Extended Survival After Accidental Finding of Malignant Pleural Mesothelioma Presenting as Solitary Lung Nodule

SESSION TITLE: Pleura and Chest Wall SESSION TYPE: Case Report Poster PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM INTRODUCTION: Current guidelines for lung cancer screening with chest computed tomography (CT) include current or former smokers [1]. There are no similar guidelines for asbestos exposure and malignant pleural mesothelioma (MPM) [2]. MPM usually presents in the chest radiography as unilateral pleural effusion or pleural thickening. Presentation of MPM as a solitary lung nodule is rare. CASE PRESENTATION: This patient was first examined because of exertional dyspnea. He was 55 years old, a builder with asbestos exposure and active smoker 70p/y. Chest x-ray and chest CT revealed emphysema. Since his emphysema was predominantly upper lobe and had exertional dyspnea, he was submitted to right Lung Volume Reduction Surgery (LVRS). A follow up CT was performed 4 months after the surgery. Besides the expected post operative changes in the right upper lobe, it also revealed a solitary pulmonary nodule in the apicoposterior segment of left upper lobe (Figure 1). The nodule had spiculated edge and thus highly suspicious for malignancy. It was located in the middle of the left upper lobe surrounded by emphysematous bullae. This made the diagnosis difficult since CT guided biopsy had an increased risk for pneumothorax and bronchoscopy had few chances to reach the nodule. Since staging was negative for secondary disease, surgical removal along with biopsy and bullectomy was performed. Two pathologist doctors classified the tumor as poorly differentiated epithelioid MPM. The patient received 6 cycles of cisplatin/pemetrexed chemotherapy. Follow up CT was performed 6 months after the surgery. It revealed again a nodule in left upper lobe. This time though, the nodule had the benign characteristics of round atelectasis and was located subpleuraly to the fissure. Follow up CTs showed the same round atelectasis without any change or signs of disease relapse. The patient 36 months after the surgery is in good health status, with no signs of disease remission. DISCUSSION: Early detection of MPM is very important since the disease has very poor survival rates and survival varies with staging. CONCLUSIONS: Screening with CT subjects with asbestos exposure, may lead to earlier diagnosis, reduced overall cost and it could save lives. Since this was not supported from previous non-randomized studies [3], a randomized study would be useful. Reference #1: National Lung Screening Trial Research Team, Aberle DR et al. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. N Engl J Med. 2011 Aug 4;365(5):395-409. Reference #2: Baas P et al. Ann Oncol. 2015 Jul 28. [Epub ahead of print]. Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Reference #3: Fasola G et al. Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population: baseline results of a prospective, nonrandomized feasibility trial - an Alpe-Adria Thoracic Oncology Multidisciplinary Group Study (ATOM 002). Oncologist 2007;12:1215-1224. DISCLOSURE: The following authors have nothing to disclose: Eugenios Metaxas, Evangelos Balis, Sotiris Kakavas, Maria Maimari, Ilias Porfiridis No Product/Research Disclosure Information