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(a) CT chest showing pleural-based left upper lobe lung mass, (b) PET showing hypermetabolic pleural-based left upper lobe lung mass, (c, d) CT abdomen showing left renal metastasis (c) axial view and (d) sagittal view.
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CT showed increased tumour size of 80 mm with extension into the left chest wall and an associated pathological rib fracture (Fig. 1a). Restaging PET, MRI brain and endobronchial ultrasound-guided biopsy of mediastinal lymph nodes were negative for metastatic disease (Fig. 1b). Five months later he presented with pneumonia, and a CT scan incidentally found a new 47-mm isolated left renal cortical lesion with no evidence of thoracic local recurrence or other metastases (Fig. 1c and d).
(a, b) Haematoxylin and eosin stain showing (a) epithelioid and (b) sarcomatoid component of resected pleural mesothelioma. (c, d) Calretinin stain of (c) resected pleural mesothelioma and (d) renal metastasis.
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Histopathology demonstrated complete excision of a 78-mm Stage III (T3N0M0) poorly differentiate biphasic mesothelioma, comprising pleomorphic epithelioid and spindled (sarcomatoid) cells in approximately equal proportions (Fig. 2a and b). Renal biopsy confirmed metastatic sarcomatoid mesothelioma, morphologically identical to the sarcomatoid component of the primary pleural mesothelioma with positive staining for calretinin (Fig. 2d) and Wilms' Tumour 1, and negative staining for cytokeratin 5/6.