2001 Volume 41 Issue 6 Pages 661-666
Background: This report describes a very rare case of localized malignant pleural mesothelioma with remarkable osseousand cartilaginous differentiation.
Case: A 72-year-old man was admitted to hospital with dry cough and severe dyspnea. A chest X-ray and CT on admissionshowed a huge mass (20×16cm in diameter) occupying the right thoracic cavity and anterior mediastinum. Therewere many calcifications in the tumor, and pleural effusion in the right pleural cavity. Chest CT revealed that the huge tumorcompressed the heart and the right lung, and the right main bronchus and the main pulmonary artery had been occluded.Microscopic examination of the needle biopsy specimen did not yield a definitive diagnosis. No malignant cell wasrecognized in pleural effusion, but serum NSE level was high (19.4ng/ml).
The tumor, together with the right lung, was resected. The mass was too huge to be removed by a median sternotomyincision or usual postero-lateral incision, so we performed a transverse thoracosternotomy. The weight of the resectedmass with the right lung was 2370g, and the volume of the evacuated bloody right pleural effusion was 2300ml. The sternumwas replaced with hard marlex mesh like a sandwich, and it was fixed with stainless wire. Hard marlex mesh wasused to fix the sternum after transverse sternotomy, to prevent respiratory failure. His postoperative course was uneventful.
Conclusion: The pathological diagnosis was malignant sarcomatoid mesothelioma with extensive ossification. This appearsto be the 17th reported case in the world and the 5th case in Japan.
