Malignant peritoneal mesothelioma mimicking mesenteric inflammatory disease

Our plain-English summary of Malignant peritoneal mesothelioma mimicking mesenteric inflammatory disease, by A. Andrion, E. Feyles, G. Zai, et al (Pathology, Research and Practice, 1994).

The study

• Authors: A. Andrion, E. Feyles, G. Zai, G. Passarino, F. Mollo
• Journal: Pathology, Research and Practice
• Published: 1994;190(6):615-22; discussion 623-6
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A case of malignant peritoneal mesothelioma mimicking mesenteric inflammatory disease (MID) is presented. The patient had mesenteric and omental lesions characterized at biopsy by extensive fibrosis of fat tissue with mild to moderate inflammation. One year later, post-mortem examination revealed a well-differentiated epithelial mesothelioma. Immunohistochemical stains for keratin and vimentin were diffusely positive, whereas EMA showed a membranous staining of scattered cells. CEA, Ber-EP4, B72.3 and Leu-M1 were negative. In addition, actin monoclonals decorated groups of cells pertaining to the tumoural component. Immunostains of sections from retrieved paraffin blocks of the previous biopsy showed that the bulk of the spindle-shaped and histiocytic-like cells present in the fibrous streams was strongly labeled by low-molecular-weight keratin, and coexpressed vimentin and actin. EMA showed a membranous staining of sporadic spindle and round cells. The other immunostains were invariably negative. This immunohistochemical pattern closely corresponded to the immunophenotype of the mesothelial tumour detected at autopsy and was very suggestive of myofibroblastic/submesothelial cell origin. The quantitative evaluation of silver nucleolar organizer regions (Ag-NORs) demonstrated high levels of cell proliferation in both surgical and autopsy tissue samples.

In plain English

This was a case report about one patient. A 60-year-old man was admitted to the City Hospital of Asti, Italy, in July 1990 with abdominal pain and weight loss. At surgery, bands of fibrous tissue involved his bowel, mesentery and omentum. Tissue samples showed scarring of fat with mild to moderate inflammation, and he was diagnosed with mesenteric inflammatory disease (MID). One year later he died, and autopsy found a well-differentiated epithelial mesothelioma of the peritoneum. No asbestos bodies were found in his lungs. He had worked all his life growing vines; his only possible asbestos contact was building a shed with asbestos-cement material about twenty years earlier. Stains of the earlier biopsy showed that most spindle-shaped and histiocytic-like cells in its fibrous bands had a marker pattern closely matching the autopsy tumour. A cell-growth measure (AgNOR count) averaged 6.7 per nucleus in the biopsies and 3.6 in the autopsy tumour. The authors interpreted the biopsy lesions as an early stage of the mesothelioma. They concluded that fibrotic, inflamed tumour-like lesions in the abdomen should be carefully evaluated to exclude malignancy.

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 (published as a teaching case)
• Who was studied: one 60-year-old man admitted to the City Hospital of Asti, Italy, in July 1990, with four months of intermittent abdominal pain and weight loss
• Exposure: a lifelong vineyard cultivator whose only possible asbestos contact, according to relatives interviewed, was building a shed with asbestos-cement material about twenty years earlier; no fiber type was named
• Main results:
  • At the 1990 operation, tissue from the mesentery and omentum showed fibrosis of fat with inflammation, and the patient was diagnosed with MID, possibly mesenteric panniculitis or retractile mesenteritis
  • At autopsy, tumour samples taken from various sites all showed epithelial mesothelioma of the peritoneum
  • At autopsy there was no interstitial pulmonary fibrosis, and the search for asbestos bodies in lung tissue was negative
  • The autopsy tumour cells were negative for high-molecular-weight keratin, CEA, Ber-EP4, Leu-M1 and B72.3, and were strongly positive for keratin cocktail and low-molecular-weight keratin
  • In the earlier biopsy, the bulk of the spindle-shaped and histiocytic-like cells in the fibrous streams was strongly positive for low-molecular-weight keratin and also expressed vimentin and actin; the authors found this pattern closely corresponded to the autopsy tumour
  • The mean AgNOR count (a measure of cell proliferation) was 3.6 dots per nucleus in the autopsy tumour tissue and 6.7 in the biopsies
• The authors' conclusion: The authors concluded that all intra-abdominal tumour-like lesions with fibrotic and inflammatory features should be carefully evaluated to exclude, as far as possible, a potential malignant behaviour, and that mesothelioma should be included among the possible malignancies. They also stated that a negative occupational history alone cannot rule out a diagnosis of malignant mesothelioma.
• Limitations the authors state:
  • The authors noted that counting asbestos bodies by light microscopy does not give a clear indication of exposure in equivocal cases

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, Biopsy, Fibrosis, Inflammation, Autopsy, Well-Differentiated, Mesothelioma, Ber-EP4.

Related studies

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• Neoplastic and inflammatory processes of the peritoneum, omentum, and mesentery: diagnosis with CT — J.E. Hamrick-Turner, M.V. Chiechi, et al. (1992)
• Malignant Peritoneal Mesothelioma: Characterization of the Inflammatory Response in the Tumor Microenvironment — S. Judge, P. Thomas, et al. (2016)
• Asbestos in extrapulmonary sites: omentum and mesentery — R.F. Dodson, M.F. O'Sullivan, et al. (2000)
• Metastatic Malignant Peritoneal Mesothelioma Mimicking an Autoinflammatory Syndrome in a 12-Year-Old Boy — G. Olmedilla, C. Undaondo, et al. (2021)
• Rapid Progression of Malignant Peritoneal Mesothelioma Mimicking a Postoperative Complication in a Young Woman: A Case Report — P.C. Altshuler, A.L. Newman, et al. (2024)

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