CTICasesPseudo-mesothelioma (Sarcomatoid Lung Carcinoma)
Imaging findings
Chest CT shows a massive, circumferential right-sided pleural tumor with nodular pleural-based deposits, loculated pleural effusion, and direct invasion into the anterior mediastinal fat. PET/CT shows intense FDG avidity of the pleural masses. Biopsy reveals sarcomatoid cells that are TTF-1 positive and calretinin/WT1 negative, confirming sarcomatoid lung carcinoma spreading diffusely along the pleura.
Key takeaways
Pseudo-mesothelioma refers to a primary peripheral lung carcinoma (most commonly adenocarcinoma or sarcomatoid carcinoma) that invades the pleural space and spreads circumferentially along the visceral and parietal pleural surfaces, mimicking malignant mesothelioma on CT. Differentiating the two requires immunohistochemistry (TTF-1 and keratins for lung cancer vs. calretinin and WT1 for mesothelioma) and evaluating for distant hematogenous metastases, particularly to bone or adrenals, which are rare in mesothelioma.
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