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A diagnostic thoracentesis was performed and on the 5th hospital day a chest drain was inserted in the right pleural cavity due to progression of the pleural effusion&#44; occupying more than one-half of the right hemithorax&#46; Macroscopically the pleural fluid was serous fluid and further analysis revealed a predominance of neutrophils &#40;44&#37;&#41; with 38&#37; lymphocytes&#44; negative culture&#44; a pH of 7&#46;71&#44; low adenosine desaminase &#40;15&#46;5<span class="elsevierStyleHsp" style=""></span>U&#47;L&#41;&#44; high LDH &#40;1359<span class="elsevierStyleHsp" style=""></span>U&#47;L&#41; and negative cytology for tumor cells&#46; A total of 2500<span class="elsevierStyleHsp" style=""></span>cc of pleural fluid was drained over 9 days&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Blood cultures and urinary antigen tests for <span class="elsevierStyleItalic">Streptococcus pneumonia</span> and <span class="elsevierStyleItalic">Legionella pneumophila</span> serogroup 1 were negative&#46; Tumor markers CYFRA 21&#46;1&#44; SCC&#44; CA 125 and CA 15&#46;3 were elevated&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Chest computed tomography &#40;CT&#41; revealed parenchymal inflammatory densification areas with air-bronchogram in the right upper lobe&#44; middle lobe and left lower lobe&#44; right hilar adenopathies&#44; right organized pleural effusion and a nodular lesion with 5&#46;8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>3&#46;3<span class="elsevierStyleHsp" style=""></span>cm in the right costophrenic sulcus invading the 8th rib and thoracic wall with pleural origin&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Fiberoptic bronchoscopy showed no endobronchial changes&#46; Tracheo-bronchial aspirate cultures were negative&#46; Abdominal ultrasound was also normal&#46; Positron emission tomography&#47;computed tomography &#40;PET&#47;CT&#41; demonstrated an extensive right pleural hypermetabolic involvement with high probability of malignancy&#44; a mass in the postero-inferior area which invaded the adjacent thoracic wall &#40;mean and maximum standardized uptake value &#8211; SUV &#8211; 15 and 22&#44; respectively&#41;&#44; a suspicious homolateral pleural effusion and secondary mediastinal and bronchohilar lymph node involvement &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Transthoracic pleural mass biopsy was performed&#46; Light microscopic findings showed malignant discohesive large epithelioid cells with eosinophilic cytoplasm and large round nuclei &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; These cells showed cytokeratin 7 cytoplasmic positivity as well as nuclear and cytoplasmic positivity for calretinin &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41; and nuclear p53 positivity&#46; Therefore&#44; deciduoid pleural mesothelioma was diagnosed&#46; Staging according to International Mesothelioma Interest Group &#40;IMIG&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> was T3 N2 M0 &#40;Stage III&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Chemotherapy was started with cisplatin and pemetrexed&#46; After 3 cycles of chemotherapy&#44; reevaluation PET&#47;CT showed progressive chest wall involvement but no extrathoracic metastasis&#46; The patient was accepted for radical surgery&#44; which included right extra pleural pneumonectomy &#40;EPP&#41; with resection of the 5th&#44; 7th and 8th ribs&#46; In the surgical specimen the diagnosis was confirmed morphologically after observation of multiple sections of an extensive lung-encasing yellowish tumor&#44; maintaining the pattern previously observed&#46; The patient died postoperatively&#44; on the second day&#44; of multi-organ failure&#44; 3 months after the initial diagnosis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Malignant deciduoid mesothelioma is a very rare variant of epithelioid mesothelioma&#44; accounting for less than 5&#37; of mesotheliomas<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and according to another author for less than 2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Talerman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1985 were the first to describe the deciduoid aspects of malignant mesothelioma in the peritoneum of a 13-year-old girl&#46; In 1994 Nascimento et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> reported a case of a peritoneal lesion in a young woman with morphological features similar to Talerman&#39;s description and named it deciduoid mesothelioma&#46; Based on early descriptions&#44; this variant was considered to be restricted to the peritoneum of young women with no history of asbestos exposure&#46; However&#44; later reports have also shown its presence in the pleura and pericardium in elderly people&#44; both female and male&#44; and sometimes in association with asbestos exposure&#46; In the case described the patient had no history of asbestos exposure&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Some cases of malignant