Abstract
Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT) scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma), with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid), supporting the diagnosis of biphasic malignant mesothelioma.
Highlights
Mesothelioma is an uncommon and highly aggressive malignant tumor [1] usually presenting as a pleural-based mass in those with history of asbestos exposure
The biphasic subtype is the second most common histologic type accounting for 20–35% of all malignant pleural mesotheliomas (MPM). It is characterized by the concomitant presence of epithelioid and sarcomatoid features, the latter associated with worse prognosis [2, 3]
Biopsy specimens suggesting MPM with sarcomatoid features may still need to be differentiated from other types of malignancies, since they may express a paucity of immunohistochemical markers
Summary
Mesothelioma is an uncommon and highly aggressive malignant tumor [1] usually presenting as a pleural-based mass in those with history of asbestos exposure. The biphasic (mixed) subtype is the second most common histologic type accounting for 20–35% of all malignant pleural mesotheliomas (MPM). It is characterized by the concomitant presence of epithelioid and sarcomatoid features, the latter associated with worse prognosis [2, 3]. Sarcomatoid and biphasic subtypes of MPM often mimic other malignant and benign conditions on radiographic and histologic examination and, due to their poor prognosis, early diagnosis becomes most imperative [4, 5]. We report a case of biphasic MPM presenting with chest pain and a rib mass in a healthy middle aged male with no identifiable risk factors
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