A 100 year old female presented to her GP with shortness of breath. Chest x-ray revealed a right-sided pleural effusion of unknown etiology.
Of note initial imaging prior to further investigation was felt to be consistent with pleural mice.
A pleural drain was inserted. Pleural fluid was consistent with exudate. Microscopy showed isolated mesothelial cells, macrophages and numerous lymphocytes. Findings were negative for pulmonary malignancy and non-specific.
The lesion between the 9th and 10th ribs was biopsied.
Histology results were: fibrous tissue consistent with pleura, infiltrated by a sarcomatoid neoplasm. The tumor consists of a haphazard proliferation of variably elongated plump spindle cells with large, markedly pleomorphic nuclei showing hyperchromasia and prominent nucleoli.
History, imaging and histopathology were all indicative of sarcomatoid mesothelioma.