Localized intrapancreatic malignant mesothelioma: a rare entity that may be confused with other pancreatic neoplasms

Our plain-English summary of Localized intrapancreatic malignant mesothelioma: a rare entity that may be confused with other pancreatic neoplasms, by R. Espinal-Witter, E.L. Servais, D.S. Klimstra, et al (Virchows Archiv, 2010).

The study

• Authors: R. Espinal-Witter, E.L. Servais, D.S. Klimstra, M.D. Lieberman, R.K. Yantiss
• Journal: Virchows Archiv
• Published: 2010;456(4):455-61
• Type of article: Case report, Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma usually presents with diffuse involvement of the pleura or peritoneum. Circumscribed or localized malignant mesothelioma has been described in these locations, as well as the viscera, in which case it may cause diagnostic confusion with other, more common entities. Herein, we describe the first well-documented case of primary intrapancreatic malignant mesothelioma in the English literature. The patient was an otherwise healthy 39-year-old woman who presented with a symptomatic mass in the head of the pancreas that was completely resected via pancreaticoduodenectomy. The tumor was composed of cysts, papillae, and tubules lined by cells with abundant eosinophilic cytoplasm and immunohistochemically expressed CA-125, calretinin, and D2-40. Follow-up revealed no evidence of residual or recurrent disease 32 months after surgery. This report also describes the clinical and pathologic characteristics of an intrapancreatic mesothelioma and provides a review of the literature regarding entities that may be considered in the differential diagnosis of this tumor.

In plain English

This case report described a 39-year-old woman with no history of asbestos exposure who had a one-month history of right-sided abdominal pain and intermittent nausea. Scans showed a 4-cm mass in the head of the pancreas, and surgeons removed it by pancreaticoduodenectomy. The tumor measured 4.5 by 4.0 by 3.9 cm. It was well circumscribed, partly solid and partly cystic. It had grown into the surrounding pancreas and into lymph or blood vessels, but 13 nearby lymph nodes were free of tumor. Tumor cells stained for CA-125, calretinin and D2-40, which are markers of mesothelial cells. The tumor was diagnosed as a localized epithelioid malignant mesothelioma. The patient received no further treatment and was well and disease-free 32 months after surgery. The authors called it, to their knowledge, the first documented case of primary mesothelioma within the pancreas in the English literature, and reviewed other tumors it can be confused with. They noted that follow-up was limited. They suggested pancreatic mesothelioma may be less aggressive than pleural and peritoneal mesothelioma.

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), with a literature discussion of tumors in the differential diagnosis
• Who was studied: one 39-year-old woman with a symptomatic mass in the head of the pancreas; the article does not give where or when she was treated
• Exposure: no history of asbestos exposure was reported for the patient
• Main results:
  • The patient had a 4.5 by 4.0 by 3.9 cm well-circumscribed, solid and cystic tumor in the pancreas.
  • The tumor was unencapsulated and infiltrated the pancreatic tissue. Lymphovascular invasion was present, but all 13 regional lymph nodes were negative for tumor.
  • Tumor cells stained strongly for the mesothelial markers CA-125, calretinin and D2-40.
  • The combined findings were judged most compatible with localized epithelioid malignant mesothelioma.
  • The patient received no adjuvant therapy and was disease-free 32 months after surgery.
• The authors' conclusion: The authors described this as, to their knowledge, the first documented primary intrapancreatic mesothelioma in the English literature. They concluded that its favorable course suggests pancreatic malignant mesothelioma may be less aggressive than pleural and peritoneal tumors, while noting that follow-up is limited.
• Limitations the authors state:
  • Clinical follow-up was limited.
  • Electron microscopy could not be evaluated because formalin fixation distorted the sample.

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Neoplasm, Pleura, Peritoneum, Localized Malignant Mesothelioma, Papillae, Tubule, Eosinophilic.

Related studies

• Localized malignant mesothelioma, an unusual and poorly characterized neoplasm of serosal origin: best current evidence from the literature and the International Mesothelioma Panel — A.M. Marchevsky, A. Khoor, et al. (2020)
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• Solitary benign fibrous mesothelioma of the peritoneum: A rare entity in a 2-year-old child — S. Singh, M. Sangwan, et al. (2016)
• Occupational exposure to dyes, metals, polycyclic aromatic hydrocarbons and other agents and K-ras activation in human exocrine pancreatic cancer — J. Alguacil, M. Porta, et al. (2003)
• Localized gastric mesothelioma with nodal metastasis-an exceptionally rare entity — M. Kazi, T. Vispute, et al. (2022)
• Occupational exposures and pancreatic cancer: a meta-analysis — I.A. Ojajärvi, T.J. Partanen, et al. (2000)

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