deciduoid mesothelioma&#44; in the pleura and peritoneum&#44; diagnosed during pregnancy have been reported&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8</span></a> and a case in the peritoneum of a woman 6 weeks after a cesarean delivery was also described&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> this latter one misinterpreted as pseudotumoral deciduosis&#46; Our case also occurred 2 weeks after a cesarean delivery&#46; It is difficult however to establish a relationship between sex hormones and deciduoid occurrence&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">As far as we know&#44; only 45 cases have been reported in the literature&#44; 22 of those described were in the pleural cavity&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Twenty-six out of the 45 cases were female&#46; Ages have ranged between 13 and 78 years &#40;mean 51 years&#41;&#46; Exposure to asbestos was documented in only 15 cases&#44; with a mean age of onset of 59&#46;1 years&#44; as opposed to 47&#46;7 years of those cases with no documented exposure to asbestos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This variant of epithelioid mesothelioma is characterized by its unique morphology&#46; It is composed of a proliferation of large round cells&#44; abundant eosinophilic cytoplasm&#44; deciduoid features and round vesicular nuclei&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Immunohistochemical data are useful in differentiating mesotheliomas from adenocarcinomas&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In the case that described deciduoid mesothelioma clearly expressed calretinin&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Several features described in patients with deciduoid mesothelioma are worth mentioning&#46; The number of cases found in the pleura and in the peritoneum is balanced whereas mesothelioma in general is about 4 times more common in the pleura&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> There is a preponderance of females in deciduoid mesothelioma as opposed to the slight male predominance in mesothelioma in general&#46; The number of young patients is significant &#40;&#60;40 years&#41; in this variant of mesothelioma&#44; such as the patient described&#44; in contrast to the older age of patients with mesothelioma in general&#46; Another characteristic is the lower rate of asbestos exposure in deciduoid mesothelioma&#46; All these differences suggest that deciduoid mesothelioma may be a clinically and pathologically distinct variant&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The best treatment option for mesothelioma is still a matter of debate and a challenge&#46; Several studies have reported good results with EPP together with neo- or adjuvant chemotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;15</span></a> However the benefit of this multimodality therapy may have been overestimated and it should be noted that EPP is a complex procedure associated with high morbidity and mortality even during the peri-operative period&#44; as in this case&#46; In fact&#44; some retrospective studies suggest that EPP offers no advantage over less radical surgical procedures such as pleurectomy and decortication<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;20</span></a> that have proven effectiveness as palliative measures&#46; Hemithoracic radiotherapy after EPP has been suggested but its role needs further evaluation&#46; Intrapleural or local therapies&#44; such as photodynamic therapy&#44; hyperthermic intrapleural chemotherapy and immunotherapy&#44; were designed to attack microscopic residual disease after surgery&#46; However&#44; all these modalities need further refinement&#46; Randomized trials have shown that systemic chemotherapy is the only type of treatment to increase survival&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Our patient was started on cisplatin and pemetrexed&#44; the standard care in the systemic therapy of mesothelioma&#44; followed by surgical resection but died postoperatively&#46; The cause of death was not determined&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The clinical outcome of malignant deciduoid mesothelioma is usually poor and 68&#37; of the patients die within 1 year after starting treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However there are reported cases of patients with deciduoid mesothelioma who have survived much longer<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a> challenging the inevitability of a poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> More systematic studies and case reports are necessary to give a clearer picture of this variant&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In conclusion&#44; we describe a case of deciduoid pleural mesothelioma in a 40-year-old-woman with clinical presentation 2 weeks after a cesarean delivery and with no known asbestos exposure&#46; We want to highlight the rarity of this variant&#44; the fact that this case is the first reported in Portugal&#44; the role of pathology