Abstract: Malignant mesothelioma is a rare and aggressive cancer that usually affects subjects with prior asbestos exposure, a major risk factor that has been widely known as carcinogenic, and its use is now controlled if not banned in many areas of the world. Malignant mesothelioma originates from mesothelial surface cells covering the serous cavities, and the pleura is its most common site. Malignant pleural mesothelioma (MPM) typically presents with pleural effusion and chest wall pain with wide pleural thickening at radiological investigation. Although the histological examination along with immunohistochemistry helps yield the diagnosis, clinicians and experts face many challenges in diagnosing malignant mesothelioma not only due to the rarity of the disease but also due to the similarities that the disease share with other malignancies.
Here, we report a case of a 55-year-old male patient with a history of chronic asbestos work exposure for 12 years who initially presented with unexplained pleural effusion and chest wall pain and was lost to follow-up but came back later with a worsening clinical state. This case is specially presented to raise awareness against cases of unexplained pleural effusion and chest pain.
Introduction: Malignant mesothelioma is a rare, insidious, and aggressive tumor that has always been described as highly common among patients with a history of chronic asbestos exposure. Although asbestos industries have been restricted in many countries, past exposure is responsible for most present cases of the disease as it can take 10-40 years from the initial exposure to develop malignancy. Mesothelioma originates from mesothelial surface cells covering the serous cavities, and the malignant pleural mesothelioma (MPM) is the most common presentation of this malignancy as three main histological subtypes are described: epithelioid, sarcomatoid, and biphasic mesothelioma. Mesothelioma can also occur without asbestos exposure as several non-asbestos etiologies are described such as therapeutic irradiation, simian virus-40, and more mineral fibers other than asbestos.
Patients with MPM present broad and nonspecific symptoms, such as chest pain, cough, dyspnea, or night sweat, but clinical suspicion should come to light in the presence of a history of professional or occupational asbestos exposure. The radiological findings, the pleural fluid cytology, and the histological results along with the immunohistochemistry studies are key to diagnosing MPM. However, this entity is often complex and difficult to diagnose due to its rarity and histopathological varieties.
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