Malignant peritoneal mesothelioma after Thorotrast exposure

Our plain-English summary of Malignant peritoneal mesothelioma after Thorotrast exposure, by C. Stey, U. Landolt-Weber, W. Vetter, et al (American Journal of Clinical Oncology, 1995).

The study

• Authors: C. Stey, U. Landolt-Weber, W. Vetter, C. Sauter, B. Marincek
• Journal: American Journal of Clinical Oncology
• Published: 1995;18(4):313-7
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A case of a malignant peritoneal mesothelioma in a 63-year-old male patient with a history of exposure to Thorotrast in 1945 is presented. There was no history of exposure to asbestos. The clinical manifestation was a serosal effusion, which required weekly ascites puncture until therapy with intraperitoneal bleomycin was initiated. The latter treatment led to a significant reduction of ascites without any influence on tumor progression. Unfortunately, intraperitoneal bleomycin was accompanied by pulmonary toxicity, but at a higher total dose than known for intravenous administration. Three years after diagnosis the patient is still alive, without relapse of ascites production after bleomycin had to be stopped. Considering the risk of pulmonary fibrosis with high-dose intraperitoneal bleomycin and the lack of efficacy on tumor reduction, bleomycin seems to offer no advantage with respect to cisplatin.

In plain English

This article was a case report about one 63-year-old man treated at University Hospital, Zürich. He noticed abdominal swelling in September 1990 and was admitted with massive fluid in the abdomen (ascites) and around the right lung. In 1945, after a World War II injury, he had a blood-vessel X-ray (cubital angiography) using Thorotrast, a thorium dioxide contrast agent. The authors reported no exposure to asbestos. CT scans showed metallic deposits in his liver, spleen and lymph nodes, which the authors described as long-standing Thorotrast-induced changes. Staining of the tumor cells led to a diagnosis of well-differentiated peritoneal mesothelioma. The tumor later also involved the lining of the chest. Bleomycin chemotherapy given into the abdomen, first weekly and then every 14 days, controlled the ascites but did not stop the tumor from growing. After a cumulative dose of 720 mg he developed lung scarring (pulmonary fibrosis). He was alive three years after diagnosis. The authors wrote that a causal link to Thorotrast must be considered. They concluded that high-dose bleomycin given into the abdomen seems to offer no advantage over cisplatin.

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 63-year-old man treated at University Hospital, Zürich, Switzerland, who first noticed abdominal swelling in September 1990 and was admitted with massive ascites and a right-sided pleural effusion
• Exposure: Thorotrast (thorium dioxide) contrast agent injected for a cubital angiography in 1945 after a World War II injury; the authors reported no exposure to asbestos and no other known carcinogenic stimulus
• Main results:
  • CT showed findings the authors called characteristic of long-standing Thorotrast-induced changes: metallic densities in the liver, spleen and peripancreatic and splenic hilar lymph nodes, greatest in the spleen
  • Tumor cells from the ascites and from a later abdominal wall metastasis were positive for Lu-5 and vimentin and negative for B12 and CEA; a well-differentiated peritoneal mesothelioma was diagnosed
  • In May 1992, thoracoscopy showed tumor infiltration of the parietal and diaphragmatic pleura, with the same appearance under the microscope as the ascites
  • Intraperitoneal bleomycin began as 30 mg weekly in September 1992; after the ascites decreased, the dose interval was prolonged to 14 days because the cumulative dose causing side effects is not known
  • Intraperitoneal bleomycin controlled the ascites but had no effect on tumor progression
  • The patient developed pulmonary fibrosis after a cumulative bleomycin dose of 720 mg, which the authors said is three to four times the total intravenous dose associated with lung toxicity
  • After bleomycin was stopped, the ascites had not returned so far, and the patient was alive three years after diagnosis
  • The authors stated that when a malignant tumor occurs in a person with Thorotrast exposure and typical thorium dioxide deposits, a causal relationship must be considered
  • The authors noted that the mesothelioma was not in a directly irradiated area, but lay close to the thorium dioxide deposits in the liver, spleen and lymph nodes
• The authors' conclusion: The authors concluded that, given the pulmonary fibrosis and the lack of effect on tumor size, high-dose bleomycin given into the abdomen seems to offer no advantage over cisplatin

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Ascites, Pulmonary Fibrosis, Cisplatin.

Related studies

• Malignant peritoneal mesothelioma after cholangiography with thorotrast — R. Maurer, B. Egloff (1975)
• Peritoneal mesothelioma — W.J. Plaus (1988)
• "Signet-ring" cells--a caveat in the diagnosis of a diffuse peritoneal mesothelioma occurring in a lady presenting with recurrent ascites: an unusual case report — B. Rekhi, S. Pathuthara, et al. (2010)
• Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma — G.H. Eltabbakh, M.S. Piver, et al. (1999)
• Clinical presentation of peritoneal mesothelioma — Y.I. Acherman, L.S. Welch, et al. (2003)
• The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience — L. Orgiano, F. Pani, et al. (2016)

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