in its diagnosis&#44; the features that distinguish deciduoid mesothelioma from mesothelioma in general and discuss the available treatment options&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma&#59; it was initially thought that it only occurred in the peritoneum of young women and had nothing to do with asbestos exposure&#46; However&#44; since these early findings it has also been observed in the pleura and the pericardium&#44; with possible association to asbestos&#46; In general the prognosis is poor compared to epithelioid mesothelioma&#46; 45 cases have been reported in the literature up to now&#44; 22 of these were located in the pleural cavity&#46; The authors describe a case of deciduoid pleural mesothelioma in a 40-year-old-woman who presented with right pleuritic chest pain&#44; with no history of asbestos exposure&#44; treated with chemotherapy followed by surgery and who died postoperatively&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O Mesotelioma Decidu&#243;ide &#233; um subtipo raro de mesotelioma epiteli&#243;ide&#44; inicialmente encontrado apenas no peritoneu de mulheres jovens&#44; sem rela&#231;&#227;o com exposi&#231;&#227;o a asbestos&#46; No entanto&#44; desde as primeiras descri&#231;&#245;es tem sido igualmente diagnosticado na pleura e no peric&#225;rdio e pode estar associado aos asbestos&#46; De um modo geral tem pior progn&#243;stico quando comparado com o mesotelioma epiteli&#243;ide&#46; H&#225; apenas 45 casos descritos na literatura at&#233; &#224; data&#44; 22 destes localizados na cavidade pleural&#46; Os autores descrevem um caso de mesotelioma decidu&#243;ide pleural numa mulher de 40 anos com toracalgia pleur&#237;tica direita&#44; sem hist&#243;ria de exposi&#231;&#227;o aos asbestos&#44; submetida a quimioterapia seguida de ressec&#231;&#227;o cir&#250;rgica&#44; que veio a falecer no p&#243;s-operat&#243;rio&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Santos C&#44; et al&#46; Mesotelioma decidu&#243;ide pleural &#8211; uma entidade rara numa mulher jovem&#46; Rev Port Pneumol&#46; 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.rppneu.2012.02.004">doi&#58;10&#46;1016&#47;j&#46;rppneu&#46;2012&#46;02&#46;004</span>&#46;</p>"
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Case report
Deciduoid pleural mesothelioma – A rare entity in a young woman
Mesotelioma deciduóide pleural – uma entidade rara numa mulher jovem
C. Santosa,
Corresponding author
claudiaraimundo80@gmail.com

Corresponding author.
, F. Gamboaa, F. Fradinhoa, A. Pêgoa, L. Carvalhob, J. Bernardoc
a Pulmonology Department, Coimbra University Hospital, Coimbra, Portugal
b Pathology Department, Coimbra University Hospital, Coimbra, Portugal
c Cardiothoracic Surgery Department, Coimbra University Hospital, Coimbra, Portugal
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A diagnostic thoracentesis was performed and on the 5th hospital day a chest drain was inserted in the right pleural cavity due to progression of the pleural effusion&#44; occupying more than one-half of the right hemithorax&#46; Macroscopically the pleural fluid was serous fluid and further analysis revealed a predominance of neutrophils &#40;44&#37;&#41; with 38&#37; lymphocytes&#44; negative culture&#44; a pH of 7&#46;71&#44; low adenosine desaminase &#40;15&#46;5<span class="elsevierStyleHsp" style=""></span>U&#47;L&#41;&#44; high LDH &#40;1359<span class="elsevierStyleHsp" style=""></span>U&#47;L&#41; and negative cytology for tumor cells&#46; A total of 2500<span class="elsevierStyleHsp" style=""></span>cc of pleural fluid was drained over 9 days&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Blood cultures and urinary antigen tests for <span class="elsevierStyleItalic">Streptococcus pneumonia</span> and <span class="elsevierStyleItalic">Legionella pneumophila</span> serogroup 1 were negative&#46; Tumor markers CYFRA 21&#46;1&#44; SCC&#44; CA 125 and CA 15&#46;3 were elevated&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Chest computed tomography &#40;CT&#41; revealed parenchymal inflammatory densification areas with air-bronchogram in the right upper lobe&#44; middle lobe and left lower lobe&#44; right hilar adenopathies&#44; right organized pleural effusion and a nodular lesion with 5&#46;8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>3&#46;3<span class="elsevierStyleHsp" style=""></span>cm in the right costophrenic sulcus invading the 8th rib and thoracic wall with pleural origin&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Fiberoptic bronchoscopy showed no endobronchial changes&#46; Tracheo-bronchial aspirate cultures were negative&#46; Abdominal ultrasound was also normal&#46; Positron emission tomography&#47;computed tomography &#40;PET&#47;CT&#41; demonstrated an extensive right pleural hypermetabolic involvement with high probability of malignancy&#44; a mass in the postero-inferior area which invaded the adjacent thoracic wall &#40;mean and maximum standardized uptake value &#8211; SUV &#8211; 15 and 22&#44; respectively&#41;&#44; a suspicious homolateral