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INTRODUCTION: We report a case of diffuse malignant pleural mesothelioma (DMPM) in a 68 years old male patient
who was admitted for right sited pleural effusion. The patient was treated by multimodality approach consisting in surgical
treatment with Extrapleural Pleuropneumonectomy followed by chemotherapy with Cisplatin and Pemetrexed. He
had a disease free period of one year and survived for 31 months.
CASE REPORT: The patient was admitted to our Institute for a right sited pleural effusion diagnosed on chest X ray.
Anamnesis revealed professional asbestos exposure and the patient presented dyspnea, dry cough, right sited chest pain,
low fever and loss of weight.
As thoracentesis and CT scan did not reveal pathological findings except of the effusion, we performed videothoracoscopy.
Several grey nodular lesions involving the costal, diaphragmatic and mediastinic parietal pleural sheets were found.
Histological examination of the specimens extracted revealed the presence of epithelial malignant pleural mesothelioma
with sarcomatoid areas. Further examinations staged the lesion as Butchart I. Extrapleural pleuropneumonectomy was
performed followed by a chemiotherapic treatment with Cisplatin and Pemetrexed. The patient underwent a follow up
program with CT scan every four months. The disease free period was of about one year and the patient died after 31
months from diagnosis for septic complications related to chronic effusion.
DISCUSSION: Single treatments do not demonstrate an acceptable efficacy on the treatment of DMPM. Multimodality
therapy provides good survival improvement and acceptable quality of life for the patients.