Long-term survival of a woman with well differentiated papillary mesothelioma of the peritoneum: a case report and review of the literature

Our plain-English summary of Long-term survival of a woman with well differentiated papillary mesothelioma of the peritoneum: a case report and review of the literature, by J.M. Clarke, P. Helft (Journal of Medical Case Reports, 2010).

The study

• Authors: J.M. Clarke, P. Helft
• Journal: Journal of Medical Case Reports
• Published: 2010;4:346
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Well-differentiated papillary mesothelioma of the peritoneum (WDPMP) is a rare subtype of epitheloid mesothelioma, which is usually seen in young women. WDPMP is generally considered of low malignant potential, however the long-term nature of the tumor remains poorly defined.

Case Presentation: We describe the long-term follow-up of a 60-year-old woman of West African descent who has survived 24 years with WDPMP after receiving extensive local and systemic adjuvant chemotherapy. Her clinical course has included three exploratory laparotomies with intraperitoneal and intravenous chemotherapy over two decades. Her course was complicated by anthracycline-induced cardiomyopathy, for which she underwent an orthotopic heart transplant. Our patient is alive with stable radiological evidence of peritoneal disease, and continues to suffer from chronic abdominal pain.

Conclusion: No consensus exists regarding optimal treatment strategies for WDPMP. However, given the low malignant potential of the tumor, careful consideration should be made before proceeding with aggressive interventions. Further, long-term follow-up reports are required to fully characterize this tumor.

In plain English

This was a case report with a review of published cases of well-differentiated papillary mesothelioma of the peritoneum (WDPMP), a rare subtype of mesothelioma of the abdominal lining. The patient was a 60-year-old woman of West African descent with no history of asbestos exposure. Twenty-four years earlier, surgery found nodules across her peritoneum, which pathology read as low-grade papillary mesothelioma. Over two decades she had repeated abdominal surgeries and many courses of chemotherapy. She developed anthracycline-induced cardiomyopathy and received a heart transplant in 2000. For a time her tumor was presumed to be malignant peritoneal mesothelioma. A repeat biopsy 19 years after diagnosis again showed low-grade papillary mesothelioma. She was alive with stable disease on imaging but had chronic renal insufficiency and severe chronic abdominal pain. Among 39 reviewed case reports, 28 patients were women and 11 men. Six had possible asbestos exposure, and no definitive causation was described. The authors questioned extensive chemotherapy and surgery for a tumor of presumed low malignant potential. They noted that imprecise past medical records limited their assessment.

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 with a review of published case reports
• Who was studied: one 60-year-old woman of West African descent with well-differentiated papillary mesothelioma of the peritoneum, followed for 24 years; the literature review covered 39 published case reports
• Exposure: No asbestos exposure: the patient had no history of asbestos exposure. The article describes her medical treatments (surgery and chemotherapy), not an asbestos exposure.
• Main results:
  • At her first surgery 24 years earlier, the pathology was interpreted as low-grade papillary mesothelioma
  • She received repeated chemotherapy, including intraperitoneal cisplatin, and was later treated under a presumed diagnosis of malignant peritoneal mesothelioma refractory to therapy
  • She was diagnosed with anthracycline-induced cardiomyopathy (ejection fraction of 14%) and had an orthotopic heart transplant in 2000
  • The probable identity of her tumor was understood only after a repeat biopsy 19 years after her original diagnosis
  • The patient had chronic renal insufficiency and severe chronic abdominal pain, with stable disease on imaging, 24 years after diagnosis
  • The authors reported this as the second longest follow-up reported for WDPMP
  • In the 39 case reports reviewed, 28 patients were women and 11 were men, and the mean age at presentation was 44 years (median 43 years)
  • In the reviewed cases, six patients were reported to have possible asbestos exposure, but no definitive causation has been described
• The authors' conclusion: The authors concluded that the need for extensive chemotherapy and surgery should be questioned for a tumor of presumed low malignant potential, given the risks of such treatment, and that accurate initial pathological diagnosis is needed to prevent overtreatment
• Limitations the authors state:
  • The authors stated that imprecise past medical records made it difficult to determine the effect of chemotherapy on the patient's tumor progression

Topics

Medical terms in this study, explained in our Lexicon: Well-Differentiated Papillary Mesothelioma, Peritoneum, Mesothelioma, Chemotherapy.

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