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Localized malignant pleural mesothelioma arising in the interlobar fissure: a unique surgical case masquerading clinicopathologically as primary lung adenocarcinoma

Authors :
Xin Guo
Jiro Watanabe
Kenji Takahashi
Tatsuro Hayashi
Nozomu Kurose
Yasuyuki Sasaguri
Hidetaka Uramoto
Hiromi Iwagaki
Kazuki Nabeshima
Sohsuke Yamada
Source :
SAGE Open Medical Case Reports, Vol 7 (2019)
Publication Year :
2019
Publisher :
SAGE Publishing, 2019.

Abstract

An 80-year-old male with previous workplace exposure to asbestos presented with a history of an increase in the pulmonary-to-hilar mass, measuring more than 50 mm in diameter, likely in the right lower lobe. We first interpreted it as suspicious of primary lung adenocarcinoma with direct invasion to the right hilar lymph node. A right middle and lower lobectomy with partial resection of upper lobe was performed, and gross examination showed a hilar tumor lesion, involving the middle/lower lobe to hilar lymph node and looking whitish to yellow-grayish, partly adjacent to the right pulmonary artery. On microscopic examination, the tumor was located on the extrapulmonary, interlobar pleural fissure, predominantly composed of a proliferation of atypical epithelioid cells, often arranged in an irregular and fused tubular growth pattern with an involvement of pulmonary artery. Immunohistochemically, these atypical cells are positive for several mesothelial markers, including calretinin, cytokeratin 5/6, and WT-1, whereas negative for thyroid transcription factor 1. Furthermore, p16 deletions were specifically detected by fluorescence in situ hybridization, and electron microscopy showed numerous, significantly elongated microvilli. Taken together, we finally made a diagnosis of localized malignant pleural mesothelioma, epithelioid-type, arising in the right interlobar fissure between lower and middle lobes. We should be aware that, owing to its characteristic features, clinicians and pathologists might be able to raise interlobar fissure localized malignant pleural mesothelioma as one of the differential diagnoses, based on careful clinicopathological examinations.

Subjects

Subjects :
Medicine (General)
R5-920

Details

Language :
English
ISSN :
2050313X
Volume :
7
Database :
Directory of Open Access Journals
Journal :
SAGE Open Medical Case Reports
Publication Type :
Academic Journal
Accession number :
edsdoj.798dc45ec3e44dca8356785f129bd20b
Document Type :
article
Full Text :
https://doi.org/10.1177/2050313X18824802