2013 Volume 35 Issue 2 Pages 145-149
Case. A 75-year-old man had been admitted to another hospital because of pleural effusion and inflammatory findings. Chest computed tomography revealed irregular pleural thickening and encapsulated effusion in the side of the left thorax. We suspected infection, including acute empyema, but the possibility of malignant tumor could not be ruled out by blood examinations and cytologic examination of pleural fluid. Video-assisted thoracic surgery (VATS) pleural biopsy under general anesthesia yielded a diagnosis of epithelial type malignant pleural mesothelioma. His serum granulocyte colony stimulating factor (G-CSF) level was elevated to 356 pg/ml. We further confirmed G-CSF-positive tumor cells by immunohistochemical staining. Taken together, we diagnosed with G-CSF-producing malignant pleural mesothelioma. He refused chemotherapy, and died 3 months after the diagnosis. Conclusions. Intractable pleuritis with inflammation could be malignant pleural mesothelioma producing G-CSF. Thoracoscopic biopsy is required to collect sufficient specimen to diagnose pleural malignancy mimicking acute empyema with malignant cytological findings of pleural effusion or elevation of tumor markers.
