A 68-year-old male complained of right-sided chest pain for 4 months with no other symptoms. He did not have history of echinococcosis, tumor, or tuberculosis. However, he had been smoking 20 cigaretes and drinking 100 g of alcohol daily for 40 years. Physical examination revealed no relevant findings. Routine blood and urine tests showed no anemia or proteinuria, respectively. Computed tomography (CT) revealed thickened pleura on the right anterolateral aspect of the chest wall, a soft tissue mass adjacent to the chest wall surrounding part of the 3rd and 4th ribs, a big pulmonary bulla with a size of 4.4 cm x 5.1 cm, and normal mediastinal lymph nodes (Figures 1A-C). We recommended PET/CT to the patient, who declined due to financial reasons. No positive lesion was found after a series of examinations were performed, including cranial magnetic resonance imaging (MRI), contrast-enhanced neck and abdominal CT scans, bronchoscopy, and whole body radionuclide bone scintigraphy. Because all these examinations did not reveal any evidence of regional or distant spread, invasive staging of the mediastinum by mediastinoscopy or of the pleural space by video-thoracoscopy was not indicated. The initial diagnosis was localized mesothelioma with pulmonary bulla. The lesion was deemed completely resectable, and the patient underwent right thoracotomy through the third intercostal space. The intraoperative exploration revealed that the mass of the subcutaneous tissue had a size of 4 cm x 5 cm, accompanied by a pleural lesion with a size of 5 cm x 6 cm. The internal margin of the lesion was attached to the edge of a small part of the adjacent bulla, but the wall of most of the remaining bulla was intact. Intraoperative frozen biopsy of the mass reported a malignant tumor, compatible with squamous cell carcinoma. Therefore, the tumor and bullae were entirely removed. The resection included the chest wall, part of the third and fourth ribs, tissues of the intercostal space and pleura, and a wedge resection of the pulmonary bulla. Appropriate nickel-titanium memory alloy embracing device was fixed on the third and fourth rib stumps to avoid the local collapse of the chest wall. The postoperative histopathological examination confirmed that the tumor was a squamous cell carcinoma that had invaded the adjacent ribs. The wall of the pulmonary bulla showed chronic inflammation (Figures 2A-D). The immunohistochemistry staining showed positive results of P63 and P40 and negative results of TTF1, napsin A, WT1, D2-40, c-kit, and calretinin (Figures 2E,F). Because there were no signs of tumor in other organs, such as lung, mediastinum, head, neck, and abdomen, it was diagnosed as a primary pleural tumor. There were no postoperative complications. Two months after the surgery, the patient returned and received radiotherapy over the operative field, with a total dose of 50 Gy. After more than a year of follow-up, no sign of tumor recurrence was detected (Figures 1D-F). The patient was satisfied to our treatment.