A case of peritoneal malignant mesothelioma following radiation therapy for cervical cancer

Our plain-English summary of A case of peritoneal malignant mesothelioma following radiation therapy for cervical cancer, by M. Yano, Y. Ikeda, T. Kato, et al (Molecular and Clinical Oncology, 2018).

The study

• Authors: M. Yano, Y. Ikeda, T. Kato, M. Sakaki, S. Sato, A. Yabuno, E. Kozawa, M. Yasuda
• Journal: Molecular and Clinical Oncology
• Published: 2018;8(2):302-305
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The present study presents a case of peritoneal malignant mesothelioma (PMM) following radiation therapy for cervical cancer. A 34-year-old Japanese woman, without asbestos exposure, was referred to the Department of Gynecologic Oncology, Saitama Medical University International Medical Center due to a cervical mass, and was diagnosed with cervical squamous cell carcinoma (SCC). The serum levels of tumor markers, including SCC antigen and cancer antigen 125 (CA125) were 229.0 ng/ml and 54.4 U/ml, respectively. The patient underwent concurrent chemoradiotherapy (CCRT), and a complete response was achieved. After 54 months, ascites was found at the rectouterine pouch, but peritoneal cytology suggested reactive mesothelial cell. After 62 months of CCRT, magnetic resonance imaging revealed masses in both the salpinges. The serum levels of SCC and CA125 were 0.9 ng/ml and 506.1 U/ml, respectively. Following this, left salpingectomy and peritoneal biopsy were performed laparoscopically. Histologic examination revealed atypical mesothelial cells with no continuity of background tubal epithelium. Immunohistochemistry showed positive staining for calretinin, thrombomodulin, mesothelin and glucose transporter 1. Based on these findings, the patient was diagnosed with PMM epithelioid type and underwent systemic chemotherapy; stable disease status has been obtained for 3 months. This case demonstrates the possibility of PMM occurrence within 10 years after radiotherapy, and indicates the importance of histological and immunohistochemical examination, particularly in cases of an atypical tumorigenesis pattern from the primary cancer.

In plain English

This case report describes one woman in Japan. At age 34, with no history of cancer or asbestos exposure, she was diagnosed with stage IIB squamous cell carcinoma of the cervix. She received 54 Gray of whole-pelvis radiation plus internal radiation (brachytherapy), with weekly cisplatin, and the cancer responded completely. After 54 months, fluid was found in the pelvis. Its cells showed mild atypia and were judged reactive. After 62 months, MRI showed 20-mm masses in both fallopian tubes. The marker CA125 was 506.1 U/ml and the cervical cancer marker SCC was 0.9 ng/ml, a pattern the authors judged unlike a cervical cancer recurrence. Surgery found multiple deposits on the peritoneum, and tissue tests led to a diagnosis of peritoneal malignant mesothelioma, epithelioid type. With cisplatin plus pemetrexed, her disease was stable for 3 months. The authors called this the third reported such case. They concluded it shows this mesothelioma can occur within 10 years of radiotherapy, and that microscopic and immunohistochemical examination of tissue is important when a tumor behaves unlike the original cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (one patient), with a review of the pertinent literature
• Who was studied: One 34-year-old Japanese woman with no history of cancer or asbestos exposure, treated at Saitama Medical University International Medical Center for stage IIB cervical squamous cell carcinoma
• Exposure: Radiation therapy for cervical cancer: 54 Gray of whole-pelvis radiation and 20 Gray in 4 fractions of high-dose-rate intracavitary brachytherapy, combined with weekly cisplatin. No asbestos exposure.
• Main results:
  • The cervical cancer responded completely to the primary chemoradiotherapy
  • Ascites appeared 54 months after chemoradiotherapy. Two months later, cytology of the fluid showed mesothelial cells with mild atypia, which were judged reactive.
  • 62 months after chemoradiotherapy, MRI showed 20-mm masses in both fallopian tubes and pelvic ascites. Serum SCC was 0.9 ng/ml and CA125 was 506.1 U/ml, compared with 229.0 ng/ml and 54.4 U/ml at the original cervical cancer diagnosis.
  • Laparoscopy found masses inside both tubes and multiple peritoneal deposits up to 10 mm. The tube tumor showed no continuity with the tubal lining.
  • Immunohistochemistry was positive for calretinin, thrombomodulin, mesothelin, D2-40, CK20 and glucose transporter 1. It was negative for markers including CK7, pax-8, CEA, claudin 4 and BAP1. The diagnosis was peritoneal malignant mesothelioma, epithelioid type.
  • After chemotherapy with cisplatin plus pemetrexed, the disease had been stable for 3 months
• The authors' conclusion: The authors reported this as the third case of peritoneal malignant mesothelioma after radiation therapy for cervical cancer. They concluded that it demonstrates the possibility of this mesothelioma occurring within 10 years after radiotherapy. They also concluded that it shows the importance of histological and immunohistochemical examination when a tumor behaves unlike the primary cancer.
• Limitations the authors state:
  • The authors noted that the first peritoneal cytology, in hindsight, showed a potential for mesothelioma, and that they might have recommended tissue examination earlier

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Asbestos Exposure, Squamous Cell Carcinoma, Tumor Marker, Ascites, Cytology, Mesothelial Cells, Biopsy.

Related studies

• Resolution of Right Hemidiaphragm Paralysis following Cervical Foraminotomies — N. Singleton, M. Bowman, et al. (2018)
• Mesothelin as a target for cervical cancer therapy — K. Jöhrens, L. Lazzerini, et al. (2019)
• Diffuse Malignant Peritoneal Mesothelioma Presenting with Psammomatous Calcification on a Cervical Smear — A. Tan, P. Cohen, et al. (2015)
• Malignant mesothelioma following radiation exposure — K.H. Antman, J.M. Corson, et al. (1983)
• A case of malignant pleural mesothelioma following exposure to atomic radiation in Nagasaki — M. Mizuki, K. Yukishige, et al. (1997)
• Different imaging methods in the assessment of radiation-induced lung injury following hemithorax irradiation for pleural mesothelioma — P. Maasilta, L. Kivisaari, et al. (1990)

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