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Mesothelioma With a Large Prevascular Lymph Node: N1 Involvement or Something Different?

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This case report details a rare instance of simultaneous malignant pleural mesothelioma and thymoma in a 64-year-old man. The patient underwent chemotherapy and surgery, revealing both distinct tumors.

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Area of Science:

  • Oncology
  • Thoracic Surgery
  • Pathology

Background:

  • A 64-year-old male presented with symptoms suggestive of thoracic malignancy.
  • Imaging revealed right-sided pleural effusion, calcified pleural plaques, and a prevascular mediastinal mass.

Observation:

  • Video-assisted thoracoscopic surgery was performed for pleural biopsy.
  • Initial histopathology diagnosed epithelial malignant pleural mesothelioma.
  • A prevascular nodule was identified and biopsied.

Findings:

  • The patient received induction chemotherapy (cisplatin and pemetrexed) followed by pleurectomy and decortication.
  • Post-operative pathology confirmed stage IB malignant pleural mesothelioma (ypT3N0M0).
  • Unexpectedly, the prevascular nodule was diagnosed as stage II thymoma type B2.

Implications:

  • This case highlights the extremely rare simultaneous occurrence of malignant pleural mesothelioma and thymoma.
  • Such co-occurrence presents diagnostic and therapeutic challenges.
  • Further research into the potential shared etiological factors or biological mechanisms is warranted.