Duodenal metastasis of malignant pleural mesothelioma

Our plain-English summary of Duodenal metastasis of malignant pleural mesothelioma, by H.C. Chen, K.B. Tsai, C.S. Wang, et al (Journal of the Formosan Medical Association = Taiwan Yi Zhi, 2008).

The study

• Authors: H.C. Chen, K.B. Tsai, C.S. Wang, T.J. Hsieh, J.S. Hsu
• Journal: Journal of the Formosan Medical Association = Taiwan Yi Zhi
• Published: 2008;107(12):961-4
• Type of article: Case report
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Metastatic malignant mesothelioma of the pleura is uncommon at the time of initial diagnosis. The gastrointestinal lumen is rarely found at autopsy in patients with widespread disease. Here, we describe an extremely rare case of isolated duodenal metastasis of sarcomatoid mesothelioma of the pleura in a 73-year-old man, without memory of any direct exposure to asbestos. The possibility of gastrointestinal tract metastasis should be considered in the presence of anemia or positive occult blood test in patients with malignant pleural mesothelioma.

In plain English

This case report from Kaohsiung, Taiwan, described a 73-year-old man admitted in December 2005 with cough and left chest wall pain. He denied occupational exposure to asbestos and, on further questioning, remembered no direct exposure. Blood tests showed anemia (hemoglobin 9.1 g/dL; normal 12–16 g/dL), and a stool test for hidden blood was positive. Scans showed nodular thickening of the lining of the left chest, and a biopsy diagnosed sarcomatoid mesothelioma of the pleura. Abdominal CT showed no evidence of spread to the peritoneum. The colon showed no abnormalities. Upper endoscopy found a fragile, ulcerated polyp-like growth in the second part of the duodenum; its biopsy was consistent with metastatic sarcomatoid mesothelioma. Advanced treatment was not suggested because of poor performance status and family objections; he died of pneumonia with septic shock one month later. The authors found five earlier cases in the English-language literature of mesothelioma involving the inside of the digestive tract (large bowel, ileum, stomach, duodenal bulb). The authors concluded that gastrointestinal spread should be considered when patients with malignant pleural mesothelioma have anemia or blood in the stool.

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 man admitted in December 2005 to the authors' hospital in Kaohsiung, Taiwan, with cough and left chest wall pain
• Exposure: No known asbestos exposure: the patient denied occupational exposure and remembered no direct exposure to asbestos
• Main results:
  • The patient had anemia, with a hemoglobin of 9.1 g/dL (normal 12–16 g/dL), and his stool occult blood test was positive
  • A core biopsy of the pleura led to a diagnosis of sarcomatoid mesothelioma
  • Abdominal CT showed no evidence of peritoneal dissemination
  • Endoscopy showed an ulcerated polypoid lesion in the second portion of the duodenum
  • Immunohistochemistry and electron microscopy of the duodenal biopsy were consistent with metastatic sarcomatoid mesothelioma
  • Advanced treatment was not suggested because of poor performance status and family objections. Despite supportive care, the patient died of pneumonia with septic shock 1 month later
  • In the English-language literature, the authors found five earlier clinical cases of malignant mesothelioma involving the gastrointestinal lumen (large bowel, ileum, stomach, duodenal bulb), from pleural (4) and peritoneal (1) primary tumors
• The authors' conclusion: The authors concluded that the possibility of gastrointestinal tract metastasis should be considered when patients with malignant pleural mesothelioma have anemia or a positive occult blood test
• Limitations the authors state:
  • The authors did not perform further small-intestine studies to look for other metastatic lesions, because the duodenal lesion could explain the anemia and occult blood

Topics

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

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Mesothelioma, Pleura, Autopsy, Sarcomatoid, Tract Metastasis.

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• Floor of mouth and tongue metastasis from malignant pleural mesothelioma — D. Kirke, K. Horwood, et al. (2010)
• Pseudo-tumor mimicking indwelling pleural catheter tract metastasis in mesothelioma — R.L. Shrestha, B.A. Wood, et al. (2014)
• Epithelioid and sarcomatoid malignant pleural mesothelioma in endoscopic gastric biopsies: a diagnostic pitfall — A. Agaimy, P.H. Wünsch (2006)
• Focal pleural tumorlike conditions: nodules and masses beyond mesotheliomas and metastasis — M.C. de Paula, D.L. Escuissato, et al. (2015)

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