Pericardial dual mesh uptake on PET scan mimicking residual mesothelioma; a case report

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer that typically arises from the mesothelial linings of the lungs. The current study presents a rare case of MPM with a good clinical response to chemotherapy, associated with pericardial dual mesh uptake in PET scan upon follow up. Case presentation: A 33-year-old male presented with dyspnea, severe headache for a period of a month. He had history dendritic cell sarcoma which had been managed by 21 cycles of radiotherapy. Chest x. ray showed multiple pleural based masses. Chest computed tomography scan showed multiple lobulated pleural masses involving right hemithorax. Pleural biopsy showed epithelial type-mesothelioma. The patient underwent 3 sessions of combination chemotherapy followed by pleurectomy. The patient's response to chemotherapy was optimal and 5 month-PET scan follow up showed uptake by the implanted mesh. Discussion: MPM is reported to be directly linked to asbestos exposure with poor prognosis. The current optimal management regarding MPM is lacking. Even though PET scan is highly sensitive, sites of infections, inflammation, and healing of surgical scars have been reported to show uptake, leading to a false positive result. Conclusion: The best therapeutic approach regarding MPM can be multimodal therapies that include surgery, radiotherapy, and chemotherapy before and after surgery. PET scan follow up of patients with previous mesh implantations can show uptake and mimic malignancy. Highlights