Localized Malignant Mesothelioma of the Pleura

Hidenobu Takahashi, MD,PhD,1,2 Masahiko Harada, MD,PhD,1,2 Sachio Maehara, MD,1,2 and Harubumi Kato, MD,PhD2

Because malignant mesothelioma is commonly seen as a diffuse neoplasm, a localized tumor is an extremely rare form of presentation. Only 45 cases have been reported, and little is known about their behavior. We report a new case of localized malignant mesothelioma with the microscopic appearance of diffuse malignant mesothelioma, but without any evidence of diffuse spread. A 54-year-old man, a former smoker, with a brief history of asbestos exposure for 3 months, presented with a severe right chest pain and a swelling in the same area. Chest-computed tomography (CT) showed a 4.5 cm extra pleural tumor with a smooth surface, located in the right anterior chest wall, and destruction of the 5th rib. A CT-guided needle biopsy revealed malignant mesothelioma. Detailed examinations revealed a resectable solitary localized mass with no distant metastasis. The patient underwent operation, a tumorectomy, plus a combined resection of the chest wall and part of the right middle lobe. A complete en bloc resection was achieved. Pathology revealed localized malignant mesothelioma, biphasic type. Immunohistochemical findings confirmed the mesothelial feature. Localized malignant mesothelioma should be distinguished from diffuse malignant mesothelioma because of its different biological behavior, and in the former complete resection it is associated with a good prognosis. (Ann Thorac Cardiovasc Surg 2007; 13: 262-266)

Key words: localized malignant mesothelioma, asbestos exposure, complete resection

1Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo, and 2First Department of Surgery, Tokyo Medical University, Tokyo, Japan

Received January 29, 2007; accepted for publication February 9, 2007
Address reprint requests to Hidenobu Takahashi, MD, PhD: Respiratory Center, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193–0998, Japan.