Journal of

Case Reports and Images in Pathology

 
     
Case Report
 
Malignant pleural mesothelioma with metastases in the abdomen and left buttock: A case report
Irene Moysset1, Gracia Valderas2, Ferran Losa3
1MD, Department of Pathology, Consorci Sanitari Integral, L’Hospitalet de Llobregat, Barcelona, Spain
2MD, Department of Radiology, Consorci Sanitari Integral, L’Hospitalet de Llobregat, Barcelona, Spain
3MD, PhD, Department of Oncology, Consorci Sanitari Integral, L’Hospitalet de Llobregat, Barcelona, Spain

Article ID: 100015Z11IM2017
doi:10.5348/Z11-2017-15-CR-4

Address correspondence to:
Irene Moysset, MD
Pathology Department, Consorci Sanitari Integral
Avenida Josep Molins, 29-41 08906 - L’Hospitalet de Llobregat
Barcelona
Spain

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How to cite this article
Moysset I, Valderas G, Losa F. Malignant pleural mesothelioma with metastases in the abdomen and left buttock: A case report. J Case Rep Images Pathol 2017;3:13–16.


ABSTRACT

Introduction: Malignant mesothelioma is a rare, aggressive neoplasia that affects the serous membranes. The pleural cavity is the most frequently affected area. Metastasis at the onset of the disease is rare, and muscular involvement is even more uncommon.
Case Report: We report a case of a 64-year-old non-smoking male, who had had intermittent exposure to asbestos for three years. He presented with dyspnea on moderate exertion that had developed over several days, discomfort in the left hemithorax, and some intolerance to decubitus positions. The patient had a weight loss of 10 kg in last three months. A chest X-ray showed bilateral pleural effusion with multiple nodular images in both hemithoraces. Computed tomography (CT) scans of the thorax and abdomen revealed multiple bilateral pleural and pulmonary lesions. We observed mediastinal lymphadenopathy, intra-abdominal implants, and a 56×40 mm polylobulated mass in the left buttock that underwent biopsy, revealing epithelioid cells that showed cytoplasmic positivity for keratins 5/6 and 7. We observed nuclear and cytoplasmic positivity for calretinin and nuclear positivity for the Wilms tumor 1 (WT1) protein, pointing to the diagnosis of metastatic malignant epithelioid mesothelioma. The medical and radiological history supported the diagnosis of primary pleural mesothelioma.
Conclusion: Initial presentation of pleural mesothelioma with distant metastasis outside the thorax is rare, and involvement of striated muscle even more unusual; only three such cases have been reported. The medical, radiological, and histological history of the patient prompted a differential diagnosis among metastases by carcinoma, mesothelioma, and sarcoma. The definitive diagnosis was established by histological and immunohistochemical study.

Keywords: Extrathoracic metastasis, Metastasis in skeletal muscle, Pleural mesothelioma


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Author Contributions
Irene Moysset – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Gracia Valderas – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Ferran Losa – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Irene Moysset et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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