08-01-2007, 06:18 PM
A 55-year-old man presents with chest pain and shortness of breath. Initial workup for myocardial infarction is negative, but a peripheral lung mass with pleural effusion is noted on x-ray. With additional history, the patient reveals that he once installed asbestos tiles. A biopsy of the lesion and pleural fluid will likely show which of the following?
A. Bronchogenic adenocarcinoma
B. Bronchogenic squamous cell carcinoma
C. Chylothorax
D. Mesothelioma
E. Silicosis
The correct answer is D. Although squamous cell carcinoma and adenocarcinoma are more frequently associated with asbestos exposure, mesothelioma presents in the pleura. It occurs 20-25 years after exposure, and can occur following only minor exposure. It is not associated with smoking. Mesothelioma presents as chest pain and shortness of breath. The tumor arises from the mesothelial cells that line the pleural cavity, and thus chest radiographs reveal pleural thickening, pulmonary effusion, and a shrunken hemithorax. Needle biopsy will establish the diagnosis, and many modalities of therapy have been tried, but none has proven more effective than symptomatic care.
A. Bronchogenic adenocarcinoma
B. Bronchogenic squamous cell carcinoma
C. Chylothorax
D. Mesothelioma
E. Silicosis
The correct answer is D. Although squamous cell carcinoma and adenocarcinoma are more frequently associated with asbestos exposure, mesothelioma presents in the pleura. It occurs 20-25 years after exposure, and can occur following only minor exposure. It is not associated with smoking. Mesothelioma presents as chest pain and shortness of breath. The tumor arises from the mesothelial cells that line the pleural cavity, and thus chest radiographs reveal pleural thickening, pulmonary effusion, and a shrunken hemithorax. Needle biopsy will establish the diagnosis, and many modalities of therapy have been tried, but none has proven more effective than symptomatic care.