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PARIPEX - INDIAN JOURNAL OF RESEARCH Volume-8 | Issue-6 | June-2019 | PRINT ISSN No. 2250 - 1991 tumor in this case demonstrated positivity for both. Electron microscopy was used to suppor t the diagnosis, demonstrating that this often forgotten technology still has a use in securing the diagnosis where IHC is equivocal.

This case serves to highlight that the presenting clinical signs and symptoms, the location of the lesion, and the histop athologic features, can be unusual in MPM. Although MPM is rare underlying cause of spontaneous (hydro) pneumothorax, the possibility should be considered and actively investigated when the pneumothorax is associated with Figure 3 effusion, in an older patient, and where these is relevant occupational history. REFERENCES 1. Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003;58 Suppl 2:ii39-52. Epub Post-test 2003/05/03. PubMed PMID: 12728149; PubMed Central PMCID: Ÿ What are the causes of (hydro)pneumothorax? PMC1766020. 2. Steinhauslin CA, Cuttat JF. Spontaneous pneumothorax. A complication of lung cancer? Chest. 1985;88(5):709-13. Epub 1985/11/01. PubMed PMID: Pneumothoraces can be primary or secondary depending on 2996838. whether they are associated with underlying pathology. Most 3. Wu H, Tino G, Gannon FH, Kaiser LR, Pietra GG. Lepidic intrapulmonary are primary and spontaneous, occurring in younger men, and growth of malignant mesothelioma presenting as recurrent hydropneu mothorax. Human Pathology. 1996;27(9):989-92. Epub 1996/09/01. PubMed secondary causes include emphysema, asthma, cystic PMID: 8816899. fibrosis, or tuberculosis, and malignancy. Hydropneu 4. Guha K, Jones D, Hull JH, Ho TB. Recurrent hydropneumothorax as a mothorax is associated with primary lung malignancy, presenting feature of malignant mesothelioma. European Journal of Internal Medicine. 2008;19(1):63-4. Epub 2008/01/22. doi: 10.1016/j.ejim. 2007.03. trauma, bronchopleural fistula, infections, infarction, 010. PubMed PMID: 18206605. radiotherapy, and rheumatoid lung disease, but is only rarely 5. Sheard JD, Taylor W, Soorae A, Pearson MG. Pneumothorax and malignant described in association with MPM. mesothelioma in patients over the age of 40. Thorax. 1991;46(8):584-5. Epub 1991/08/01. PubMed PMID: 1926028; PubMed Central PMCID: PMC463282. 6. Alkhuja S, Miller A, Mastellone AJ, Markowitz S. Malignant pleural Ÿ What is the epidemiology and etiology of malignant mesothelioma presenting as spontaneous pneumothorax: a case series and pleural mesothelioma and why is this important? review. American Journal of Industrial Medicine. 2000;38(2):219-23. Epub 2000/07/14. PubMed PMID: 10893511. 7. Takeda T, Nishimura Y, Tsuchiya T, Nakata K, Takenaka K, Nakata H, et al. A MPM is primarily caused by occupational exposure to large abdominal wall mass as an initial manifestation of malignant asbestos and most commonly arises after a long latency mesothelioma. The American Journal of the Medical Sciences. 2007;333(4):218-20. Epub 2007/04/17. doi: 10.1097/MAJ.0b013e318039c7d1. period from pleural mesothelial cells, although it can arise PubMed PMID: 17435414. from other mesothelial surfaces such as the peritoneum. This 8. Maguire B, Whitaker D, Carrello S, Spagnolo D. Monoclonal antibody Ber-EP4: is important since the incidence is still rising from remote its use in the differential diagnosis of malignant mesothelioma and carcinoma in cell blocks of malignant effusions and FNA specimens. Diagnostic exposures from before young doctors were born, and Cytopathology. 1994;10(2):130-4. Epub 1994/01/01. PubMed PMID: 8187591. therefore vigilance and good occupational history taking is 9. Pu RT, Pang Y, Michael CW. Utility of WT-1, p63, MOC31, mesothelin, and required in order to raise the index of suspicion and ensure a cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in timely diagnosis. effusions. Diagnostic Cytopathology. 2008;36(1):20-5. Epub 2007/12/08. doi: 10.1002/dc.20747. PubMed PMID: 18064689. Figure legends Figure 1. Upright frontal chest radiograph demonstrating hydropneumothorax. Pleural edge (arrow A), air-fluid level (arrow B).

Figure 2. Axial contrast-enhanced CT of the upper abdomen demonstrating the large left chest flank mass (M).

Figure 3. Photomicrographs of: (A) H&E (x400) showing characteristic nests of malignant epithelioid cells with a hobnail pattern of growth; (B) calretinin positivity (x200); (C) WT1 positivity (x200); (D) patchy MOC31 positivity (x200); (E) patchy BerEP4 positivity (x200); (F) electron micrograph showing long slender microvilli on the surface of epithelial cells.

Figure 1

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