Aisikaer A, Sun MM, Shen J. Positron emission tomography/computed tomography in risk-factor-negative young female with malignant pleural mesothelioma: A case report and review of literature. World J Clin Cases 2025; 13(32): 110897 [DOI: 10.12998/wjcc.v13.i32.110897]
Corresponding Author of This Article
Jie Shen, Chief, MD, PhD, Professor, Department of Nuclear Medicine, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. 5020200073@nankai.edu.cn
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Radiology, Nuclear Medicine & Medical Imaging
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 16, 2025 (publication date) through Nov 15, 2025
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World Journal of Clinical Cases
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2307-8960
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Aisikaer A, Sun MM, Shen J. Positron emission tomography/computed tomography in risk-factor-negative young female with malignant pleural mesothelioma: A case report and review of literature. World J Clin Cases 2025; 13(32): 110897 [DOI: 10.12998/wjcc.v13.i32.110897]
World J Clin Cases. Nov 16, 2025; 13(32): 110897 Published online Nov 16, 2025. doi: 10.12998/wjcc.v13.i32.110897
Positron emission tomography/computed tomography in risk-factor-negative young female with malignant pleural mesothelioma: A case report and review of literature
Aikedan Aisikaer, Mo-Mo Sun, Jie Shen
Aikedan Aisikaer, Mo-Mo Sun, Jie Shen, Department of Nuclear Medicine, Tianjin First Central Hospital, Tianjin 300192, China
Author contributions: Aisikaer A made the diagnosis, reviewed the literature and contributed to manuscript drafting; Sun MM made partial revisions to the manuscript; Shen J participated in the design of case report and was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by the Tianjin Science and Technology Project, No. TJWJ2025RC008.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jie Shen, Chief, MD, PhD, Professor, Department of Nuclear Medicine, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. 5020200073@nankai.edu.cn
Received: July 3, 2025 Revised: July 29, 2025 Accepted: September 17, 2025 Published online: November 16, 2025 Processing time: 134 Days and 18.5 Hours
Abstract
BACKGROUND
Malignant pleural mesothelioma (MPM), a rare aggressive malignancy, is primarily caused by asbestos exposure. MPM typically affects older adults (median age, 76 years), is uncommon in those under age 50 years and shows male predominance. Based on the American Society of Clinical Oncology guidelines, F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) is essential for initial MPM staging. Integrating quantitative FDG metabolic data with computed tomography (CT) anatomy optimizes biopsy accuracy and staging.
CASE SUMMARY
A 21-year-old female college student presented with fever (peak 38.4 °C), cough, and white mucoid sputum after cold exposure. Initial evaluation revealed elevated C-reactive protein [C-reactive protein (CRP); 65.52 mg/L] and Mycoplasma pneumoniae IgM. Despite resolution of fever following a 14-day moxifloxacin regimen, persistent cough prompted chest CT, which demonstrated left pleural mass-like thickenings. Levofloxacin therapy for 2 weeks failed to alleviate symptoms, accompanied by 2.5-kg weight loss over 1 month. Re-evaluation showed rising CRP (88.87 mg/L) with stable CT lesions, and negative T-cell spot test for tuberculosis and tumor markers. Contrast-enhanced CT revealed heterogeneously enhancing masses, while PET/CT detected two broad-based pleural lesions with intense FDG avidity. CT-guided biopsy confirmed epithelioid MPM. Thoracoscopy exposed diffuse fragile, hemorrhagic nodules implanting on diaphragmatic and parietal pleura, confirming metastatic MPM with partial resection performed. This presentation challenges conventional imaging paradigms of MPM, underscoring its diagnostic complexity.
CONCLUSION
MPM should still be considered an important differential diagnosis in young patients presenting with solitary pleural masses and no history of typical asbestos exposure. F-18 FDG PET/CT, while serving as an essential component of initial staging for MPM, has some inherent limitations.
Core Tip: In China, malignant pleural mesothelioma (MPM) is characterized by low definitive diagnosis rates and high misdiagnosis frequencies due to nonspecific clinical manifestations, epidemiological rarity and under-recognition in systemic diagnosis. We present a paradigmatic case of MPM in a young female patient without documented asbestos exposure, detected by F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT), but failed to demonstrate disseminated pleural micrometastases. This case challenges the conventional risk stratification paradigm (elderly/asbestos-exposed populations), reveals the technical limitations of F-18 FDG PET/CT in detecting localized lesions, and provides evidence-based impetus for enhancing diagnostic vigilance among clinicians and nuclear medicine specialists.
