A 46-year-old female was admitted to our hospital due to diffuse swelling of the left chest wall. Contrast-enhanced chest computed tomography image revealed left pleural effusion with scattered pleural nodules, and diffuse swelling in the left chest wall. Medical thoracoscopy was done and showed the visceral pleura to be normal in appearance, and multiple nodules in the parietal pleura and diaphragm. Pathological examination by pleural biopsy revealed malignant cells, diagnosed as malignant mesothelioma epithelioid type. Echo-guided biopsy from the chest wall revealed malignant cells similar to pleural tumor cells, consistent with chest wall invasion by malignant mesothelioma. Therefore, we diagnosed her as having malignant pleural mesothelioma epithelioid type cT4N0M0 stage IV. We treated her with chemotherapy including cisplatin and pemetrexed, her condition improved, and we judged this to be a partial response. She died from progressive disease 5 years and 4 months after diagnosis.
Malignant pleural mesothelioma should be considered in the differential diagnosis of patients with swelling of the chest wall.