A Cace of Diffuse Pleural Mesothelioma Demonstrated Multiple Nodularities on Chest Roentgenogram

A 59-year-old man was hospitalized complaining of pain in chest and shoulder with some weightloss of two months' duration. Physical examination revealed dullness to percussion and decreased breath sounds in right lower lung field. Chest roentgenograms showed the multiple nodular densitres in the right hemithorax and irregularly thickened pleura extended over the right hemidiaphragm. Laminograms demonstrated these tumor masses were in periphery with extrapulmonary nature or entrapped in the interlobar fissure. The aspiration biopsy of mass was read as adenocarcinoma and showed the negative alcian Blue-PAS reaction. The patient became progressively weaker and died 4 months after admission. At antopsy, entire right pleural space was involved with yellow-white, fleshy tumor tissue, most severely involved in the diaphragmatic and costal surface of the lower lobe. On cut-section, there was a large semispherical tumor mass on the diaphragmatic surface and spread of the tumor involved the costal, diaphragmatic and interlobar pleura. The diaphragm had been penetrated, and tumor was present over the peritoneum and especially over the omentum. Microscopic examination showed the characteristic apperance of mesothelioma as described elsewhere. There were areas shown glandnlar, tubular or tubulopapillary pattern with well-defined epithelial cells that graded gradually fibrosarcomatous areas.