CASE REPORT   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2018 September;177(9):504-7

DOI: 10.23736/S0393-3660.17.03599-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Can pneumothorax unveil malignant pleural mesothelioma? A case report and literary review

Maria C. MENNITTI ¹, Rosaria CORTESE ¹, Silvia DI STASI ¹, Arianna VISCARDI ¹, Alessandro CASCINA ¹, Patrizia MORBINI ², Roberto DORE ³, Filippo ANTONACCI ⁴, Francesco VALENTINO ⁵, Giulia M. STELLA ¹ ✉

¹ Unit of Pneumology, IRCCS Policlinico San Matteo and University of Pavia Medical School, Pavia, Italy; ² Unit of Pathology, IRCCS Policlinico San Matteo and University of Pavia Medical School, Pavia, Italy; ³ Unit of Radiology, IRCCS Policlinico San Matteo and University of Pavia Medical School, Pavia, Italy; ⁴ Unit of Thoracic Surgery, IRCCS Policlinico San Matteo and University of Pavia Medical School, Pavia, Italy; ⁵ Unit of Medical Oncology, IRCCS Policlinico San Matteo and University of Pavia Medical School, Pavia, Italy

Malignant pleural mesothelioma is an aggressive cancer with an ominous prognosis due to the absence of effective treatments. MPM diagnosis is often delayed consequently to insidious and non-specific symptoms. Past asbestos exposure represents the major risk factor for MPM onset, although the carcinogenic mechanisms of asbestos is not fully understood. In those cases, the parietal pleura is the target of disease arousal. As opposite, here we present and discuss two clinical cases of MPM who firstly presented as primary spontaneous pneumothorax. In both cases lung nodules where detected, allowing in one of them a misdiagnosis of lung cancer. None of the patients referred exposure to asbestos fibers. We strongly suggest considering MPM among the differential diagnosis of spontaneous pneumothorax in elderly population. Moreover, in this setting, a main pathogenic involvement of the visceral pleura can be hypothesized.

KEY WORDS: Mesothelioma - Pneumothorax - Lung neoplasms