A Rare Case of Epithelial Type Malignant Mesothelioma Associated with Axillary Lymph Node Metastasis and Tuberculous Lymphadenitis

We report a patient with pleural epithelial type mesothelioma who presented with metastasis to axillary lymph nodes. Pathology also revealed findings consistent with tuberculous lymphadenitis.A 47-year-old man presented with chest pain, dyspnea and a history of asbestos exposure, and on physical examination a 2 cm lymph node in the right axilla and a 1 cm lymph node in the left supraclavicular area were detected. The lesions were hard in consistency, moveable and tender. Excisional biopsies were performed to both sets of lymph nodes and a transtho­racic fine needle aspiration biopsy was performed to the extensive mass in the right hemitorax. Morphological, immunohisto­chemical, and ultrastructural findings of both biopsies revealed malignant mesothelioma. Histological examination of the left supraclavicular lymph node biopsy specimen showed a granu­lomatous lesion with caseation, a finding consistent with a tuberculous infection.We believe this is the first reported case of pleural epithelial type mesothelioma with metastasis to axillary lymph nodes which is also associated with tuberculous lymphadenitis.