.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Remarkable features of our case include the patient's young age and the absence of factors directly related with the genesis of mesothelioma, even after a thorough clinical investigation. Asbestos, comprising 2 natural types of silicates (serpentine and amphiboles), is the main etiological agent. Certain professions incur more risk of developing this tumor, and the risk extends not only to exposed workers but also their family members.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Other known risk factors include the SV-40 virus (a potent oncogenic DNA virus) and post-radiation of malignant tumors such as Hodgkin's lymphoma, or breast or lung cancer.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The absence in our patient of factors associated with malignant pleura mesothelioma and other reports of this entity in children suggest that there may be other etiological factors as yet undiscovered.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Espinosa Muñoz E, Ramírez Ocaña D, Gutiérrez Cardo AL. Mesotelioma pleural maligno en adulto joven sin exposición conocida al asbesto. Arch Bronconeumol. 2016;52:615–616.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1748 "Ancho" => 1700 "Tamanyo" => 260995 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronal, sagittal and axial slices of PET-CT fusion imaging. (a) A large mass is observed occupying almost all the right hemithorax, with heterogeneous density and highly intense peripheral uptake (SUV<span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18.9), in contact with the parietal pleura, posterior mediastinum and right hilum. (b) Reduced metabolic uptake (SUV<span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16.8) seen after chemotherapy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mesotelioma maligno y otros tumores primarios de la pleura" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Guzmán de Alba" 1 => "J.M. Mier Odriozola" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Temas Selectos de Oncología Torácica. 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| 2023 March | 12 | 2 | 14 |
| 2023 February | 50 | 20 | 70 |
| 2023 January | 44 | 27 | 71 |
| 2022 December | 55 | 24 | 79 |
| 2022 November | 46 | 26 | 72 |
| 2022 October | 64 | 48 | 112 |
| 2022 September | 42 | 26 | 68 |
| 2022 August | 51 | 34 | 85 |
| 2022 July | 54 | 41 | 95 |
| 2022 June | 60 | 36 | 96 |
| 2022 May | 59 | 29 | 88 |
| 2022 April | 57 | 26 | 83 |
| 2022 March | 57 | 45 | 102 |
| 2022 February | 56 | 23 | 79 |
| 2022 January | 51 | 33 | 84 |
| 2021 December | 61 | 39 | 100 |
| 2021 November | 54 | 44 | 98 |
| 2021 October | 72 | 59 | 131 |
| 2021 September | 43 | 45 | 88 |
| 2021 August | 43 | 49 | 92 |
| 2021 July | 56 | 41 | 97 |
| 2021 June | 60 | 44 | 104 |
| 2021 May | 51 | 37 | 88 |
| 2021 April | 126 | 70 | 196 |
| 2021 March | 87 | 31 | 118 |
| 2021 February | 52 | 23 | 75 |
| 2021 January | 55 | 34 | 89 |
| 2020 December | 48 | 18 | 66 |
| 2020 November | 50 | 21 | 71 |
| 2020 October | 65 | 20 | 85 |
| 2020 September | 30 | 13 | 43 |
| 2020 August | 32 | 14 | 46 |
| 2020 July | 35 | 31 | 66 |
| 2020 June | 31 | 5 | 36 |
| 2020 May | 41 | 15 | 56 |
| 2020 April | 37 | 27 | 64 |
| 2020 March | 43 | 11 | 54 |
| 2020 February | 31 | 19 | 50 |
| 2020 January | 38 | 28 | 66 |
| 2019 December | 64 | 18 | 82 |
| 2019 November | 42 | 28 | 70 |
| 2019 October | 22 | 10 | 32 |
| 2019 September | 29 | 13 | 42 |
| 2019 August | 29 | 15 | 44 |
| 2019 July | 34 | 12 | 46 |
| 2019 June | 30 | 22 | 52 |
| 2019 May | 39 | 20 | 59 |
| 2019 April | 70 | 35 | 105 |
| 2019 March | 45 | 24 | 69 |
| 2019 February | 34 | 18 | 52 |
| 2019 January | 42 | 12 | 54 |
| 2018 December | 50 | 12 | 62 |
| 2018 November | 57 | 16 | 73 |
| 2018 October | 73 | 20 | 93 |
| 2018 September | 44 | 10 | 54 |
| 2018 August | 1 | 0 | 1 |
| 2018 May | 13 | 1 | 14 |
| 2018 April | 33 | 6 | 39 |
| 2018 March | 21 | 4 | 25 |
| 2018 February | 34 | 10 | 44 |
| 2018 January | 64 | 10 | 74 |
| 2017 December | 56 | 3 | 59 |
| 2017 November | 27 | 5 | 32 |
| 2017 October | 23 | 5 | 28 |
| 2017 September | 28 | 6 | 34 |
| 2017 August | 23 | 13 | 36 |
| 2017 July | 29 | 9 | 38 |
| 2017 June | 27 | 18 | 45 |
| 2017 May | 34 | 13 | 47 |
| 2017 April | 36 | 14 | 50 |
| 2017 March | 21 | 12 | 33 |
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