Peritoneal malignant mesothelioma in a patient with recurrent peritonitis

Our plain-English summary of Peritoneal malignant mesothelioma in a patient with recurrent peritonitis, by R.H. Riddell, M.J. Goodman, A.R. Moossa (Cancer, 1981).

The study

• Authors: R.H. Riddell, M.J. Goodman, A.R. Moossa
• Journal: Cancer
• Published: 1981;48(1):134-9
• Type of article: Case report
• Cited by: 59 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000771).

Abstract

A patient is presented who developed a peritoneal malignant mesothelioma in association with severe persistent and recurrent diverticulitis. The case is unusual in that a spectrum of mesothelial proliferation was documented beginning initially as benign foci of mesothelial proliferation and passing through a stage of atypical proliferation before terminating as a malignant process. The possible role of the diverticular disease in the pathogenesis of the tumor is discussed.

In plain English

This article was a case report of one patient, a white man who died in 1976 at age 44, who developed malignant mesothelioma of the peritoneum (the lining of the abdomen). He had no known exposure to asbestos, and review of his chest x-rays showed no evidence of it. His first attack of fever and abdominal pain, in 1963, was diagnosed as peritonitis; after a similar attack two years later, x-rays showed sigmoid diverticula and diverticulitis was diagnosed. Over about nine months he had three abdominal operations. Tissue from the first showed small foci of papillary mesothelial cells that looked benign. Tissue from the second showed atypical mesothelial proliferation, and other pathologists were equally divided on whether it was reactive or malignant. Biopsies from the third were interpreted as malignant mesothelioma. Diverticulitis itself was never found in the removed bowel, and fluid in the abdomen (ascites) was never present. He received three courses of Adriamycin without significant benefit and died suddenly. Autopsy was refused. The authors said the exact relationship between his diverticulitis and the mesothelioma was unclear, but suggested that chronic irritation may well have played a part.

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 white male patient, a part-time student and part-time insurance agent, 44 years old at death in 1976, treated at the University of Chicago Hospitals from 1975
• Exposure: No known asbestos exposure; the condition studied was severe recurrent abdominal inflammation, first diagnosed as peritonitis in 1963 and later as diverticulitis
• Main results:
  • The first attack, in 1963, was diagnosed clinically as peritonitis at another hospital
  • After a recurrence two years later, barium x-rays showed sigmoid diverticula and diverticulitis was diagnosed
  • Chest x-rays showed no evidence of asbestos exposure, and no source of exposure was found
  • First resection (sigmoid colon, 1975): small foci of papillary proliferating mesothelial cells on the bowel surface, with no evidence of diverticulitis
  • Second operation (total abdominal colectomy, late 1975): atypical mesothelial proliferation; reviewing pathologists were equally divided between reactive proliferation and malignant mesothelioma
  • Third operation (March 1976): omental and peritoneal biopsies were interpreted as malignant mesothelioma
  • Only nine months passed between the first and third operations
  • Diverticulitis was never found in this patient's removed tissue
  • Ascites was never present, which the authors noted was unusual for malignant mesothelioma
  • The patient received three courses of Adriamycin without significant benefit, died suddenly, and autopsy was refused
• The authors' conclusion: The authors concluded that, given the severity of his diverticular disease in a man in his early forties, it was difficult to conclude there was no relationship between the two diseases, and that chronic irritation of the peritoneum may well have played a part in causing the mesothelioma
• Limitations the authors state:
  • The authors stated that the exact relationship between the diverticulitis and the mesothelioma was unclear
  • The authors could not be certain of the sequence from benign to atypical to malignant, because no biopsies of other parts of the peritoneum or omentum were taken at the first operation
  • Benign neoplastic and reactive mesothelial lesions cannot be told apart by appearance, so the initial lesion may already have been a low grade tumor
  • No autopsy was performed

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: Malignant Mesothelioma.

Related studies

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• Coexistence of diffuse malignant peritoneal mesothelioma and Candida norvegensis peritonitis — E. Virgilio, P. Mercantini, et al. (2014)
• Genomic profiling of malignant peritoneal mesothelioma reveals recurrent alterations in epigenetic regulatory genes BAP1, SETD2, and DDX3X — N.M. Joseph, Y.Y. Chen, et al. (2017)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• 18F-FDG PET/CT in a recurrent diffuse malignant peritoneal mesothelioma — Q. Cao, M. Lu, et al. (2012)

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