Pérez-Guzmán C, Barrera-Rodríguez R, Portilla-Segura J
Hospital General Tercer Milenio. Instituto de Salud del Estado de Aguascalientes, Av. Siglo XXI s/n Col. Satélite Morelos, Aguascalientes 20140, México.
Depto. de Bioquímica y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias-SSA, Clza. Tlalpan, 4502, Col Sec. XVI. México, D.F., 14080, México.
Respir Med Case Rep. 2016 Jan 20;17:57-60. doi: 10.1016/j.rmcr.2016.01.005. eCollection 2016.
Malignant pleural mesothelioma is a rare, invasive and often fatal neoplasm that develops in the thin layer of tissue surrounding the lungs known as the pleura. Although rare, mesotheliomas do occur in the young; their characteristics are distinct from those of older patients.
This is a case report of a 17-year-old boy who had moderate dyspnea, cough, right-sided pleuritic chest pain, fever, headache and no weight loss. Physical examination showed a right pleural effusion and chest roentgenograms revealed a homogenous opacity on lower right hemithorax. Biochemical analysis of pleural fluid showed hemorrhagic/turbid effusion compatible with exudate. It was initially treated as an empyema. The pleural fluid culture was negative. Adenosine deaminase level was 34.3 U/L (admission) and 19.02 U/L (two weeks after). Pleural fluid smear and culture for Mtb were negative. During the open pleural biopsy, thickened pleura and multiple pale yellow nodules in the lung were observed. The histopathological report was compatible with malignant pleural mesothelioma. With this diagnosis, a chemotherapy regimen with cisplatin was initiated. After two cycles, the patient had no clinical and radiological improvement. The patient is currently under regular follow up.
MPM is rare in young adults and its clinical presentation makes it different from mesothelioma in elderly patients, so it will be necessary to identify the new risk factors that can identify these patients.
恶性胸膜间皮瘤是一种罕见、侵袭性且往往致命的肿瘤，发生于围绕肺部的薄层组织即胸膜中。尽管罕见，但间皮瘤确实会在年轻人中出现；其特征与老年患者不同。
本文报告一名17岁男孩，有中度呼吸困难、咳嗽、右侧胸膜炎性胸痛、发热、头痛，无体重减轻。体格检查显示右侧胸腔积液，胸部X线片显示右下胸部有均匀的不透光区。胸腔积液生化分析显示为血性/浑浊积液，符合渗出液。最初按脓胸治疗。胸腔积液培养为阴性。腺苷脱氨酶水平入院时为34.3 U/L，两周后为19.02 U/L。结核分枝杆菌胸腔积液涂片及培养均为阴性。在开放性胸膜活检时，观察到胸膜增厚及肺内多个淡黄色结节。组织病理学报告符合恶性胸膜间皮瘤。基于此诊断，开始使用顺铂的化疗方案。两个周期后，患者在临床和影像学上均无改善。患者目前正在接受定期随访。
恶性胸膜间皮瘤在年轻人中罕见，其临床表现与老年患者的间皮瘤不同，因此有必要确定可识别这些患者的新危险因素。