pleural effusion and secondary mediastinal and bronchohilar lymph node involvement &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Transthoracic pleural mass biopsy was performed&#46; Light microscopic findings showed malignant discohesive large epithelioid cells with eosinophilic cytoplasm and large round nuclei &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; These cells showed cytokeratin 7 cytoplasmic positivity as well as nuclear and cytoplasmic positivity for calretinin &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41; and nuclear p53 positivity&#46; Therefore&#44; deciduoid pleural mesothelioma was diagnosed&#46; Staging according to International Mesothelioma Interest Group &#40;IMIG&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> was T3 N2 M0 &#40;Stage III&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Chemotherapy was started with cisplatin and pemetrexed&#46; After 3 cycles of chemotherapy&#44; reevaluation PET&#47;CT showed progressive chest wall involvement but no extrathoracic metastasis&#46; The patient was accepted for radical surgery&#44; which included right extra pleural pneumonectomy &#40;EPP&#41; with resection of the 5th&#44; 7th and 8th ribs&#46; In the surgical specimen the diagnosis was confirmed morphologically after observation of multiple sections of an extensive lung-encasing yellowish tumor&#44; maintaining the pattern previously observed&#46; The patient died postoperatively&#44; on the second day&#44; of multi-organ failure&#44; 3 months after the initial diagnosis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Malignant deciduoid mesothelioma is a very rare variant of epithelioid mesothelioma&#44; accounting for less than 5&#37; of mesotheliomas<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and according to another author for less than 2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Talerman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1985 were the first to describe the deciduoid aspects of malignant mesothelioma in the peritoneum of a 13-year-old girl&#46; In 1994 Nascimento et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> reported a case of a peritoneal lesion in a young woman with morphological features similar to Talerman&#39;s description and named it deciduoid mesothelioma&#46; Based on early descriptions&#44; this variant was considered to be restricted to the peritoneum of young women with no history of asbestos exposure&#46; However&#44; later reports have also shown its presence in the pleura and pericardium in elderly people&#44; both female and male&#44; and sometimes in association with asbestos exposure&#46; In the case described the patient had no history of asbestos exposure&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Some cases of malignant deciduoid mesothelioma&#44; in the pleura and peritoneum&#44; diagnosed during pregnancy have been reported&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8</span></a> and a case in the peritoneum of a woman 6 weeks after a cesarean delivery was also described&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> this latter one misinterpreted as pseudotumoral deciduosis&#46; Our case also occurred 2 weeks after a cesarean delivery&#46; It is difficult however to establish a relationship between sex hormones and deciduoid occurrence&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">As far as we know&#44; only 45 cases have been reported in the literature&#44; 22 of those described were in the pleural cavity&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Twenty-six out of the 45 cases were female&#46; Ages have ranged between 13 and 78 years &#40;mean 51 years&#41;&#46; Exposure to asbestos was documented in only 15 cases&#44; with a mean age of onset of 59&#46;1 years&#44; as opposed to 47&#46;7 years of those cases with no documented exposure to asbestos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This variant of epithelioid mesothelioma is characterized by its unique morphology&#46; It is composed of a proliferation of large round cells&#44; abundant eosinophilic cytoplasm&#44; deciduoid features and round vesicular nuclei&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Immunohistochemical data are useful in differentiating mesotheliomas from adenocarcinomas&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In the case that described deciduoid mesothelioma clearly expressed calretinin&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Several features described in patients with deciduoid mesothelioma are worth mentioning&#46; The number of cases found in the pleura and in the peritoneum is balanced whereas mesothelioma in general is about 4 times more common in the pleura&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> There is a preponderance of females in deciduoid mesothelioma as opposed to the slight male predominance in mesothelioma in general&#46; The number of young patients is significant &#40;&#60;40 years&#41; in this variant of mesothelioma&#44; such as the patient described&#44; in contrast to