Dual Malignancies Discovered: A Rare Case of Malignant Peritoneal Epithelioid Mesothelioma and Lung Adenocarcinoma.

Clinicians diagnosing malignant peritoneal epithelioid mesothelioma (MPM or MPeM) have historically had challenges due to the low incidence of the disease, as well as the often vague symptomatology that patients present with. Newer advances in technology, specifically in immunocytochemistry, have provided a clearer path to diagnosis. Additionally, malignant mesotheliomas must be differentiated from carcinomas. This is done via histology, immunocytochemistry, as well as a careful incorporation of the patient's clinical history. In this case, we present an asymptomatic 73-year-old non-smoker female with no past medical history of asbestos exposure. She was diagnosed with MPM following a routine abdominal hernia repair. Subsequent workup revealed a lung infiltrate that was successfully biopsied and resected, evidently found to be adenocarcinoma. A careful review of the resulting pathology, as well as the interpretation of immunocytochemistry, supported the notion that the patient had two independent malignant processes occurring at once. This case underscores the rarity of two similar, yet distinct cancers, as well as epidemiology, symptomatology, histology, immunocytochemistry, and prognosis.

Alloyed Airways: Chromium, Beryllium, and Titanium in the Lungs of an Aerospace Veteran.

Pneumoconiosis is a form of interstitial lung disease (ILD) that commonly occurs secondary to occupational or environmental exposures. This is an emerging disease as there are many potential forms of pathologic insults. Further adding to the complication is that clinical symptomatology secondary to pneumoconiosis can have long latent periods, as repetitive exposure over years leads to long-standing inflammation and subsequent irreversible damage. Exposure to asbestos, coal, silica, aluminum, talc, hay, and many more agents has the potential to cause pneumoconiosis. This case highlights a veteran, who made his career working with heavy metals such as chromium, beryllium, and titanium in the aerospace defense industry. This case discusses high-risk occupations, a workup for suspected pneumoconiosis, management, and the mechanism of lung injury underlying the three aforementioned pathologic agents. In each case of pneumoconiosis, a thorough history is essential, and diagnoses are made via the incorporation of the patient's historical risk factors, pulmonary function test (PFT) findings, and high-resolution chest computed tomography (HRCT).