Dual Malignancies Discovered: A Rare Case of Malignant Peritoneal Epithelioid Mesothelioma and Lung Adenocarcinoma

Our plain-English summary of Dual Malignancies Discovered: A Rare Case of Malignant Peritoneal Epithelioid Mesothelioma and Lung Adenocarcinoma, by M.A. Potesta, E. Guld, J. Laman (Curēus, 2024).

The study

• Authors: M.A. Potesta, E. Guld, J. Laman
• Journal: Curēus
• Published: 2024;16(5):e59962
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Clinicians diagnosing malignant peritoneal epithelioid mesothelioma (MPM or MPeM) have historically had challenges due to the low incidence of the disease, as well as the often vague symptomatology that patients present with. Newer advances in technology, specifically in immunocytochemistry, have provided a clearer path to diagnosis. Additionally, malignant mesotheliomas must be differentiated from carcinomas. This is done via histology, immunocytochemistry, as well as a careful incorporation of the patient's clinical history. In this case, we present an asymptomatic 73-year-old non-smoker female with no past medical history of asbestos exposure. She was diagnosed with MPM following a routine abdominal hernia repair. Subsequent workup revealed a lung infiltrate that was successfully biopsied and resected, evidently found to be adenocarcinoma. A careful review of the resulting pathology, as well as the interpretation of immunocytochemistry, supported the notion that the patient had two independent malignant processes occurring at once. This case underscores the rarity of two similar, yet distinct cancers, as well as epidemiology, symptomatology, histology, immunocytochemistry, and prognosis.

Copyright © 2024, Potesta et al.

In plain English

This article is a case report about one patient, a 73-year-old female non-smoker. It reports she had no history of asbestos exposure, no occupational or environmental exposure, and no other chronic illnesses. Malignant peritoneal mesothelioma (MPM), epithelioid type, was discovered after routine umbilical hernia surgery. Rare, atypical epithelioid cells stained positive for markers including WT1 and calretinin. A PET/CT scan then showed a right upper lobe pleural mass, at first suspected to be pleural mesothelioma. Lung surgery instead found invasive mixed mucinous and nonmucinous adenocarcinoma, which was fully removed with clear margins. Her pleural biopsy was negative for malignancy. A later diagnostic laparoscopy re-confirmed the peritoneal mesothelioma, and she was deemed stage IV. She received five rounds of pemetrexed-based chemotherapy and then immunotherapy with nivolumab/ipilimumab. Recent imaging showed stability in her disease. The authors concluded that the pathology and staining results supported two independent cancers occurring at once. Because this report describes only one person, it cannot be used to estimate how often these cancers occur.

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 (single patient)
• Who was studied: one 73-year-old female non-smoker with no history of asbestos exposure or other chronic illnesses; no location or dates given
• Exposure: none reported: the article states the patient had no history of asbestos exposure, and no occupational or environmental exposure
• Main results:
  • Malignant peritoneal mesothelioma was discovered after routine umbilical hernia surgery
  • The patient's peritoneal tissue showed rare atypical epithelioid cells that stained positive for WT1 and calretinin, among other markers
  • PET/CT showed a right upper lobe pleural mass
  • Lung surgery found invasive mixed mucinous and nonmucinous adenocarcinoma, staged T2aN0M1, which was fully removed with clear margins
  • The patient's pleural biopsy was negative for malignancy, so no evidence of pleural mesothelioma was found
  • Diagnostic laparoscopy re-confirmed the peritoneal mesothelioma, and the patient was deemed stage IV
  • The patient's CA-125 tumor marker was elevated at 158.7 (reference range 0-35 U/mL)
  • After five rounds of chemotherapy and two months of nivolumab/ipilimumab immunotherapy, imaging showed stability in her disease
• The authors' conclusion: The authors concluded that the findings supported two independent cancers, peritoneal mesothelioma and lung adenocarcinoma, occurring at once in a patient who had no symptoms and no known risk factors

Topics

Medical terms in this study, explained in our Lexicon: Epithelioid, Mesothelioma, Lung Adenocarcinoma, Malignant Mesothelioma, Carcinoma, Histology, Asbestos Exposure, Adenocarcinoma.

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