Exclusive Intrapulmonary Lepidic Growth of a Malignant Pleural Mesothelioma Presenting With Pneumothorax and Involving the Peritoneum

Abstract

We report a rare case of malignant pleural mesothelioma presenting clinically with pneumothorax and histologically with an exclusive intrapulmonary lepidic growth. Neither intrathoracic nodules nor pleural thickening were found. The patient subsequently experienced acute abdominal pain with peritonitis and intestinal occlusion by peritoneal mesothelioma. The morphologic clues leading to the correct diagnosis of mesothelioma with prominent intrapulmonary growth are briefly discussed.

Rapidly progressing lepidic pulmonary metastases from a treated poorly differentiated hepatocellular carcinoma demonstrating new pathologic features of cholangiocarcinoma: A potential diagnostic pitfall that may mimic pneumonia

“…Less common features such as nodules with surrounding ground-glass opacification, the so-called halo sign, and prominence of contrast opacified vessels traversing areas of lower attenuating consolidation, known as the “CT angiogram sign,” have been described [6] , [20] . Development of malignant pleural effusions in the setting of disseminated disease has also been reported in at least 1 case of lepidic spread of malignant mesothelioma [16] .…”

“…Radiographic features of lepidic metastases are often very nonspecific and manifest as areas of consolidation that may be associated with air bronchograms [2] , [13] , [14] , [15] . Pleural effusions may be present in the setting of advanced disease [16] . HRCT findings of lepidic metastases are characterized by consolidation, ground-glass opacity, and centrilobular and tree-in-bud micronodules typically of ground-glass attenuation, reflecting cancer cells lining intact distal bronchioles with variable amounts of intra-alveolar involvement [6] , [7] , [13] .…”

Pleural malignant mesothelioma with invasive micropapillary component and its association with pulmonary metastasis

“…This direct invasion of the subpleural lung parenchyma was identified in 22/118 (19%) of the epithelioid subtype in a recent study 13 . In contrast, mesothelioma‐induced pulmonary metastasis is uncommon, although some patients with pulmonary metastasis have been previously reported 14–19 . In the metastatic foci, the mesothelioma cells line the surface of alveolar walls, 16–18 and appear as discohesive single cells or form small clusters, 19 while no invasive micropapillary pattern in association with lymph vessel involvement was reported.…”

“…13 In contrast, mesothelioma-induced pulmonary metastasis is uncommon, although some patients with pulmonary metastasis have been previously reported. [14][15][16][17][18][19] In the metastatic foci, the mesothelioma cells line the surface of alveolar walls, [16][17][18] and appear as discohesive single cells or form small clusters, 19 while no invasive micropapillary pattern in association with lymph vessel involvement was reported. In the present study pulmonary metastasis was noted only in patients with invasive micropapillary pattern, and was also associated with lymph node and lymphatic involvement.…”

Localized intrapulmonary desmoplastic mesothelioma: A case report

“…Desmoplastic mesothelioma is a relatively rare histological subtype of mesothelioma with sarcomatoid histology (1) arising most frequently in the pleura, peritoneum or pericardium and less frequently in organs such as lung, spleen [4], pancreas [5] and liver [6]. In fact, few cases of intrapulmonary malignant mesothelioma have been described [2,3,7,8] presenting with bilateral miliary pulmonary nodules and diffuse bilateral opacities or characterized by diffuse intrapulmonary growth, among which some cases [7,8] were pathologically con irmed as intrapulmonary metastases from a clinically undetectable pleural mesothelioma, while the others [2,3] were diagnosed as diffuse intrapulmonary malignant mesothelioma. However, we described an unusual presentation of intrapulmonary mesothelioma characterized by a localized mass without pleural lesions.…”