the older age of patients with mesothelioma in general&#46; Another characteristic is the lower rate of asbestos exposure in deciduoid mesothelioma&#46; All these differences suggest that deciduoid mesothelioma may be a clinically and pathologically distinct variant&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The best treatment option for mesothelioma is still a matter of debate and a challenge&#46; Several studies have reported good results with EPP together with neo- or adjuvant chemotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;15</span></a> However the benefit of this multimodality therapy may have been overestimated and it should be noted that EPP is a complex procedure associated with high morbidity and mortality even during the peri-operative period&#44; as in this case&#46; In fact&#44; some retrospective studies suggest that EPP offers no advantage over less radical surgical procedures such as pleurectomy and decortication<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;20</span></a> that have proven effectiveness as palliative measures&#46; Hemithoracic radiotherapy after EPP has been suggested but its role needs further evaluation&#46; Intrapleural or local therapies&#44; such as photodynamic therapy&#44; hyperthermic intrapleural chemotherapy and immunotherapy&#44; were designed to attack microscopic residual disease after surgery&#46; However&#44; all these modalities need further refinement&#46; Randomized trials have shown that systemic chemotherapy is the only type of treatment to increase survival&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Our patient was started on cisplatin and pemetrexed&#44; the standard care in the systemic therapy of mesothelioma&#44; followed by surgical resection but died postoperatively&#46; The cause of death was not determined&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The clinical outcome of malignant deciduoid mesothelioma is usually poor and 68&#37; of the patients die within 1 year after starting treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However there are reported cases of patients with deciduoid mesothelioma who have survived much longer<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a> challenging the inevitability of a poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> More systematic studies and case reports are necessary to give a clearer picture of this variant&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In conclusion&#44; we describe a case of deciduoid pleural mesothelioma in a 40-year-old-woman with clinical presentation 2 weeks after a cesarean delivery and with no known asbestos exposure&#46; We want to highlight the rarity of this variant&#44; the fact that this case is the first reported in Portugal&#44; the role of pathology in its diagnosis&#44; the features that distinguish deciduoid mesothelioma from mesothelioma in general and discuss the available treatment options&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma&#59; it was initially thought that it only occurred in the peritoneum of young women and had nothing to do with asbestos exposure&#46; However&#44; since these early findings it has also been observed in the pleura and the pericardium&#44; with possible association to asbestos&#46; In general the prognosis is poor compared to epithelioid mesothelioma&#46; 45 cases have been reported in the literature up to now&#44; 22 of these were located in the pleural cavity&#46; The authors describe a case of deciduoid pleural mesothelioma in a 40-year-old-woman who presented with right pleuritic chest pain&#44; with no history of asbestos exposure&#44; treated with chemotherapy followed by surgery and who died postoperatively&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O Mesotelioma Decidu&#243;ide &#233; um subtipo raro de mesotelioma epiteli&#243;ide&#44; inicialmente encontrado apenas no peritoneu de mulheres jovens&#44; sem rela&#231;&#227;o com exposi&#231;&#227;o a asbestos&#46; No entanto&#44; desde as primeiras descri&#231;&#245;es tem sido igualmente diagnosticado na pleura e no peric&#225;rdio e pode estar associado aos asbestos&#46; De um modo geral tem pior progn&#243;stico quando comparado com o mesotelioma epiteli&#243;ide&#46; H&#225; apenas 45 casos descritos na literatura at&#233; &#224; data&#44; 22 destes localizados na cavidade pleural&#46; Os autores descrevem um caso de mesotelioma decidu&#243;ide pleural numa mulher de 40 anos com toracalgia pleur&#237;tica direita&#44; sem hist&#243;ria de exposi&#231;&#227;o aos asbestos&#44; submetida a quimioterapia seguida de ressec&#231;&#227;o cir&#250;rgica&#44; que veio a falecer no p&#243;s-operat&#243;rio&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Santos C&#44; et al&#46; Mesotelioma decidu&#243;ide pleural &#8211; uma entidade rara numa mulher jovem&#46; Rev Port Pneumol&#46; 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.rppneu.2012.02.004">doi&#58;10&#46;1016&#47;j&#46;rppneu&#46;2012&#46;02&#46;004</span>&#46;</p>"
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