Malignant pleural mesothelioma presenting as an acute surgical abdomen due to metastatic jejunal perforation

Our plain-English summary of Malignant pleural mesothelioma presenting as an acute surgical abdomen due to metastatic jejunal perforation, by K. Gocho, K. Isobe, K. Kaburaki, et al (Internal Medicine, 2010).

The study

• Authors: K. Gocho, K. Isobe, K. Kaburaki, Y. Honda, A. Mitsuda, Y. Akasaka, N. Shimada, K. Takagi, S. Homma
• Journal: Internal Medicine
• Published: 2010;49(6):597-601
• Type of article: Case report, Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 52-year-old man was admitted to our hospital in June 2008 presenting abnormal tumor lesions along the left pleura on chest X-ray. The needle-biopsied specimen of the left pleura proved the biphasic type of malignant mesothelioma. However, he complained of acute abdominal pain 7 days after the diagnosis. Chest X-ray revealed free air below the right diaphragm. Emergency surgery revealed a 4-cm perforating jejunal tumor with peritonitis. Histopathology of the resected jejunum demonstrated a metastatic tumor of malignant pleural mesothelioma. This is the first reported case of malignant pleural mesothelioma presenting as an acute surgical abdomen due to jejunal metastasis with perforation.

In plain English

This case report from Toho University Omori Medical Center, Tokyo, described a 52-year-old man admitted in June 2008 with tumor lesions along the left pleura. The patient, a heavy smoker, had been exposed to asbestos for over 30 years as an electrical engineer. A needle biopsy of the left pleura showed the biphasic type of malignant pleural mesothelioma, stage IV, with no evidence of distant spread at initial staging. Seven days after diagnosis, the patient was readmitted with sudden severe abdominal pain, and a chest X-ray showed free air below the right diaphragm. Emergency surgery found a 4 cm tumor that had perforated the jejunum, part of the small intestine. Its microscopic and staining pattern matched the pleural tumor, which the authors judged consistent with spread from the pleural mesothelioma. After chemotherapy with cisplatin and pemetrexed, brain and liver metastases appeared, and the patient died 12 months after the operation. The authors concluded that small bowel metastasis should be considered when patients with this disease have acute abdominal pain or bloody stool.

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 52-year-old man admitted in June 2008 to Toho University Omori Medical Center, Tokyo, with tumor lesions along the left pleura
• Exposure: Asbestos exposure for over 30 years working as an electrical engineer (fiber type not stated); the patient was also a heavy smoker
• Main results:
  • Needle biopsy of the left pleura showed the biphasic type of malignant pleural mesothelioma. The disease was staged as stage IV (cT4N1M0) under the International Mesothelioma Interest Group criteria.
  • At initial staging there was no evidence of distant metastases. Abdominal CT and FDG-PET showed no peritoneal spread, metastatic masses or ascites.
  • Seven days after diagnosis the patient was readmitted with sudden severe acute abdominal pain. A chest X-ray showed free air below the right diaphragm.
  • Emergency surgery found a 4 cm perforating tumor of the jejunum, 40 cm beyond the ligament of Treitz. It invaded the full thickness of the bowel wall and had a central perforating ulcer.
  • The jejunal tumor showed a biphasic growth pattern. It was positive for calretinin and vimentin and negative for CEA, the same pattern as the pleural biopsy. The authors found this consistent with a metastatic jejunal tumor arising from the pleural mesothelioma.
  • FDG-PET did not detect the jejunal metastasis.
  • The patient received cisplatin and pemetrexed for one month after the operation. Brain metastasis developed at 8 months, and multiple liver metastases with peritoneal dissemination at 10 months. The patient died of advanced disease 12 months after the operation.
• The authors' conclusion: The authors stated that this presentation had not been reported before. They concluded that small bowel metastasis should be considered in patients with malignant pleural mesothelioma who have acute abdominal pain and/or bloody stool.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleura, Chest X-Ray, Biphasic Mesothelioma, Malignant Mesothelioma, Diaphragm, Histopathology, Metastasis.

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• Jejunal Perforation by Metastasis of Malignant Pleural Mesothelioma — M.I. Navarro García, A. Sánchez Pérez, et al. (2015)
• Incidental mesonephric remnant hyperplasia of the jejunal mesentery: A diagnostic challenge — J.F. Val-Bernal, M.M. Mayorga, et al. (2021)
• Acute severe abdominal pain in a young woman caused by a well-differentiated papillary mesothelioma of the peritoneum — J.E. Bousema, K.M. van de Luijtgaarden, et al. (2019)
• Acute abdomen in an asbestos factory worker — S. Narasimhan, D. Brian, et al. (2008)
• Malignant pleural mesothelioma presenting as acute empyema with severe leukocytosis — K. Matsuoka (2014)
• Metastatic pleural mesothelioma presenting with solitary involvement of the tongue: report of a new case and review of the literature — F. Zanconati, A. DelConte, et al. (2003)

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