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Annual Congress of Malaysian Thoracic Society
PP 16
A Case of Malignant Mesothelioma Diagnosed via Pleuroscopy
Arfian Ibrahim 1 , Razul Kassim 1 , Jafaar Sadeq 2 , Kunji Kannan 1 , Jamalul Azizi 1
1
Department of Respiratory Medicine, 2 Department of Pathology, Queen Elizabeth Hospital,
Kota Kinabalu, Sabah, Malaysia
Introduction:
Diagnosis and treatment of malignant pleural mesothelioma (MPM) is difficult. Pleural effusion or pleural
thickening on plain chest x-ray is frequently observed in patients with MPM.
Case description:
We describe a 59 year old lady who was referred from a district hospital for a recurrent right pleural effusion
associated with loss of weight and haemoptysis of two months’ duration. She has a history of right breast
mastectomy for malignancy in 1980. Pleural tap revealed straw coloured exudative fluid. CT scan thorax
was reported as metastatic breast malignancy involving the lung, pleura, liver, spleen, adrenal and bones.
Pleuroscopy revealed multiple nodules over the parietal surface and on the diaphragm. Biopsy showed
multiple fragments of malignant tumor which tested positive for CK 116, CK5-6, vimentin and CK7. These
findings were consistent with diffuse mesothelioma (epithelioid variant).
Discussion
Tissue diagnosis is essential for accurate diagnosis as illustrated in this case. Her previous history of
breast malignancy was a ‘red herring’. Exudative pleural effusion in Sabah has always been thought to be
predominantly due to tuberculosis leading to empirical anti-TB treatment. Pleuroscopy ensures adequate
tissue since biopsy is performed under direct vision (unlike Abrams needle closed blind pleural biopsy).
Adequate tissue is essential for immunohistochemical examination.
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