PMC5925959_01
AP Chest X-ray of the patient on admission, remarkable for images suggesting bilateral pleural effusions and right sided pneumothorax (marked by arrows).
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In the ER chest x-ray suggested a large right hydro pneumothorax with moderate left sided pleural effusion (Fig. 1), which was confirmed by chest CT (Fig. 2, Fig. 3).
CT Chest coronal view showing right sided hydro-pneumothorax and left sided pleural effusion.
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In the ER chest x-ray suggested a large right hydro pneumothorax with moderate left sided pleural effusion (Fig. 1), which was confirmed by chest CT (Fig. 2, Fig. 3).
Pathology slides of the patient showing malignant mesothelioma. Low (A), medium (B) and high (C) power magnification of pleural biopsy specimen with hematoxylin-eosin staining. A) Low (40x) magnification view agglomeration of tumor cells are appreciated, forming part of the mesothelial plaque by sheets of malignant mesothelial cells. B) Medium (100x) powered magnification of polygonal epithelioid cells arranged in sheets, and involving isolated adipocytes, compatible with parietal pleural tissue source. C: High (400x) power magnification showing polygonal epithelioid morphology of mesothelial cells. No direct invasion of pulmonary tissue was identified in biopsy samples.
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As infectious and inflammatory etiologies were ruled out as the cause of recurrent hydro-pneumothorax, video-assisted thoracoscopy (VATS) and pleural biopsy confirmed the diagnosis of malignant pleural mesothelioma-epithelioid variant-in the context of histologic findings (Fig. 4, Fig. 5) and imunohistochemical markers positive for calretinin, CK 5/6, mesothelin and focal Glut-1 and negative for EpCam, CEA, Napsin A, TTF-1, and BerEP4.