Tuberc Respir Dis.  2009 Oct;67(4):369-373.

Malignant Mesothelioma Presenting as Large Neck Mass

• Lee BY
• Kim HS
• Song KS
• Cho SM
• Lee KH
• Choi JE
• Lee SH
• Moon HS
• Kang JY
• Kang HH
• Min KO

Abstract

Malignant mesothelioma is the most common primary malignant tumor involving pleura, but its diagnosis is difficult to determine by pathology in addition to the fact that it is rare. We present an unusual case of malignant mesothelioma, which initially presented as large neck mass contrary to the more common presentation of a rind like growth along the pleura demonstrated on imaging and by pathologic findings.

Keyword

Mesothelioma; Neck; Pleura

MeSH Terms

Mesothelioma
Neck
Pleura

Figure

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  Figure 1 Images of malignant mesothelioma. Chest radiography (A) shows large soft tissue mass (☆) in right lower neck and right apex and small pleural effusion (arrow) in right costophrenic sulcus. There is no definite displacement or destruction of rib and contracture of right hemithorax. Contrast enhanced coronal CT image (B) reveals large muscle density malignant mesothelioma (☆) in right lower neck and right apex through rib cages. Mild pleural thickening (arrow head) and small pleural effusion (arrow) are also seen. The mass (☆) shows iso-signal intensity on T1 weighted axial MR image (C) and high signal intensity on T2 weighted image (D) with good contrast enhancement on coronal T1 weighted image (E). Soft tissue contrast between tumor and adjacent soft tissue is superior in MR than CT. Coronal PET image (F) reveals the intense uptake (SUV=9.6) of large malignant mass (☆) and small pleural nodules (arrow heads). SUV: standardized uptake valve.

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  Figure 2 Histology of malignant mesothelioma. The tumor is composed of diffuse asheets of round to polygonal cells (H&E stain, ×200) (A). Immunohistochemical stains by CK 5/6 (B) and calretinin (C) show strong and diffuse cytoplasmic immunoreactivity in the tumor cells.

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  Figure 3 Follow up chest radiograph after 19 months shows regression of large neck mass and bilateral pleural effusions (arrows).

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