Mucin-positive epithelial mesothelioma of the peritoneum: small bowel involvement

Our plain-English summary of Mucin-positive epithelial mesothelioma of the peritoneum: small bowel involvement, by J.H. Kim, K.Y. Kwon, Y.K. Jeon, et al (Pathology International, 2011).

The study

• Authors: J.H. Kim, K.Y. Kwon, Y.K. Jeon, J.H. Nam, C. Choi, C.L. Hyeon, Y.D. Choi
• Journal: Pathology International
• Published: 2011;61(12):756-61
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mucin-positive epithelial mesothelioma has been reported in the peritoneum only once, and that mainly involved the stomach wall. We report the second peritoneal case and this is the first case mainly involving the small bowel wall. A 65-year-old man showed diffuse involvement from the duodenum to the ileum and metastatic masses in the left adrenal gland. Segmental resection of the small bowel was performed; 2 months later the patient died. Light microscopy showed diffusely anaplastic epithelioid cell proliferation and foci of glandular formation with granular mucinous materials in the cytoplasmic vacuoles or within glandular lumina. Histochemically, these mucin materials were PAS-positive and diastase-resistant. Immunohistochemically, the various mesothelial markers were positive, and a few adenocarcinoma markers were focally positive. Ultrastructurally, the tumor cells showed long slender microvilli on the apical surface, consistent with mesothelioma. Electron microscopy can play a decisive role in the case of ambiguous histochemical and immunohistochemical results.

© 2011 The Authors. Pathology International © 2011 Japanese Society of Pathology and Blackwell Publishing Asia Pty Ltd.

In plain English

This case report described one 65-year-old man with mucin-positive epithelial mesothelioma of the peritoneum. The authors said this tumor type had been reported in the peritoneum only once before. He had about 20 years of asbestos exposure working as a boiler repairman. Asbestos bodies were not found in his pleural fluid or ascites, and the article did not name a fiber type. He came to hospital with bowel obstruction. Scans showed small bowel wall thickening and a mass in the left adrenal gland. Surgeons removed part of the small bowel, where tumor extended about 1.5 m. The tumor contained mucin-like material that stained in ways usually linked to adenocarcinoma, and some adenocarcinoma markers were focally positive. Several mesothelial markers were also positive. Scanning electron microscopy showed long, slender, branching microvilli consistent with mesothelioma. Genetic testing found a heterozygous 9p21 deletion. He refused further therapy and died 2 months after surgery, with no autopsy. The authors concluded that electron microscopy was very crucial for reaching the final diagnosis.

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
• Who was studied: One 65-year-old man with bowel obstruction symptoms; the authors are from university pathology departments in Korea
• Exposure: About 20 years of asbestos exposure while employed as a boiler repairman; no fiber type given
• Main results:
  • Tumor formed circumferential masses about 1.5 m long through the small intestine from the jejunum to the ileum
  • CT showed a mass in the left adrenal gland
  • Asbestos bodies were not found in the pleural fluid or ascites
  • The mucin material was PAS-positive and diastase-resistant and positive with mucicarmine stain
  • Hyaluronidase pretreatment only slightly reduced the intensity of the mucin stains
  • Mesothelial markers thrombomodulin, WT1 gene product and CD146 were diffusely positive
  • Adenocarcinoma markers MOC-31, CEA and Ber-EP4 were focally positive (Leu-M1 negative)
  • Scanning electron microscopy showed long, slender, often branching and undulating microvilli on the tumor cell surface
  • FISH showed heterozygous deletion of the 9p21 locus (9p21/CEP9 ratio 0.64), and tumor cells were negative for p16
  • The patient refused further therapy and died 2 months after surgery
• The authors' conclusion: The authors concluded that scanning electron microscopy on paraffin-embedded tissue was very crucial for establishing the final diagnosis of epithelioid malignant mesothelioma with mucin-producing tumor cells

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: Mesothelioma, Peritoneum, Epithelioid, Adenocarcinoma.

Related studies

• 'Mucin-positive' epithelial mesothelioma of the peritoneum: an unusual diagnostic pitfall — D.S. Cook, R.L. Attanoos, et al. (2000)
• Primary Peritoneal Mesothelioma Resulting in Small Bowel Obstruction: A Case Report and Review of Literature — S.C. Frontario, A. Loveitt, et al. (2015)
• Airway epithelial NF-kappaB activation modulates asbestos-induced inflammation and mucin production in vivo — A. Haegens, T.F. Barrett, et al. (2007)
• Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands — T.R. van Oudheusden, V.E. Lemmens, et al. (2015)
• Gene expression profiles reveal increased mClca3 (Gob5) expression and mucin production in a murine model of asbestos-induced fibrogenesis — T. Sabo-Attwood, M. Ramos-Nino, et al. (2005)
• Immunocytochemistry and ELISA quantitation of mucin for diagnosis of malignant pleural effusions — P.C. Yang, K.T. Luh, et al. (1992)

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