bims-mesote 2025-10-19 papers

Issue of 2025–10–19
four papers selected by
Laura Mannarino, Humanitas Research

Cureus. 2025 Sep;17(9): e92297

A Rare Clinical Presentation of Malignant Pleural Mesothelioma With Central Nervous System Metastases: A Case Report.

Magdalena A Miernik-Skrzypczak, Elwira Misztela-Lisiecka, Piotr Nowakowski, Anna Strozak, Grazyna Waska.

Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer arising from the pleural mesothelial cells, most often associated with long-term asbestos exposure. Symptoms are typically nonspecific, including shortness of breath, chest pain, and pleural effusion, which may delay diagnosis. We report a case of a 63-year-old woman with bilateral MPM and subsequent central nervous system (CNS) metastases. She received systemic chemotherapy with cisplatin and pemetrexed, achieving a partial radiological response. Several months after completing treatment, she developed neurological symptoms. Imaging revealed multiple CNS metastases. Palliative radiotherapy provided temporary control; however, her condition progressively deteriorated. This case illustrates an unusual presentation and metastatic pattern of MPM in a female patient, highlighting diagnostic and therapeutic challenges, as well as the aggressive nature of the disease despite palliative care.

Keywords: central nervous system metastases; malignant pleural mesothelioma; mesothelial neoplasm; palliative chemotherapy; palliative radiotherapy; pleural effusion; rare malignancy

DOI: https://doi.org/10.7759/cureus.92297

Cureus. 2025 Oct;17(10): e94484

Apical Malignant Pleural Mesothelioma Presenting as Horner's Syndrome: A Case Report.

Shruthi Mankal, Chris Jacobs.

Horner's syndrome is a well-recognized presentation of apical lung tumors, though rarely associated with malignant pleural mesothelioma (MPM), with only a few cases documented. We report the case of an 82-year-old man with persistent right-sided chest pain who developed unilateral right-sided ptosis, miosis and a sunken appearance to the eye, in the context of known asbestos exposure. Initial chest radiograph was reported as normal; however, subsequent computed tomography revealed an irregular right apical pleural mass measuring 7.0×4.3×7.5 cm. Biopsy with immunohistochemistry confirmed sarcomatoid MPM. This case report illustrates apical MPM mimicking Pancoast syndrome through compression of the upper thoracic sympathetic chain, resulting in preganglionic Horner's syndrome characterized by unilateral ptosis, miosis and anhidrosis ipsilateral to the lesion. In patients with known asbestos exposure, persistent respiratory symptoms should prompt a thorough investigation for MPM. The presence of preganglionic Horner's syndrome alone, or in combination with brachial plexopathy (arm pain, paresthesia or weakness, shoulder pain, or chest pain) - termed Pancoast syndrome, should heighten clinical suspicion of apical MPM. Cross-sectional imaging should be considered in all cases with a high index of suspicion, even if initial radiographs appear normal. Early recognition may facilitate timely diagnosis. This report contributes valuable insight to the limited literature documenting the association between apical MPM and pre-ganglionic Horner's syndrome.

Keywords: apical lung tumor; asbestos exposure; brachial plexopathy; horner’s syndrome; malignant pleural mesothelioma (mpm); pancoast syndrome

DOI: https://doi.org/10.7759/cureus.94484

Cancers (Basel). 2025 Sep 30. pii: 3199. [Epub ahead of print]17(19):

Perioperative Treatments in Pleural Mesothelioma: State of the Art and Future Directions.

Luigi Giovanni Cecchi, Marta Aliprandi, Fabio De Vincenzo, Matteo Perrino, Nadia Cordua, Federica Borea, Alessandro Bertocchi, Antonio Federico, Giuseppe Marulli, Armando Santoro, Giovanni Luca Ceresoli, Paolo Andrea Zucali.

Pleural Mesothelioma (PM) remains a challenging malignancy associated with asbestos exposure and characterized by poor prognosis. This review aims to consolidate recent findings on the efficacy of perioperative therapies encompassing chemotherapy, surgery, and emerging immunotherapy strategies. Current management strategies debate the role of surgery in early-stage patients, particularly due to the limited success of solitary treatment modalities and significant rates of postoperative complications. Retrospective studies indicate that multimodal treatment, incorporating surgical resection with perioperative chemotherapy, can enhance overall survival (OS), especially in favorable prognostic subsets. However, significant randomized trials, notably the MARS and MARS 2 trials, revealed that the addition of aggressive surgical strategies like extrapleural pneumonectomy (EPP) did not confer survival benefits and was accompanied by heightened morbidity. In light of persistent challenges, integrating perioperative chemotherapy-primarily with platinum-based regimens-has shown improved disease control outcomes. Neoadjuvant chemotherapy permits real-time assessment of tumor responsiveness, providing valuable clinical insights for surgical candidacy. The role of immunotherapy, particularly immune checkpoint inhibitors (ICIs), is also under active exploration, with preliminary results suggesting promising activity and manageable safety profiles. In conclusion, while current protocols primarily recommend surgery for a select group of patients, ongoing investigations into neoadjuvant approaches, adjuvant therapies, and novel immunotherapeutic strategies are crucial for developing effective, personalized treatment paradigms for PM. Future efforts should prioritize clinical trials that integrate these therapies within a structured multidisciplinary approach to optimize patient outcomes.

Keywords: peri-operative treatments; pleural mesothelioma; thoracic neoplasms

DOI: https://doi.org/10.3390/cancers17193199

Molecules. 2025 Sep 29. pii: 3922. [Epub ahead of print]30(19):

The Role of Breath Analysis in the Non-Invasive Early Diagnosis of Malignant Pleural Mesothelioma (MPM) and the Management of At-Risk Individuals.

Marirosa Nisi, Alessia Di Gilio, Jolanda Palmisani, Niccolò Varesano, Domenico Galetta, Annamaria Catino, Gianluigi de Gennaro.

Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy associated with occupational or environmental exposure to asbestos. Effective management of MPM remains challenging due to its prolonged latency period and the typically late onset of clinical symptoms. Accordingly, there is an increasing demand for the implementation of reliable, non-invasive, and data-driven diagnostic strategies within large-scale screening programs. In this context, the chemical profiling of volatile organic compounds (VOCs) in exhaled breath has recently gained recognition as a promising and non-invasive approach for the early detection of cancer, including MPM. Therefore, in this cross-sectional observational study, an overall number of 125 individuals, including 64 MPM patients and 61 healthy controls (HC), were enrolled. End-tidal breath fraction (EXP) was collected directly onto two-bed adsorbent cartridges by an automated sampling system and analyzed by thermal desorption-gas chromatography-mass spectrometry (TD-GC/MS). A machine learning approach based on a random forest (RF) algorithm and trained using a 10-fold cross-validation framework was applied to experimental data, yielding remarkable results (AUC = 86%). Fifteen VOCs reflecting key metabolic alterations characteristic of MPM pathophysiology were found to be able to discriminate between MPM and HC. Moreover, twenty breath samples from asymptomatic former asbestos-exposed (AEx) and eight MPM patients during follow-up (FUMPM) were exploratively analyzed, processed, and tested as blinded samples by the validated statistical method. Good agreement was found between model output and clinical information obtained by CT. These findings underscore the potential of breath VOC analysis as a non-invasive diagnostic approach for MPM and support its feasibility for longitudinal patient and at-risk subjects monitoring.

Keywords: MPM follow-up; VOCs; at-risk asbestos exposed subjects; biomarkers; breath analysis; diagnosis; malignant pleural mesothelioma

DOI: https://doi.org/10.3390/molecules30193922