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Malignant Pleural Mesothelioma with Osteoblastic Heterologous Elements

CT and MR Imaging Findings

¹ Department of Radiology, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex, France.
² Department of Pathology, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, 28 Ave. Doyen Lépine, 69500 Bron-France.
³ Department of Radiology, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, 69500 Bron-France.

View larger version (99K): [in a new window]   Fig. 1A. —59-year-old man with malignant pleural mesothelioma with osteoblastic heterologous elements. Initial unenhanced CT scan (lung window setting) shows right focalized pleural thickening (long arrow) with no calcification. Air (short arrow) in pleural thickening is related to prior puncture.

View larger version (171K): [in a new window]   Fig. 1B. —59-year-old man with malignant pleural mesothelioma with osteoblastic heterologous elements. Photomicrograph of initial histologic specimen obtained from pleural biopsy using thoracoscopy shows biphasic pleural tumor with epithelial component (arrowhead) intermingled with spindle cells (arrow). (H and E, x40)

View larger version (140K): [in a new window]   Fig. 1C. —59-year-old man with malignant pleural mesothelioma with osteoblastic heterologous elements. Unenhanced CT scan (mediastinal window setting), obtained 3 years later at same level as A, shows increase in pleural thickening spreading into chest wall (arrow) associated with two coarse calcifications (arrowheads) that were situated close to mediastinal pleura and into right paratracheal space. These calcifications may be due to direct tumoral extension, because of their continuity with mass, although it is not possible to formally exclude enlarged calcified lymph node in region 4R.

View larger version (151K): [in a new window]   Fig. 1D. —59-year-old man with malignant pleural mesothelioma with osteoblastic heterologous elements. Unenhanced axial T1-weighted MR image displays chest wall and apical extension by tumor (arrow) and pleural calcifications with no signal (arrowheads).

View larger version (166K): [in a new window]   Fig. 1E. —59-year-old man with malignant pleural mesothelioma with osteoblastic heterologous elements. Unenhanced coronal short tau inversion-recovery MR image reveals calcified areas with no signal (arrow) and remainder of tumor with bright signal (arrowhead) spreading into chest wall and lung apex.

View larger version (196K): [in a new window]   Fig. 1F. —59-year-old man with malignant pleural mesothelioma with osteoblastic heterologous elements. Photomicrograph of histologic specimen obtained from pleural biopsy 3 years after B reveals highly malignant proliferation of poorly differentiated tumoral cells of epithelioid type with osteoid tissue (arrowhead). (H and E, x25)

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