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Pneumothorax and malignant mesothelioma in patients over the age of 40
J D Sheard1, W Taylor, A Soorae
1Department of Pathology, Aintree Chest Centre, Liverpool.
Abstract:
Five patients over the age of 40 with malignant mesothelioma of the pleura presented with a spontaneous pneumothorax in the course of five years. The diagnosis of malignant mesothelioma was not suspected at surgery but was made by histological examination of the pleurectomy specimens. During this time 91 pleurectomies for recurrent pneumothorax were performed, 45 in patients over the age of 40; malignant mesothelioma therefore accounted for 11% of spontaneous pneumothorax requiring pleurectomy in this age group. The association of spontaneous pneumothorax and malignant mesothelioma is not emphasised in current publications. These five cases highlight the need for all pleurectomy specimens in cases of spontaneous pneumothorax to be sent for histological examination and for a full occupational history to be taken, especially in older patients.
Insights
Spontaneous pneumothorax in patients over 40 may indicate malignant mesothelioma. Histological examination of all pleurectomy specimens is crucial for early diagnosis, especially in older individuals.
Area of Science:
- Pulmonology
- Oncology
- Pathology
Background:
- Malignant mesothelioma of the pleura is a rare but aggressive cancer.
- Spontaneous pneumothorax is a known complication, but its association with mesothelioma is often overlooked.
- Older patients presenting with spontaneous pneumothorax require thorough diagnostic evaluation.
Purpose of the Study:
- To investigate the incidence of malignant mesothelioma in patients over 40 presenting with spontaneous pneumothorax.
- To emphasize the importance of histological examination of pleurectomy specimens in diagnosing mesothelioma.
- To highlight the under-recognized association between spontaneous pneumothorax and pleural malignancy.
Main Methods:
- Retrospective review of five cases of malignant mesothelioma presenting as spontaneous pneumothorax in patients over 40.
- Analysis of pleurectomy specimens for histological confirmation of diagnosis.
- Comparison with the overall incidence of pleurectomies for recurrent pneumothorax in the same age group.
Main Results:
- Five patients over 40 were diagnosed with malignant mesothelioma after presenting with spontaneous pneumothorax.
- Malignant mesothelioma accounted for 11% of spontaneous pneumothorax cases requiring pleurectomy in this age group.
- Diagnosis was confirmed histologically after surgery, not suspected pre-operatively.
Conclusions:
- Spontaneous pneumothorax in older adults can be an initial presentation of malignant mesothelioma.
- Histological examination of all pleurectomy specimens is essential for accurate diagnosis.
- Taking a comprehensive occupational history is vital for identifying potential risk factors in patients with spontaneous pneumothorax.