Malignant Pleural Mesothelioma with Concurrent Pleural Plaques Following Occupational Asbestos Exposure: A Case Report

Chayuth Tangwiwat; Saleela  Wiwatniwong; Apichat  Suwanchanratsamee; Narongpon  Dumavibhat; Nisa  Muangman; Supakorn   Chansaengpetch

Authors

Chayuth Tangwiwat Division of Occupational Medicine, Saraburi Hospital
Saleela Wiwatniwong Division of Occupational Medicine, Saraburi Hospital
Apichat Suwanchanratsamee Department of Internal Medicine, Saraburi Hospital
Narongpon Dumavibhat Siriraj Tuberculosis Comprehensive Center, Siriraj Hospital, Mahidol University
Nisa Muangman Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University
Supakorn Chansaengpetch Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University

Keywords:

malignant mesothelioma, pleural plaque, asbestos-related disease, occupational disease, asbestos

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive neoplasm primarily associated with occupational asbestos exposure and typically manifests decades after initial contact. We report the case of a 73-year-old Thai male presented with non-productive cough, progressive dyspnea and left-sided pleuritic chest pain for 3 months. He underwent medical thoracoscopy with pleural biopsy and was diagnosed with malignant pleural mesothelioma with pulmonary metastases. The patient had a 39-year occupational history as an asbestos processing operator in a roof-tile factory and had ceased asbestos exposure for over 10 years before developing symptoms. Imaging demonstrated a pleural mass, loculated effusion, and multiple calcified pleural plaques, while histopathology and immunohistochemistry confirmed MPM. Despite chemotherapy, his condition deteriorated, leading to palliative care.
This case emphasizes the aggressive course of malignant pleural mesothelioma, the prolonged latency of asbestos-related disease, and illustrates that clinical manifestations can occur long after cessation of exposure. It highlights the urgent need for preventive policies, strict regulation of asbestos, and comprehensive occupational health strategies. Importantly, periodic health examinations and long-term surveillance of asbestos-exposed workers remain essential even after exposure cessation or retirement, to support early detection and strengthen preventive strategies.

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