Ahmad Zaheer, Jehanzeb Hashir, Hussain Saad Noor, Umar M, Saleem Humna
Department of Pulmonology, Lady Reading Hospital, Peshawar, Pakistan.
Khyber Medical College, Peshawar, Pakistan.
J Med Case Rep. 2025 Jan 20;19(1):25. doi: 10.1186/s13256-024-04949-7.
Malignant mesotheliomas are aggressive forms of tumors arising from mesothelial cells. The most common type is malignant pleural mesothelioma, which progresses rapidly and leads to pleural effusion. It typically affects older men and is strongly associated with asbestos exposure. However, a few studies have reported cases of malignant pleural mesothelioma resulting from non-asbestos factors, including radiotherapy for breast cancer, viruses, chronic inflammation, and BRCA1-associated protein-1-associated genetic mutations. Breast cancer is the most common sporadic cancer among women, and a small percentage of cases are related to genetic factors, such as BRCA1/2 and BRCA1-associated protein-1 mutations. While breast cancer can be linked with other primary malignancies through germline mutations, the synchronous occurrence of breast cancer with pleural mesothelioma is extremely rare.
We present the case of a 40-year-old Pashtun woman diagnosed with primary breast cancer. She underwent surgery followed by chemotherapy (paclitaxel). During chemotherapy, she developed right-sided chest pain and dyspnea. A computed tomography scan revealed pleural thickening, and a pleural biopsy confirmed the diagnosis of malignant pleural mesothelioma, with positive results for the diagnostic markers WT1 and D240.
This case represents a rare occurrence of synchronous breast cancer and pleural mesothelioma in a 40-year-old female, and is the first case reported in Khyber Pakhtunkhwa, Pakistan. These findings demonstrate the importance of comprehensive diagnostic testing and the potential role of genetic mutations in concurrent cancers. The challenge of simultaneously treating these cancers highlights the need for further research and the importance of multidisciplinary approaches.
恶性间皮瘤是起源于间皮细胞的侵袭性肿瘤形式。最常见的类型是恶性胸膜间皮瘤，其进展迅速并导致胸腔积液。它通常影响老年男性，且与石棉暴露密切相关。然而，一些研究报告了由非石棉因素导致的恶性胸膜间皮瘤病例，包括乳腺癌放疗、病毒、慢性炎症以及与BRCA1相关蛋白-1相关的基因突变。乳腺癌是女性中最常见的散发性癌症，一小部分病例与遗传因素有关，如BRCA1/2和BRCA1相关蛋白-1突变。虽然乳腺癌可通过种系突变与其他原发性恶性肿瘤相关联，但乳腺癌与胸膜间皮瘤同时发生极为罕见。
我们报告一例40岁的普什图族女性被诊断为原发性乳腺癌的病例。她接受了手术，随后进行化疗（紫杉醇）。化疗期间，她出现右侧胸痛和呼吸困难。计算机断层扫描显示胸膜增厚，胸膜活检确诊为恶性胸膜间皮瘤，诊断标志物WT1和D240呈阳性。
该病例代表了一名40岁女性罕见地同时发生乳腺癌和胸膜间皮瘤，且是巴基斯坦开伯尔-普赫图赫瓦省报道的首例病例。这些发现证明了全面诊断检测的重要性以及基因突变在并发癌症中的潜在作用。同时治疗这些癌症的挑战凸显了进一步研究的必要性以及多学科方法的重要性。
