Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review

Abstract

Background Malignant pleural mesothelioma (MPM) is thought to arise from the mesothelial cells that line the pleural cavities. Most patients initially experience the insidious onset of chest pain or shortness of breath, and it rarely presents as spontaneous pneumothorax. Case reports We report four patients who presented in this manner. Three of the patients were exposed to asbestos directly or indirectly at shipyards during World War II; the fourth was exposed as an insulator's wife. Two of our cases were not recognized to have MPM on histologic examination at ®rst thoracotomy and remained asymptomatic for 12 and 22 months, respectively. In none of the patients described herein, was spontaneous pneumothorax the cause of death. Conclusion Since many people were exposed to asbestos during and after World War II, spontaneous pneumothorax in a patient with the possibility of such exposure should raise the suspicion of malignant pleural mesothelioma.

Malignant pleural mesothelioma in a patient with pneumothorax: A cumbersome subtype both clinically and pathologically

“…Spontaneous pneumothorax is infrequently caused by neoplasms of which primary malignancies are few 7 . MPM seldom complicates pneumothorax during the illness, especially at initial presentation 3–5 . Pathological mechanisms of MPM‐associated pneumothorax include the rupture of a necrotic tumor or ball–valve action by a tumor 8 .…”

“…Their primary cause is asbestos, with tumors developing 30–40 years after exposure 1 . While chest pain and pleural effusion are the most common symptoms/signs, 2 a few patients present with pneumothorax 3–5 . Here, we report an MPM case that was difficult to diagnose due to a peculiar clinical course: the patient had no asbestos exposure, showed pneumothorax as an initial symptom, and died of malignant esophageal stricture.…”

Malignant pleural mesothelioma detected by spontaneous pneumothorax

“…1 Spontaneous pneumothorax is a rare presentation of malignant pleural mesothelioma. 2 Spontaneous pneumothorax secondary to malignant mesothelioma was fi rst described by Eisenstadt. 9 The following mechanisms have been suggested to explain how pneumothorax occurs secondary to malignant tumors.…”

“…1 Spontaneous pneumothorax is a rare presentation of malignant pleural mesothelioma. 2 Localized malignant mesothelioma is an uncommon tumor with no evidence of diffuse spread; it is classifi ed as a separate entity among the pleural tumors in the 2004 World Health Organization (WHO) classifi cation. 3 The pattern of diffuse spread over the serosal surface is fundamental to the diagnosis of diffuse malignant mesothelioma.…”

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

“…Clinically, primary spontaneous pneumothorax usually occurs in healthy young people and, although well recognized, such presentation is exceedingly rare in MM. 4 By far, COPD is the most common cause of secondary spontaneous pneumothorax. 5 In our case, the patient had a well-known medical history of emphysema and chronic bronchitis.…”