Malignant peritoneal mesothelioma in a patient with intestinal fistula, incisional hernia and abdominal infection: A case report

Our plain-English summary of Malignant peritoneal mesothelioma in a patient with intestinal fistula, incisional hernia and abdominal infection: A case report, by S. Hong, M.M. Bi, P.W. Zhao, et al (Oncology Letters, 2016).

The study

• Authors: S. Hong, M.M. Bi, P.W. Zhao, X.U. Wang, Q.Y. Kong, Y.T. Wang, L. Wang
• Journal: Oncology Letters
• Published: 2016;11(3):2047-2050
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a rare type of cancer, most commonly associated with exposure to asbestos. Mesothelioma of the peritoneum, the membrane lining the abdominal cavity, is extremely rare. The current study reports the case of a 60-year-old female who presented with intestinal fistula, recurrent incisional hernia and abdominal infection, with no history of asbestos exposure, and was diagnosed with clear cell MPM. Computed tomography scans of the abdomen revealed extensive small bowel adhesions and massive peritoneal effusion. Histological examination of biopsy specimens indicated a diagnosis of malignant peritoneal mesothelioma with clear cell morphology. A laparotomy was performed, with subsequent resection of the bowel with fistula. Follow-up examination performed at 1-year post-surgery revealed that the patient was alive and in generally good health.

In plain English

This article is a case report about one patient: a 60-year-old woman admitted to The First Hospital of Jilin University in Changchun, China, in August 2012 with an intestinal fistula, a recurrent incisional hernia and an abdominal infection. The authors reported that she had no history of asbestos exposure. They noted that she underwent three laparotomies, and that malignant peritoneal mesothelioma was diagnosed only after the last pathological analysis. A CT scan showed extensive small bowel adhesions and a large peritoneal effusion. During surgery, a 15x12x3 cm pus-filled cavity was found, and the necrotic fistula, which had white tumor-like nodules on its surface, was removed. Tissue examination showed malignant peritoneal mesothelioma that had invaded the intestinal submucosa and mesentery, with clear cells present. The tumor stained positive for calretinin. She refused chemotherapy. One year after surgery she was in generally good health, and she was still alive with no signs of recurrence when the article was written. The authors concluded that this diagnosis should be considered in patients with intractable intestinal fistula, incisional hernia and abdominal infection.

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 (one patient)
• Who was studied: One 60-year-old woman admitted to The First Hospital of Jilin University, Changchun, China, on August 21, 2012, with intestinal fistula, incisional hernia and abdominal infection
• Exposure: None. The authors report the patient had no history of asbestos exposure.
• Main results:
  • The patient underwent three laparotomies for incisional hernia and abdominal infection. Malignant peritoneal mesothelioma was diagnosed only after the last pathological analysis.
  • Abdominal CT scans showed extensive small bowel adhesion and massive peritoneal effusion.
  • At laparotomy on August 27, 2012, a massive purulent cavity (15x12x3 cm) was found outside the peritoneum in the lower abdomen. Multiple white nodules (1 to 5 mm) were found in the peritoneum.
  • Histological examination of the intestinal fistula biopsy showed malignant peritoneal mesothelioma invading the intestinal submucosa and mesenterium.
  • Some tumor cells were clear cells with prominent nuclei and clear cytoplasm.
  • The tumor showed positive immunoreactivity for calretinin, as well as pan-cytokeratin, cytokeratins 7, 14 and 19, EMA and other markers.
  • Blood tests showed a marginal increase in platelet count: 381 x 10^9 cells per litre, against a normal range of 100 to 300 x 10^9 cells per litre.
  • A fistula of the anastomotic lesion occurred 1 week after the operation and was treated with local flushing and dressing.
  • The patient refused all chemotherapy.
  • At 1-year follow-up the patient was in generally good health. At the time of writing she remained alive with no signs of recurrence.
• The authors' conclusion: The authors concluded that a diagnosis of malignant peritoneal mesothelioma should be considered in patients with intractable intestinal fistula, incisional hernia and abdominal infection. They suggested that these presentations may obscure recognition of the disease.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Malignant Mesothelioma, Mesothelioma, Peritoneum, Asbestos Exposure, Biopsy, Laparotomy.

Related studies

• Clear cell mesothelioma presenting as an incarcerated abdominal hernia — N.G. Ordóñez (2005)
• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2011)
• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2012)
• Benign cystic peritoneal mesothelioma incorrectly diagnosed as an ovarian borderline mucinous tumor of intestinal type at transvaginal preoperative ultrasound evaluation — A.C. Testa, G.F. Zannoni, et al. (2011)
• Malignant peritoneal mesothelioma giving rise to multiple intestinal polyps — F.G. Mayall, A.R. Gibbs (1991)
• Diffuse malignant peritoneal mesothelioma presenting as intestinal obstruction — J. Griniatsos, S. Sougioultzis, et al. (2009)

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