Diagnosis of a Pleural Mesothelioma by Transbronchial Needle Aspiration/Biopsy of a Mediastinal Lymph Node

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Clinically documented distant metastases are very rare in mesothelioma and tend to occur late in the course of the disease, well after the diagnosis has been made. In this case, diagnosis was not made until a metastatic deposit was identified microscopically in the enlarged mediastinal lymph node by transbronchial needle biopsy. A 68-year-old woman with no definite history of occupational asbestos exposure and no history of smoking, presented with chest pain, pleural effusion, and mediastinal lymphadenopathy. The thoracentesis was nondiagnostic. Surprisingly, the cytologic examination of material obtained by transbronchial needle aspiration (TBNA) from the mediastinal lymph node through the flexible bronchoscope revealed malignant mesothelioma. This was confirmed on histology. This is the first case in which mesothelioma was diagnosed by TBNA from mediastinal lymph node through the fiberoptic bronchoscope. Perhaps it is important to remind that when confronted with mediastinal lymph nodes involved by tumor, the possibility of mesothelioma should be included in the differential diagnosis.

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