Abstract
Background. Malignant pleural mesothelioma (MPM) occurs from the parietal pleura and even in early MPM some macroscopic changes, such as non-specific inflammatory changes and minute white nodules, may arise from the surfaces of the parietal pleura. Case. A 78-year-old male was admitted to our hospital complaining of fatigue and weight loss. A chest X-ray and CT revealed pleural effusion. Pleural effusion cytology showed class IV, suggesting MPM. A pleural biopsy with video-assisted thoracoscopic surgery (VATS) was performed, however, no macroscopic findings were detected in the pleural space and a histological diagnosis of MPM was not obtained. After a one-year follow-up, a re-biopsy showed one small nodular lesion in the visceral pleura without macroscopic changes in the parietal pleura. A histologically definitive diagnosis of MPM was finally obtained from the small nodule in the visceral pleura. Conclusion. In this case, macroscopic findings may not be detected in the parietal pleura despite pleural effusion suspicious of MPM. MPM rarely expands from the visceral pleura without macroscopic changes in the parietal pleura. A constant follow-up and repeated thoracoscopy are needed in highly suspicious cases without a definitive diagnosis of MPM.
