Follow-up history: The patient was admitted on 1/26/98 to a nursing home for chest pain. CT on 1/8 showed an increased size of the tumor, which involved the interspaces between ribs 8 to12. Periaortic lymph nodes were enlarged. He was made comfortable and died on 3/9/98, about 6 years after diagnosis.

Postmortem findings: The right parietal pleura had several glistening, white plaques, and the cavity contained 1500 ml of serosanguineous fluid. The lung was slightly heavy (720 g) but showed no visible fibrosis. On the left, tumor surrounded the lung, was adherent to the pericardium, and involved lymph nodes.

This CT shows marked contracture of the left hemithorax. Bulky pleural tumor encases the lung, surrounds the aorta, and encroaches on the pericardium.

 

The lung was cut transversely in the CT plane. Tumor-filled, hilar lymph nodes (LN) are adjacent to the bronchus (B) and pulmonary artery (A). Tumor compresses and invades lung and is adherent to the pericardium.

 

Histologic changes: Mild interstitial fibrosis was present in the uninvolved right lung. An iron stain showed 5 ferruginous bodies in an area of 10 cm2, or 0.5 body/cm2, which confirms his history of occupational exposure to asbestos.

Discussion

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