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Clinically Occult Diffuse Pleural Mesothelioma in Patients Presenting With Spontaneous Pneumothorax
Daffolyn Rachael Fels Elliott1, Kristine E Konopka2, Steven M Hrycaj2
1Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, US.
American Journal of Clinical Pathology
|May 31, 2023
Summary
Diffuse pleural mesothelioma (DPM) can present as unsuspected pneumothorax, especially in older patients. Histologic examination and ancillary markers are crucial for early DPM detection in such cases.
Area of Science:
- Pulmonology
- Oncology
- Pathology
Background:
- Diffuse pleural mesothelioma (DPM) is a rare malignancy.
- Spontaneous pneumothorax is a common condition, often treated surgically.
- Early detection of DPM is critical for patient outcomes.
Observation:
- Two cases of DPM were diagnosed in patients presenting with spontaneous pneumothorax without prior suspicion.
- This presentation occurred in 2.3% of DPM patients and 0.9% of pneumothorax patients, with a higher incidence in those over 70.
- Mesothelioma in situ (MIS) was identified retrospectively in one pneumothorax case that later progressed to invasive DPM.
Findings:
- Histologic examination of surgical specimens from pneumothorax cases can reveal unsuspected DPM.
- Ancillary markers like BAP-1 and MTAP are essential for confirming DPM diagnosis.
- The link between spontaneous pneumothorax and MIS as a precursor remains uncertain.
Implications:
- Surgical specimens from pneumothorax, particularly in older individuals, should be carefully examined for early DPM.
- Ancillary testing aids in diagnosing DPM in ambiguous cases.
- Further research is needed to determine if pneumothorax is a manifestation of MIS.
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