Malignant peritoneal mesothelioma and Crohn disease

Our plain-English summary of Malignant peritoneal mesothelioma and Crohn disease, by K.J. Butnor, E.N. Pavlisko, T.A. Sporn, et al (Journal of Clinical Pathology, 2017).

The study

• Authors: K.J. Butnor, E.N. Pavlisko, T.A. Sporn, V.L. Roggli
• Journal: Journal of Clinical Pathology
• Published: 2017;70(3):228-232
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: Mesothelial reaction simulating peritoneal diffuse malignant mesothelioma (MM) has been reported in the setting of Crohn ileitis. To our knowledge, peritoneal MM arising in patients with inflammatory bowel disease (IBD) has not been reported. The purpose of this study is to report the clinicopathological characteristics of patients with peritoneal MM and IBD.

Methods: A database of approximately 3800 MM was reviewed for cases of MM in patients with IBD.

Results: Three patients (0.08%) with peritoneal MM and Crohn disease (CD) were identified, including two women and one man ranging in age from 56 to 65 years. All had a long-standing history of diarrhoea and an established diagnosis of CD of 3 years or greater duration. Two had epithelial MM and one had biphasic MM. Only one had documented asbestos exposure.

Conclusions: Peritoneal MM occurs rarely in patients with IBD, but interestingly, has only been observed in the setting of CD and not in patients with ulcerative colitis. Chronic inflammation has been associated with the development of MM in rare instances and these three cases suggest that CD with transmural inflammation may also be a precursor. The precise role of CD-related transmural inflammation in the carcinogenesis of peritoneal MM remains to be determined.

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In plain English

This was a case series. The authors searched about 3800 malignant mesothelioma cases, 500 of them peritoneal, in one author's database of cases received for professional and medicolegal consultation since 1982. They looked for patients who also had inflammatory bowel disease. They found three patients with peritoneal mesothelioma and Crohn disease, 0.08% of all cases in the database: two women and one man, aged 56 to 65. Crohn disease had been diagnosed 3 to 40 years before the mesothelioma. Two tumours were epithelial and one was biphasic. In all three, mesothelioma symptoms were first attributed to Crohn disease for up to 4 months. Two patients died at 2 and 30 months; one was alive with disease at 30 months. Only one, who had chrysotile exposure through brake repair, had documented asbestos exposure. No lung tissue was available to check for asbestos bodies. No peritoneal mesothelioma was found with ulcerative colitis. The authors concluded that inflammation from Crohn disease should be considered a possible inducing factor in rare cases of 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: Retrospective case series drawn from a mesothelioma consultation database
• Who was studied: About 3800 malignant mesothelioma cases (500 peritoneal) received for professional and medicolegal consultation from 1982 onward. Three patients had peritoneal mesothelioma and Crohn disease: two women and one man, aged 56 to 65 (median 60).
• Exposure: The condition studied was Crohn disease (inflammatory bowel disease). For asbestos, one of the three patients (case 3) had documented exposure to chrysotile asbestos through brake repair as a mechanic. The other two had no identified asbestos exposure.
• Main results:
  • Three patients had peritoneal mesothelioma and Crohn disease. They made up 0.08% of all approximately 3800 mesothelioma cases in the database, not 0.08% of the 500 peritoneal cases.
  • In all three patients, Crohn disease had been diagnosed at least 3 years (range 3 to 40 years) before the mesothelioma.
  • Two of the three tumours were epithelial mesothelioma and one was biphasic.
  • In all three cases, signs and symptoms of mesothelioma were first attributed to Crohn disease and managed as such for up to 4 months.
  • Two patients died of the disease at 2 and 30 months after diagnosis. The third was alive with disease at 30 months of follow-up.
  • All three peritoneal mesothelioma cases occurred with Crohn disease. None occurred with ulcerative colitis.
  • Based on US population prevalence figures, the authors estimated that less than one case of Crohn disease would have been expected among the 500 peritoneal mesotheliomas. They suggested that their three cases point to an increased prevalence of Crohn disease in people with peritoneal mesothelioma.
• The authors' conclusion: The authors concluded that their observations prompt consideration of chronic serosal inflammation caused by Crohn disease as a possible inducing factor in rare cases of peritoneal mesothelioma. They also stated that its precise role remains to be determined.
• Limitations the authors state:
  • No lung tissue was sampled in any case, so the presence or absence of asbestos bodies or asbestosis could not be assessed.
  • The authors could not identify objective markers of asbestos exposure in any of the three cases.
  • The slides had been returned to the original institutions, and the Crohn disease diagnosis was confirmed pathologically in only one case.
  • Several newer immunohistochemical markers for distinguishing mesothelioma from carcinoma were not in widespread use when these cases were evaluated.

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Malignant Mesothelioma, Standing, Biphasic Mesothelioma, Asbestos Exposure, Chronic Inflammation, Inflammation, Carcinogenesis.

Related studies

• Malignant peritoneal mesothelioma in patients with endometriosis — K.J. Butnor, J. Rueckert, et al. (2018)
• Asbestos content of lung tissue in patients with malignant peritoneal mesothelioma: A study of 42 cases — G.G. de Ridder, A. Kraynie, et al. (2016)
• Sarcomatoid Peritoneal Mesothelioma: Clinicopathologic Correlation of 13 Cases — E.N. Pavlisko, V.L. Roggli (2015)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• Target region resection in patients undergoing cytoreductive surgery for peritoneal metastases-is it necessary in absence of visible disease? — A. Bhatt, Y. Yonemura, et al. (2020)
• Current practice in cytoreductive surgery and HIPEC for metastatic peritoneal disease: Spanish multicentric survey — R. Morales-Soriano, N. Esteve-Pérez, et al. (2018)

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