Extrapleural Pneumonectomy for Pleural Mesothelioma: Case Report

Abstract

A 28-year-old female patient, with excellent performance status, presented with pain in the right hypochondrium. Computed tomography revealed pleural nodulations in the right hemithorax, without pleural effusion, and videopleuroscopy with biopsy demonstrated that it was a diffuse maline mesothelioma of the epithelioid type. PET-CT for staging showed disease limited to the right hemithorax, without involvement of mediastinal lymph nodes, with involvement of the parietal pleura, diaphragm and pericardium. We opted for trimodal treatment starting with chemotherapy based on pemetrexed and carboplatin. The patient then underwent a right extrapleural pneumonectomy with mediastinal lymphadenectomy, pericardiectomy and resection of the diaphragm, with reconstructions using bovine pericardium. The postoperative hospital stay was 10 days, due to a paralytic ileus. Subsequently, intensity modulated radiotherapy (IMRT) was performed on the right hemithorax. Twelve months after surgery, the control PET-CT demonstrated an area of high uptake corresponding to the bovine pericardium patch, suggesting a reactive inflammatory process. The choice of treatment involved a radical surgical approach (EPP) due to the patient’s good performance status and with the aim of a complete macroscopic resection. This case report demonstrates the complexity and personalization in the management of malignant pleural mesothelioma. Eight years after treatment, the patient has no evidence of recurrence of the disease and has even given birth to a child.