CRA26 RARE PRESENTATION OF SVC OBSTRUCTION AND AIRWAY INVOLVEMENT IN MALIGNANT MESOTHELIOMA AT YOUNG AGE

Amar Izzuddin Roslan
Universiti Putra Malaysia, Serdang, Malaysia
Amar Izzudin Roslan1, Ummi Nadira Daut1, Arvindran Alaga2, Chan Tha A. Hing2
1Universiti Putra Malaysia 2Respiratory Department, Hospital Sultanah Bahiyah

Introduction

Mesothelioma is an infrequent but highly aggressive tumour that typically appears in individuals aged 40–50 years or older, with over 80% of cases linked to asbestos exposure.  No previous cases have reported pleural mesothelioma presenting with symptoms of superior vena cava obstruction.

Case report

A 31-year-old man, non-smoker with no history of asbestos exposure, was referred to our centre with months of chronic coughing and weeks of increasing neck swelling. Radiological imaging revealed a massive pleural effusion. Pleural fluid cytology confirmed a diagnosis of primary malignant mesothelioma. Bronchoscopy showed airway involvement, and histopathological examination confirmed a similar diagnosis. The patient’s condition worsened, with increasing dyspnea complicated by superior vena cava obstruction. Contrasted computed tomography of the thorax revealed tumour infiltration from the mediastinal pleura, compressing the superior vena cava, along with extensive venous thrombosis as well as bone metastasis. His symptoms were slightly improved with dexamethasone. Radiotherapy or stenting were not possible due to the extensive thrombosis. Thus, he was scheduled for palliative chemotherapy. Unfortunately, his condition deteriorated rapidly, and he succumbed to death within two months of his initial presentation and diagnosis.

Conclusion

Malignant mesothelioma is typically diagnosed after the 40s and often presents with pleural effusion, and some with pneumothorax. This young patient presented with superior vena cava obstruction as the initial symptom, which is exceptionally rare. This underscores the importance of good clinical judgement, as malignant mesothelioma has a slow progression but is highly aggressive, with a high mortality rate and less than 12 months of survival time.