title: FISH analysis of intrapulmonary malignant mesothelioma without a clinically detectable primary pleural lesion: an autopsy case.
abstract: Patients with malignant mesothelioma typically present with a pleural effusion or pleural thickening and masses. A rare autopsy case of mesothelioma presenting with multiple bilateral lung nodules without clinically detectable pleural lesions is presented. A definitive diagnosis of the video-assisted thoracic surgery specimen could not be made, though a pattern of fibrosis mimicking organizing pneumonia was identified. Despite corticosteroid therapy, follow-up chest computed tomography showed enlargement of multiple nodules accompanied by the appearance of pleural thickening and effusions. The patient died of respiratory failure 11 months after initial presentation. Autopsy and retrospective analysis of the video-assisted thoracic surgery specimen using a p16 fluorescence in situ hybridization assay showed p16 homozygous deletion. The final diagnosis was sarcomatoid mesothelioma, and the lung nodules were intrapulmonary metastases from a clinically undetectable pleural sarcomatoid mesothelioma. It is important both to consider the possibility of mesothelioma with unusual clinical, radiological and pathological presentations and to remember that p16 fluorescence in situ hybridization analysis can play an important role in the diagnosis of mesothelioma.
authors.affiliation: Department of Respiratory Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka hasemizue@yahoo.co.jp.
authors.forename: Mizue
authors.initials: M
authors.lastname: Hasegawa
authors.affiliation: Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka.
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Sakai
authors.affiliation: Department of Respiratory Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo.
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Sato
authors.affiliation: Department of Respiratory Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo.
authors.forename: Sayuri
authors.initials: S
authors.lastname: Tsubomizu
authors.affiliation: Department of Respiratory Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo.
authors.forename: Ken
authors.initials: K
authors.lastname: Arimura
authors.affiliation: Department of Respiratory Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo.
authors.forename: Hideki
authors.initials: H
authors.lastname: Katsura
authors.affiliation: Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo.
authors.forename: Eitetsu
authors.initials: E
authors.lastname: Koh
authors.affiliation: Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sekine
authors.affiliation: Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan.
authors.forename: Di
authors.initials: D
authors.lastname: Wu
authors.affiliation: Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hiroshima
mesh_terms: D000368:Aged; D001344:Autopsy; D003937:Diagnosis, Differential; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008654:Mesothelioma / Q000473:pathology*; D000086002:Mesothelioma, Malignant; D010997:Pleural Neoplasms / Q000473:pathology*; D014057:Tomography, X-Ray Computed
keywords: fluorescence; genes; in situ hybridization; mesothelioma; neoplasm metastasis; p16