An 85 year old man presents with progressive dyspnea, fatigue and anorexia for three months. He also experienced pain in the lower right side of his chest during this time. He was a shipyard worker for 30 years, retiring at the age of 55. His medical history is unremarkable. There is no family history of lung disease.
There is a moderate pleural effusion in the right hemi-thorax.
Protein: 3.5 g/dL Pleu. fluid:Serum protein: 0.67 LDH: 240 IU/L Pleu. fluid:Serum LDH: 0.7 AFB: -ve IFN-gamma release test: -ve Gram stain & culture: -ve Cytology: +ve for malignant cells
A moderate right sided pleural effusion is noted. A nodular mass contiguous with the right parietal pleura is seen. There is no mediastinal lymphadenopathy.
Histology of the biopsy sample is suggestive of a malignant mesothelioma of the epithelioid type. There is no evidence of vascular or lymphatic invasion, and regional lymph nodes are negative for disease.