Malignant peritoneal mesothelioma without asbestos exposure: An ovarian cancer imitator

Our plain-English summary of Malignant peritoneal mesothelioma without asbestos exposure: An ovarian cancer imitator, by K.S. Grzankowski, R.M. Brightwell, J.M. Kasznica, et al (Gynecologic Oncology Reports, 2015).

The study

• Authors: K.S. Grzankowski, R.M. Brightwell, J.M. Kasznica, K.O. Odusi
• Journal: Gynecologic Oncology Reports
• Published: 2015;11:10-2
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

•Malignant peritoneal mesothelioma is a rare aggressive tumor with approximately 400 new cases annually in the US.•In optimal cytoreduction HIPEC is the standard treatment.•In suboptimal cytoreduction IV cisplatin and pemetrexed have high efficacy.

In plain English

This was a case report from Roswell Park Cancer Institute in Buffalo, New York. It described one 67-year-old postmenopausal woman with malignant peritoneal mesothelioma, a cancer of the lining of the abdomen, and no known asbestos exposure. She was a nonsmoking retired teacher who had been treated for breast cancer in 1997. After a month of worsening abdominal bloating, distension and early satiety, a CT scan showed fluid in the abdomen (ascites) and omental caking, and her CA-125 blood marker was 188 U/mL. Tests on the fluid were inconclusive. During surgery, a quick frozen-section test was reported as serous adenocarcinoma of primary peritoneal origin. Debulking surgery removed 95% of the tumor. Final pathology showed mesothelioma in the omentum and uterus, with surface involvement of both ovaries. She received four cycles of cisplatin and pemetrexed, followed by maintenance pemetrexed. A CT scan a year from diagnosis showed no interval change. The authors wrote that diagnosing this disease can be challenging and that frozen sections are often called serous in this setting.

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 (a single patient)
• Who was studied: One 67-year-old postmenopausal woman, a nonsmoking retired teacher with a history of stage I breast cancer treated in 1997 and negative BRCA testing, seen at Roswell Park Cancer Institute, Buffalo, NY, USA
• Exposure: No known asbestos exposure. The article gives no fiber type, job exposure or dose.
• Main results:
  • A CT scan of the patient showed ascites and omental caking.
  • The patient's CA-125 level was 188 U/mL.
  • During surgery, frozen-section assessment of the omental tumor was reported as serous adenocarcinoma, consistent with primary peritoneal origin.
  • Debulking surgery removed 95% of the tumor. Nodules of 1 cm were left behind.
  • Final pathology showed malignant peritoneal mesothelioma in the omentum and uterus, with surface involvement of both ovaries.
  • Immunohistochemical staining of the tumor was positive for WT-1, calretinin, D2-40 and cytokeratin 5/6.
  • The patient received cisplatin 60 mg/m2 and pemetrexed 500 mg/m2 every 21 days for 4 cycles. A CT scan after treatment showed mesenteric stranding but overall improvement of disease.
  • On maintenance pemetrexed, the most recent CT scan, a year from diagnosis, showed no interval change, with stable mesenteric stranding and nodularity.
• The authors' conclusion: The authors wrote that the diagnosis of malignant peritoneal mesothelioma can often be challenging, and that frozen sections are often called serous (resembling ovarian-type cancer) in the setting of this disease.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure, Ovarian Cancer, Cytoreductive Surgery, HIPEC, Cisplatin, Pemetrexed (Alimta).

Related studies

• Anticancer effect of bromelain with and without cisplatin or 5-FU on malignant peritoneal mesothelioma cells — K. Pillai, A. Ehteda, et al. (2014)
• Two cases of malignant peritoneal mesothelioma without asbestos exposure: cytologic and immunohistochemical features — Y. Kinoshita, K. Takasu, et al. (2013)
• Malignant Peritoneal Mesothelioma Without Asbestos Exposure — H. Abbas, J.C. Rodriguez, et al. (2019)
• Peritoneal mesothelioma without ascites formation — E. van der Harst, E.H. van Dongen, et al. (1993)
• A comparative immunohistochemical study of peritoneal and ovarian serous tumors, and mesotheliomas — N. Khoury, U. Raju, et al. (1990)
• Drugs, doses, and durations of intraperitoneal chemotherapy: standardising HIPEC and EPIC for colorectal, appendiceal, gastric, ovarian peritoneal surface malignancies and peritoneal mesothelioma — L. Lemoine, P. Sugarbaker, et al. (2017)

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