Mesothelioma is a rare and insidious neoplasm and is characterized by its highly malignant and aggressive nature. The most common etiology is asbestos exposure, but there are some reports without known asbestos exposure and other factors leading to malignant pleural mesothelioma (MPM).
Here, we present the case of a 58-year-old woman with pleuritic chest pain, dyspnea, and fever on presentation to the emergency department (ED), which caused several admissions to the ED in 20 days. The patient was then admitted to the internal medicine department with a diagnosis of community-acquired pneumonia with parapneumonic effusion. During hospitalization, a positron emission tomography (PET) scan, thoracic computed tomography (CT), and pleural biopsy were performed and a final diagnosis of malignant epithelioid pleural mesothelioma was made. Six weeks after the onset of symptoms, the patient presented with an exponential disease progression, dying two months after the diagnosis, despite the initiation of chemotherapy.
MPM remains a diagnostic and therapeutic challenge with a very poor prognosis. However, studies show that mesothelioma patients who undergo treatment live at least twice as long as patients who do not receive treatment. This case report is particularly significant because, although it was epithelioid mesothelioma, multiple solid masses were noted on CT and the patient exhibited rapid disease progression, dying a few weeks after starting treatment.
Mesothelioma is a rare neoplasm with an estimated incidence of about 20 per million inhabitants in Europe and it is increasing worldwide. It is known to be insidious due to its long latency period which can last up to 40 years. More frequently, it arises from the mesothelial tissue surfaces of the pleura but can also occur in the peritoneum and tunica vaginalis. Malignant pleural mesothelioma (MPM) remains a severe problem as the incidence continues to increase worldwide and is likely to peak until 2030. MPM occurs predominantly in men (with a male-to-female ratio of 5:1), and the risk increases with age, with the vast majority occurring in patients aged 60 years or older. Asbestos exposure is the most commonly known etiology linked to mesothelioma, however, there are some case reports where no exposure has been found, and some other factors have been emerging as important causes of MPM.
Asbestos-Mesothelioma Case Evaluation
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