PMC9160749_01
(A) Chest CT showing a ground glass opacity of 32 mm in size in her middle lobe of the right lung. (B) At 2 years and 3 months after pulmonary resection, the follow-up chest CT revealed right pleural effusion. (C-F) At 4 year and 7 months after pulmonary resection, the chest CT revealed multiple pulmonary nodules and bilateral pleural effusion with a right pleural tumor directly invading into the abdominal cavity. A right malignant pleural mesothelioma (sarcomatoid type) invaded to the right adrenal gland and the liver.
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She underwent a right middle lobectomy and nodal dissection for pulmonary AD which showed a ground glass opacity of 32 mm in size ( Figure 1A ). At 2 years and 3 months after the pulmonary resection, the follow-up chest CT revealed a right pleural effusion ( Figure 1B ). At 4 years and 7 months after the pulmonary resection, the chest CT revealed multiple pulmonary nodules and bilateral pleural effusion with a right pleural tumor directly invading into the abdominal cavity ( Figures 1C-F ).
(A) Pathology of primary lung cancer (x100). (B) TTF-1 of lung cancer (positive; x400). (C) Calretinin of lung cancer (negative; x400). (D) Pathology of malignant pleural mesothelioma (x200). (E) Calretinin of malignant pleural mesothelioma (MPM; weakly positive; x400). (F) D2-40 of MPM (positive; x400).
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For this diagnosis, we used not only morphological methods but also immunohistochemistry methods ( Figures 2A-C ). TTF-1, Napsin A, or p40 and weakly positive for calretinin and positive for D2-40 ( Figures 2D-F ), which meant a mesothelium origin. The pathology was quite different from the adenocarcinoma.
Structural chromosomal aberration analysis by DNA microarray (OncoScan CNV). All chromosomes showed abnormality in malignant pleural mesothelioma, whereas the chromosomal aberration of lung adenocarcinoma was relatively local. A commonality was not found in the patterns of the chromosomal aberration between the adenocarcinoma and the malignant pleural mesothelioma.
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In the structural chromosomal aberration analysis by DNA microarray with OncoScan CNV (Affymetrix) ( Figure 3 ), all chromosomes of the MPM showed abnormality, whereas the chromosomal aberration of AD showed relatively local abnormality.