Metastasis of malignant peritoneal epithelioid mesothelioma in endoscopic gastric biopsy: a diagnostic pitfall

Our plain-English summary of Metastasis of malignant peritoneal epithelioid mesothelioma in endoscopic gastric biopsy: a diagnostic pitfall, by L. Daniele, A. Righi, A. Ferraris, et al (International Journal of Surgical Pathology, 2011).

The study

• Authors: L. Daniele, A. Righi, A. Ferraris, L. Macrì, S. Asioli
• Journal: International Journal of Surgical Pathology
• Published: 2011;19(2):217-9
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: To describe a case of metastasis of malignant peritoneal epithelioid mesothelioma in gastric antral mucosa in a patient with a cryptogenic liver cirrhosis associated with esophageal varices, abdominal pain and distension, ascites, and weight loss.

Materials And Method: The patient underwent esophageal gastric endoscopy for varices, and a biopsy of a polypoid antral lesion was performed. The latter revealed a proliferation of polygonal cells with moderately atypical nuclei and pale eosinophilic, peripherally condensed cytoplasm infiltrating into the lamina propria between the normal mucosal glands of the antrum. The tumor cells were diffusely positive to anticalretinin antibody, whereas anti-claudin 4 and anti-CEA antisera were negative.

Conclusions: Metastases of malignant peritoneal mesotheliomas are unusual, and a predominantly gastrointestinal localization is rare. Pathologists should be aware of this possibility to avoid misdiagnosis, particularly in small biopsy specimens.

In plain English

This article was a case report about one patient. In August 2007, a 64-year-old man with liver cirrhosis of unknown cause came to an Italian hospital with abdominal pain and swelling, abdominal fluid (ascites) and weight loss of up to 30 kg over the past year. He had no history of known exposure to asbestos. Antibiotics for suspected abdominal infection did not help; blood tumor markers were normal. Endoscopy found a swollen, polyp-like area in the lower stomach, which was biopsied. Special stains showed tumor cells positive for calretinin and cytokeratin and negative for claudin-4 and CEA. These findings were consistent with metastatic malignant mesothelioma of the epithelial type in the stomach lining. A CT scan then showed thickening of the abdominal lining. The patient received chemotherapy and, after 7 months of follow-up, was alive with disease but severely wasted (cachectic). The authors stated that, to their knowledge, this was the first reported case in which a stomach metastasis was the first sign of peritoneal mesothelioma. They concluded that mesothelioma in gastrointestinal biopsies is rare and can be hard to diagnose if not considered.

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), with a brief literature search in the discussion
• Who was studied: one 64-year-old man with cryptogenic liver cirrhosis and esophageal varices, seen in August 2007 at the authors' hospital in Italy
• Exposure: No asbestos exposure was studied. The patient had no history of known exposure to asbestos.
• Main results:
  • The patient presented with abdominal pain and distension, ascites, and significant weight loss (up to 30 kg) during the past year
  • Treatment for suspected spontaneous bacterial peritonitis with antibiotics for a couple of weeks produced no response
  • Serum tumor markers (CA125, CEA and CA15.3) were within normal limits
  • Endoscopy showed edematous, polypoid gastric antral mucosa, which was biopsied
  • Tumor cells in the biopsy showed strong reactivity for AE1/AE3 cytokeratin and calretinin
  • Tumor cells were negative for claudin-4 and CEA, and stains for intracellular mucin (PAS and PAS-D) were negative
  • The appearance and staining results were consistent with a metastasis of malignant mesothelioma, epithelial type, in the antral mucosa
  • After diagnosis, a CT scan with contrast showed parietal peritoneal thickening, particularly in the mesogastric region
  • The patient received single-drug chemotherapy (Alimta protocol)
  • At the time of the report the patient was alive with disease and cachectic (severely wasted)
  • Follow-up at the time of the report was 7 months
  • The authors' literature search found only 5 earlier clinical cases of malignant mesothelioma involving the luminal gastrointestinal tract: 4 from the pleura and 1 from the peritoneum
  • The authors stated that, to their knowledge, this was the first reported case of a gastric metastasis occurring as the first sign of peritoneal mesothelioma
• The authors' conclusion: The authors concluded that finding malignant mesothelioma in endoscopic gastrointestinal biopsies is exceptionally rare and may pose great diagnostic challenges if pathologists do not consider the possibility.

Topics

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

Medical terms in this study, explained in our Lexicon: Metastasis, Epithelioid, Mesothelioma, Biopsy, Ascites, Endoscopy, Eosinophilic, Peritoneal Mesothelioma.

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