Asbestos-induced peritoneal mesothelioma in a construction worker

Our plain-English summary of Asbestos-induced peritoneal mesothelioma in a construction worker, by R. Fonte, S. Gambettino, M. Melazzini, et al (Environmental Health Perspectives, 2004).

The study

• Authors: R. Fonte, S. Gambettino, M. Melazzini, M. Scelsi, C. Zanon, S.M. Candura
• Journal: Environmental Health Perspectives
• Published: 2004;112(5):616-9
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Occupational and environmental asbestos exposure continues to represent a public health problem, despite increasingly restrictive laws adopted by most industrialized countries. Peritoneal mesothelioma is a rare and aggressive asbestos-related malignancy. We present the case of a 65-year-old man who developed recurrent ascites after having been exposed to asbestos in the building industry for > 40 years. Liver function and histology were normal. Abdominal computed tomography initially excluded the presence of expansive processes, and no abnormal cells were found in the ascitic fluid. Laparoscopy showed diffuse neoplastic infiltration of the peritoneum. Histopathology of bioptic samples revealed epithelioid neoplastic proliferation with a tubulopapillary pattern, falsely suggesting metastatic adenocarcinomatosis. In consideration of the occupational history, and after further diagnostic procedures had failed to identify the hypothetical primitive tumor, immunostaining of the neoplastic tissue was performed. Results were negative for carcinoembrionary antigen and the epithelial glycoprotein Ber-EP4, whereas results were positive for the mesothelial markers cytokeratins, calretinin, epithelial membrane antigen, and HBME-1, thus leading to the correct diagnosis of peritoneal epithelial mesothelioma. The Italian Workers' Compensation Authority recognized the occupational origin of the disease. Cytoreductive surgery associated with continuous hyperthermic peritoneal perfusion (cisplatin at 42 degrees C, for 1 hr) was performed. The disease relapsed after 4 months and was later complicated by a bowel obstruction requiring palliative ileostomy. The patient died 23 months after diagnosis. This case illustrates the insidious diagnostic problems posed by peritoneal mesothelioma, a tumor which often simulates other malignancies (e.g., metastatic carcinomas) at routine histopathological examination. Occupational history and immunohistochemistry are helpful for the correct diagnosis, which, in turn, is important in relation to prognosis and treatment (adoption of new integrated procedures that seem to promise prolonged survival and increased quality of life), and in relation to medicolegal issues and occupation-related compensation claims following asbestos exposure.

In plain English

This article is a case report about one man in Italy who developed peritoneal mesothelioma, a cancer of the lining of the abdomen. He worked in the building industry from 1949 to 1990. His work included cutting and shaping asbestos-cement panels with an electric saw and an abrasive disk, which exposed him to inhaled asbestos fibers. The article does not name the fiber type. In June 2000, at age 65, he was hospitalized with fluid in the abdomen (ascites). Early tests, including fluid analysis and a liver biopsy, found no cause. In April 2001, tissue samples looked like cancer that had spread from elsewhere, but no original tumor was found. Prompted by his asbestos history, the doctors used special stains, which led to a diagnosis of epithelial peritoneal mesothelioma. The Italian Workers’ Compensation Authority recognized the disease as occupational. He had surgery followed by heated cisplatin perfusion of the abdomen. The disease returned after 4 months, and he died 23 months after diagnosis, at age 67. The authors concluded that occupational history and immunohistochemistry can resolve such diagnostic doubts.

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)
• Who was studied: One man in Italy, a construction worker who worked in the building industry from age 14 to 55 (1949 to 1990). He was hospitalized at age 65 in June 2000.
• Exposure: Occupational asbestos exposure over more than 40 years in construction. The work was installing industrial roofing, pipes, flues and tanks, which required cutting and shaping asbestos-cement panels with an electric saw and a rotating abrasive disk. The fiber type is not named.
• Main results:
  • At first, no cause for the patient's ascites was found. Analysis of the abdominal fluid showed no abnormal cells, and a liver biopsy in December 2000 showed normal liver tissue.
  • Biopsy samples taken during laparoscopy in April 2001 showed a pattern suggesting cancer that had spread to the peritoneum from elsewhere (metastatic peritoneal adenocarcinomatosis).
  • Further tests did not find an original tumor elsewhere. Because of the patient's long-term asbestos exposure, the authors performed immunohistochemical tests on the tumor tissue.
  • Stains for CEA and Ber-EP4 were negative. Stains for the mesothelial markers cytokeratins, calretinin, EMA and HBME-1 were positive, leading to a diagnosis of peritoneal epithelial mesothelioma.
  • The case was referred to the Italian Workers’ Compensation Authority, which recognized the occupational origin of the disease.
  • In May 2001 the patient had cytoreductive surgery, followed by peritoneal perfusion with cisplatin heated to 42°C for 1 hour.
  • After discharge in July 2001, the patient was apparently free of disease for 4 months before the ascites returned.
  • In February 2003 a bowel obstruction required a palliative ileostomy. The patient died 1 month later at age 67, 23 months after diagnosis.
• The authors' conclusion: The authors concluded that this case illustrates the diagnostic problems of peritoneal mesothelioma. The epithelial subtype can look like metastatic adenocarcinoma on routine examination, and in such cases occupational history and immunohistochemistry can resolve the doubts.

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: Peritoneal Mesothelioma, Asbestos Exposure, Ascites, Histology, Peritoneum, Histopathology, Epithelioid, Tubulopapillary.

Related studies

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• Malignant mesothelioma induced by asbestos and zeolite in the mouse peritoneal cavity — Y. Suzuki, N. Kohyama (1984)
• Hemizygosity of Nf2 is associated with increased susceptibility to asbestos-induced peritoneal tumours — J. Fleury-Feith, C. Lecomte, et al. (2003)
• DNA fingerprint analysis reveals differences in mutational patterns in experimentally induced rat peritoneal tumors, depending on the type of environmental mutagen — N. Kociok, K. Unfried, et al. (1999)
• Colonic invasion induced by malignant peritoneal mesothelioma — S.B. Cao, S. Jin, et al. (2014)
• Identification of carcinogens by measurement of cell-mediated immunity. III. Immunity to asbestos-induced rat peritoneal mesothelioma — D.A. Cole, R.H. Stevens, et al. (1982)

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