An unusual presentation of malignant mesothelioma: the incidental finding of tumor in the hernia sac during herniorrhaphy

Our plain-English summary of An unusual presentation of malignant mesothelioma: the incidental finding of tumor in the hernia sac during herniorrhaphy, by J. Brenner, P.P. Sordillo, G.B. Magill (Journal of Surgical Oncology, 1981).

The study

• Authors: J. Brenner, P.P. Sordillo, G.B. Magill
• Journal: Journal of Surgical Oncology
• Published: 1981;18(2):159-61
• Type of article: Case report
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Two cases of malignant mesothelioma that were found incidently at the time of hernia repair are described. In contrast to the majority of patients with peritoneal mesothelioma, both patients had a relatively prolonged survival after diagnosis, although both eventually died with widespread disease. The possible causes of this unusual presentation are discussed.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This article was a report of two cases of malignant mesothelioma found by chance during surgery to repair an inguinal hernia. Both patients were men treated at Memorial Sloan-Kettering Cancer Center in New York, and neither had a history of exposure to asbestos. In the first, a 63-year-old, small nodules were found in the hernia sac and on nearby bowel. He received radioactive phosphorus (P-32) in the abdomen and external radiation, and remained relatively free of symptoms for seven years. At autopsy, a ruptured aortic aneurysm was the cause of death, and extensive mesothelioma was present in the abdomen. In the second, a 61-year-old, a tumor of the tunica vaginalis was found. He received the same kind of treatment, remained well for seven years, was treated again, and stayed relatively well for another three years. The authors noted that the tumor had already spread in the abdomen in both men at diagnosis. They suggested that diagnosis before symptoms appeared may explain the long survival, noted that both men had radiation, and concluded that radiotherapy appears to be the treatment of choice.

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 (two cases)
• Who was studied: Two men, aged 63 and 61, with inguinal hernias. Both were referred to Memorial Hospital (Memorial Sloan-Kettering Cancer Center, New York) after malignant mesothelioma was found at hernia surgery. The article does not give dates.
• Exposure: Neither patient had a history of asbestos exposure. No fiber type is mentioned.
• Main results:
  • Case 1: at hernia repair, nodules in the hernia sac and on the adjacent bowel were biopsied and diagnosed as malignant mesothelioma.
  • Case 1: after partial removal of the tumor, P-32 placed in the peritoneal cavity, and external radiation (3,050 rads to the whole abdomen and 1,600 rads to the pelvis), he remained relatively asymptomatic for seven years.
  • Case 1: at autopsy, a ruptured atherosclerotic abdominal aortic aneurysm was the cause of death. Extensive malignant mesothelioma involved the peritoneum, omentum, diaphragm, mesenteric lymph nodes, liver and stomach.
  • Case 2: at herniorrhaphy, a tumor of the tunica vaginalis was found and diagnosed as malignant mesothelioma. Exploratory laparotomy found multiple peritoneal metastases.
  • Case 2: after P-32 and external radiation (2,100 rads to the abdomen and 1,800 rads to the pelvis), he remained well for seven years. He then developed signs of small bowel obstruction and was given radiation again.
  • Case 2: he remained relatively well for another three years, until he was admitted with cachexia, ascites and cough.
  • Case 2: he did not respond to cyclophosphamide and vincristine and died a month later. At postmortem, bronchopneumonia was the direct cause of death. There was extensive tumor throughout the peritoneal cavity but none in the chest.
• The authors' conclusion: The authors concluded that physicians should be aware that malignant mesothelioma may present this way, and that radiotherapy appears to be the treatment of choice in these patients.
• Limitations the authors state:
  • The authors noted that in both patients the tumor had already spread in the abdomen at diagnosis. They only postulated that the disease was less advanced than usual because it was found before symptoms appeared.
  • The authors noted that both patients received intracavitary P-32 and external radiation, a treatment after which prolonged survival has been documented. The long survival therefore may not be due only to earlier diagnosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Peritoneal Mesothelioma.

Related studies

• Fine-needle aspiration of a well-differentiated papillary mesothelioma in the inguinal hernia sac: A case report and review of literature — Y.Y. Wheeler, F. Burroughs, et al. (2009)
• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2011)
• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2012)
• Incarcerated inguinal hernia from metastatic pleural mesothelioma: PET/CT imaging — V.X. Nguyen, B.D. Nguyen, et al. (2012)
• Incidental finding of multiple well-differentiated papillary mesotheliomas in peritoneum — M. Jakobsen, B. Engvad, et al. (2016)
• Spontaneous urinary bladder perforation: An unusual presentation of well-differentiated papillary peritoneum mesothelioma — A. Serao, F. Ambrosini, et al. (2022)

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