Posters
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: Spindle cell mesothelioma, or Sarcomatoid mesothelioma, is a rare and insidious type of malignant mesothelioma with a high mortality rate. It arises from mesothelial surfaces of the pleural cavity, peritoneal cavity, tunica vaginalis, or pericardium, and it is usually associated with asbestos exposure. Spindle cell mesothelioma could be challenging to treat because most patients have advanced disease at presentation with an average prognosis of six months. In this case report we present a rare case of spindle-cell mesothelioma arising from the right pleura.
Case presentation: An 82-year-old male with a history of atrial fibrillation and coronary artery disease, status post-stenting in February 2023, was admitted with worsening shortness of breath (SOB) for the last four weeks. He experienced SOB even at rest and more severe with walking. Furthermore, he reported generalized weakness and decreased oral intake. Initial vital signs included RR 24 bpm and SpO2 of 88% on room air. Physical exam revealed normal breath sounds on the right lung but was noted to have dull percussion and increased tactile fremitus. Chest X-rays revealed opacification of the whole right lung with minimal residual aeration of the right apex and mediastinal deviation to the left. CT scan of the chest without contrast showed right lung collapse with a large and thick-walled irregular pleura and large pleural fluid collection. Thoracentesis was performed, and approximately 1600 cc of bloody pleural fluid was sent for diagnostic studies and to treat the SOB. Fluid analysis was consistent with exudative pleural effusion, lymphocyte-predominant cells, and normal levels of adenosine deaminase enzyme. Given a history of exposure to asbestos when he worked in the shipyard for more than 40 years, mesothelioma was the first working diagnosis. Subsequently the pleural biopsy confirmed the diagnosis of malignant spindle cell neoplasia with a CDKN2A gene heterozygous deletion giving the patient a poor prognosis. Following the patient’s wishes a do-not-resuscitate (DNR) and do-not-intubate (DNI) order was placed and he passed away due to acute respiratory failure and the development of hospital-acquired pneumonia in the left lung.
Conclusion: Spindle cell mesothelioma, a rare form of malignant mesothelioma, manifests its effects several years after the initial exposure. When symptoms eventually appear, the prognosis is typically unfavorable due to late diagnosis and advanced disease. Although spindle cell mesothelioma is not directly treated, the shortness of breath can improve with therapeutic thoracentesis which is considered the optimal choice. In our patient's case, the analysis revealed that 32% of the examined cells exhibited a hemizygous deletion of CDKN2A. This finding suggests that Spindle cell mesothelioma can arise not only from a homozygous deletion but also from a hemizygous deletion of the CDKN2A gene.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Ngo, Duc Khiem; Torres, Karina; Hassan Memon, Sobia; and Ramos, Carlos T. Jr., "Spindle-Cell Mesothelioma Arising From The Right Pleura: A Case Report And Review of the Literature" (2024). Research Symposium. 14.
https://scholarworks.utrgv.edu/somrs/2023/posters/14
Included in
Spindle-Cell Mesothelioma Arising From The Right Pleura: A Case Report And Review of the Literature
Background: Spindle cell mesothelioma, or Sarcomatoid mesothelioma, is a rare and insidious type of malignant mesothelioma with a high mortality rate. It arises from mesothelial surfaces of the pleural cavity, peritoneal cavity, tunica vaginalis, or pericardium, and it is usually associated with asbestos exposure. Spindle cell mesothelioma could be challenging to treat because most patients have advanced disease at presentation with an average prognosis of six months. In this case report we present a rare case of spindle-cell mesothelioma arising from the right pleura.
Case presentation: An 82-year-old male with a history of atrial fibrillation and coronary artery disease, status post-stenting in February 2023, was admitted with worsening shortness of breath (SOB) for the last four weeks. He experienced SOB even at rest and more severe with walking. Furthermore, he reported generalized weakness and decreased oral intake. Initial vital signs included RR 24 bpm and SpO2 of 88% on room air. Physical exam revealed normal breath sounds on the right lung but was noted to have dull percussion and increased tactile fremitus. Chest X-rays revealed opacification of the whole right lung with minimal residual aeration of the right apex and mediastinal deviation to the left. CT scan of the chest without contrast showed right lung collapse with a large and thick-walled irregular pleura and large pleural fluid collection. Thoracentesis was performed, and approximately 1600 cc of bloody pleural fluid was sent for diagnostic studies and to treat the SOB. Fluid analysis was consistent with exudative pleural effusion, lymphocyte-predominant cells, and normal levels of adenosine deaminase enzyme. Given a history of exposure to asbestos when he worked in the shipyard for more than 40 years, mesothelioma was the first working diagnosis. Subsequently the pleural biopsy confirmed the diagnosis of malignant spindle cell neoplasia with a CDKN2A gene heterozygous deletion giving the patient a poor prognosis. Following the patient’s wishes a do-not-resuscitate (DNR) and do-not-intubate (DNI) order was placed and he passed away due to acute respiratory failure and the development of hospital-acquired pneumonia in the left lung.
Conclusion: Spindle cell mesothelioma, a rare form of malignant mesothelioma, manifests its effects several years after the initial exposure. When symptoms eventually appear, the prognosis is typically unfavorable due to late diagnosis and advanced disease. Although spindle cell mesothelioma is not directly treated, the shortness of breath can improve with therapeutic thoracentesis which is considered the optimal choice. In our patient's case, the analysis revealed that 32% of the examined cells exhibited a hemizygous deletion of CDKN2A. This finding suggests that Spindle cell mesothelioma can arise not only from a homozygous deletion but also from a hemizygous deletion of the CDKN2A gene.