Mesothelioma, A Most Difficult Diagnosis

Mesothelioma, A Most Difficult Diagnosis

A case published in the International Journal of Surgical Pathology is another example of how hard it can be to reach a mesothelioma diagnosis.

Mesothelioma is a rare type of cancer caused by asbestos exposure. Pleural mesothelioma develops in the lining of the lungs and chest wall. Signs and symptoms may include shortness of breath due to fluid around the lung, chest pain, cough, and fatigue.

A Difficult Diagnosis

In this case, a 93-year-old man went to the hospital because he was having trouble breathing. A CT scan showed doctors that the man had a hole in his lung that was causing air to leak out into the chest cavity. This is not a typical symptom of pleural mesothelioma.

To diagnose someone with pleural mesothelioma, doctors will usually run some type of scan on the chest. This could be an X-ray, a CT scan, or an MRI. These scans can show doctors where on the lungs the cancer might be growing.

Doctors may also run additional tests to diagnose pleural mesothelioma. They might test a patient’s blood for a specific protein called mesothelin. This test is 95% sensitive which makes it one of the most accurate blood tests available for mesothelioma.

Most Accurate Methods

The most accurate way to diagnose pleural mesothelioma is also the most invasive. Doctors will perform a tissue biopsy to take a small sample of the suspected cancer tissue for testing in a lab. The tissue that is examined during a biopsy will determine if the tumor is definitively mesothelioma or another form of cancer. In addition, a biopsy can indicate the stage of the disease and assist in determining the proper course of treatment.

For the elderly man in this case, doctors were able to collect a tissue sample when they were performing surgery to fix the hold in his lung. The biopsy testing showed the doctors that this man actually had pleural mesothelioma. The damage caused by the mesothelioma cells is probably what caused the hole in his lungs to form.

This interesting case highlights the importance of testing elderly patients who are having trouble breathing for pleural mesothelioma. The symptoms of this cancer aren’t always obvious and starting treatment early is the best way to improve prognosis.


Marshall T, Lane J, Lahorra J. A Rare Presentation of Minimally Invasive Mesothelioma as a Large Tension Pneumothorax [published online ahead of print, 2023 May 1]. Int J Surg Pathol. 2023;10668969231167492. doi:10.1177/10668969231167492. https://pubmed.ncbi.nlm.nih.gov/37128670/

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