Localized gastric mesothelioma with nodal metastasis-an exceptionally rare entity

Our plain-English summary of Localized gastric mesothelioma with nodal metastasis-an exceptionally rare entity, by M. Kazi, T. Vispute, P. Shah, et al (Indian Journal of Surgical Oncology, 2022).

The study

• Authors: M. Kazi, T. Vispute, P. Shah, M. Ramadwar, M.S. Bhandare, S.V. Shrikhande, V.A. Chaudhari
• Journal: Indian Journal of Surgical Oncology
• Published: 2022;13(3):612-615
• Read it: PubMed · Publisher · Free full text

Abstract

Localized mesothelioma is a rare disease with very few reports of presentation in visceral organs. We report a case of localized gastric mesothelioma with lymph node metastasis in a 32-year-old man without asbestos exposure. A failed attempt at resection was made before presentation at another center. He was given perioperative chemotherapy that was followed by a D2 radical subtotal gastrectomy and hyperthermic intraperitoneal chemotherapy. Histopathology showed epithelioid mesothelioma with nodal metastasis but without visceral peritoneal involvement. Cytoreductive surgery and regional chemotherapy are standard in diffuse mesothelioma. Management of localized mesothelioma is anecdotal; however aggressive surgery plays a central role with selective use of perioperative chemotherapy.

© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2022.

In plain English

This article was a case report of a 32-year-old man with a localized mesothelioma of the stomach that had spread to nearby lymph nodes. The patient had no history suggestive of asbestos exposure. An operation at another center removed only part of the mass before it was abandoned, and a review of the tissue showed epithelioid mesothelioma. The patient received 3 cycles of pemetrexed and cisplatin before surgery. The lymph nodes partly shrank and the stomach tumor stayed stable. Surgeons then removed most of the stomach, the omentum and the regional lymph nodes. They found no evidence of peritoneal disease. They also gave heated chemotherapy (cisplatin and Adriamycin) directly into the abdomen (HIPEC). Under the microscope the tumor involved the fat beneath the serosa, but the serosa itself was free of disease. Five of 17 removed nodes contained cancer, and all margins were free of tumor. After 3 more cycles of chemotherapy, the patient was disease-free at 30 months of follow-up. The authors concluded that localized mesothelioma is potentially curable and that aggressive surgery is warranted, with selective use of chemotherapy.

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
• Who was studied: One 32-year-old man with no comorbidities, first evaluated at another center for upper abdominal pain of 2 months duration
• Exposure: No asbestos exposure: the patient had no history suggestive of asbestos exposure
• Main results:
  • At the first center, the operation was abandoned after only part of the mass was excised
  • Pathology review showed epithelioid mesothelioma
  • After 3 cycles of pemetrexed and cisplatin before surgery, the lymph nodes partly responded and the disease in the stomach wall was stable
  • At surgery there was a 5-cm mass in the posterior wall of the antrum with enlarged perigastric nodes and no evidence of peritoneal disease
  • Subtotal gastrectomy, omentectomy and D2 lymphadenectomy were performed
  • HIPEC was given with cisplatin and Adriamycin
  • The subserosal fat was involved by tumor but the serosa was free of disease
  • 5 of the 17 dissected lymph nodes had metastatic deposits
  • All surgical margins were free of tumor
  • After 3 cycles of pemetrexed and cisplatin following surgery, the patient was disease-free at 30 months of follow-up
• The authors' conclusion: The authors concluded that localized mesothelioma is potentially curable and that aggressive surgery is warranted, with selective use of perioperative and regional chemotherapy
• Limitations the authors state:
  • The authors were unsure whether the tumor arose from the gastric serosa or from the stomach's muscle layer

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Metastasis, Localized Malignant Mesothelioma, Asbestos Exposure, Chemotherapy, HIPEC, Histopathology, Epithelioid.

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