Colonic invasion induced by malignant peritoneal mesothelioma

Our plain-English summary of Colonic invasion induced by malignant peritoneal mesothelioma, by S.B. Cao, S. Jin, J.Y. Cao, et al (International Journal of Colorectal Disease, 2014).

The study

• Authors: S.B. Cao, S. Jin, J.Y. Cao, J. Shen, J.W. Zhang, Y. Yu
• Journal: International Journal of Colorectal Disease
• Published: 2014;29(7):891-2
• Type of article: Case report, Letter
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter to the editor reported a case of malignant peritoneal mesothelioma (MPM) invading the colon. The authors aimed to help prevent misdiagnosis of the disease. A 53-year-old man was admitted to the Department of Surgical Oncology, Harbin Medical University Cancer Hospital, China, in November 2013. He had had constipation, weight loss and occasional abdominal discomfort for 2 months. He was a heavy smoker, had diabetes mellitus and had been exposed to asbestos in childhood. Tumor markers were normal. CT showed thickening of the colon wall at the hepatic flexure of up to 16.8 mm, an infiltrating mass of 67.7 mm, multiple small peritoneal nodules and enlarged abdominal lymph nodes. Colonoscopy suggested an infiltrating lesion at the hepatic flexure. At laparotomy, nodules were found throughout the peritoneum, and the mass had penetrated the serosa. Histology showed a well-differentiated epithelioid malignant mesothelioma, positive for HBME-1, CK5/6, CK7 and calretinin. After 2 cycles of pemetrexed with carboplatin, which he did not tolerate, the disease progressed with ascites and rectal involvement, attributed to compression by enlarged lymph nodes. Treatment was changed to oxaliplatin and capecitabine, and his symptoms were relieved. He did not receive heated intraperitoneal chemotherapy because of adhesions. The authors noted that about 60% of MPM cases are linked to asbestos contact. They concluded that MPM should be considered in the differential diagnosis of difficult defecation.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This letter to the editor reported a single case. A 53-year-old man was admitted to Harbin Medical University Cancer Hospital, China, in November 2013 after 2 months of constipation, weight loss and occasional abdominal discomfort. He had a history of asbestos exposure in childhood (the fiber type was not stated), was a heavy smoker and had diabetes. Tumor marker blood tests were in the normal range. CT scans showed a thickened wall at the hepatic flexure of the colon, a 67.7 mm infiltrating mass, multiple small nodules on the peritoneum and swollen abdominal lymph nodes. Colonoscopy found a lesion at the same spot that bled easily. At surgery, nodules lay throughout the peritoneum, and the mass had penetrated the serosa. Tissue tests showed a well-differentiated epithelioid malignant peritoneal mesothelioma. He received two cycles of pemetrexed and carboplatin chemotherapy, but then did not tolerate the therapy, and the disease progressed. After a switch to oxaliplatin and capecitabine, his symptoms were relieved at the time of writing. The authors concluded that this cancer should be considered when patients have difficulty passing stools.

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 (letter to the editor)
• Who was studied: one 53-year-old man, a heavy smoker with diabetes, admitted to the Department of Surgical Oncology, Harbin Medical University Cancer Hospital, China, in November 2013
• Exposure: asbestos exposure in childhood; no fiber type, source or amount given. He was also a heavy smoker (15 packs per month).
• Main results:
  • Tumor markers (CEA, CA724, CA19-9, CA-125) and routine blood tests were in the normal range except for a raised platelet count (thrombocytosis)
  • Abdominal CT showed thickening of the wall of the hepatic flexure of the colon up to 16.8 mm
  • Abdominal CT showed a 67.7 mm infiltrating mass, multiple small peritoneal nodules and swollen abdominal lymph nodes
  • Colonoscopy suggested an infiltrating lesion at the hepatic flexure of the colon that was broken on the surface and bled easily
  • At surgery, the infiltrating mass had penetrated the serosa and the right side of the peritoneum
  • Histology showed a well-differentiated epithelioid malignant mesothelioma, positive for HBME-1, CK5/6, CK7 and calretinin, supporting the diagnosis of malignant peritoneal mesothelioma
  • The patient successfully received 2 cycles of pemetrexed with carboplatin, but then did not tolerate the therapy, and the disease progressed with ascites and rectal involvement on CT
  • The authors judged that the rectal involvement was caused by pressure from swollen lymph nodes
  • Treatment was changed to oxaliplatin and capecitabine, and his symptoms were relieved at the time of writing
  • The patient did not receive heated intraperitoneal chemotherapy (HIPEC) because of adhesions of the intestine and lymph nodes
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma should be considered in the differential diagnosis of difficult defecation, and that awareness of such atypical presentations may help make a correct diagnosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Misdiagnosis, Tumor Marker, Laparotomy, Peritoneum, Histology, Well-Differentiated, Epithelioid.

Related studies

• Colonic invasion of malignant peritoneal mesothelioma — C.C. Chan, H. Isomoto, et al. (2010)
• Benign multicystic mesothelioma with concurrent colonic adenocarcinoma: a report of two cases — A. Husain, M. Ozdemirli (2012)
• Metastasis of pleural mesothelioma presenting as bleeding colonic polyp — S. Sibio, P. Sammartino, et al. (2011)
• American Cancer Society plans for a long-range study of colonic and rectal cancer — E.C. Hammond (1970)
• Perineal and colonic metastases in two cases of malignant mesothelioma — B. Grewal, G. Reid, et al. (2012)
• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)

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