Peritoneal malignant mesothelioma with multiple distant skin metastases

Our plain-English summary of Peritoneal malignant mesothelioma with multiple distant skin metastases, by N.G. Ordóñez, J.L. Smith (Archives of Dermatology, 1983).

The study

• Authors: N.G. Ordóñez, J.L. Smith
• Journal: Archives of Dermatology
• Published: 1983;119(10):827-30
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Metastases in multiple distant sites, including the skin, developed in a 54-year-old man with diffuse malignant abdominal mesothelioma. To our knowledge, this represents the first reported case of cutaneous metastasis arising from malignant mesothelioma. Recent advances in diagnostic techniques, such as electron microscopy, may be helpful in differentiating this condition from metastatic adenocarcinoma.

In plain English

This article was a case report of one patient. He was a 54-year-old man with a history of asbestos exposure in his work as an insulator, and he had diffuse malignant mesothelioma of the abdomen (peritoneal mesothelioma). He was treated at M. D. Anderson Hospital and Tumor Institute in Houston from 1980. He received several chemotherapy regimens, one of which brought temporary improvement. In early 1981, papules and nodules appeared in the skin of the neck, chest, right flank and left abdominal wall. These were not biopsied during life. The patient died in October 1981. At autopsy, the skin nodules looked the same under the microscope as the abdominal tumor. Tumor had also spread to lymph nodes, pleura, lungs, kidneys, thyroid and adrenal glands. Pleural plaques were present on both sides. The lungs contained 266,000 asbestos bodies per gram of wet lung, along with chrysotile, amosite and crocidolite fibers. The authors reported finding no earlier report of skin metastases from mesothelioma. They concluded that awareness of this possibility, special stains and electron microscopy may help pathologists avoid mistaking these tumors for more common carcinomas.

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, including autopsy findings)
• Who was studied: One 54-year-old man with diffuse malignant abdominal (peritoneal) mesothelioma, referred to M. D. Anderson Hospital and Tumor Institute, Houston, and followed from September 1980 until his death in October 1981
• Exposure: Occupational asbestos exposure as an insulator; no fiber types or doses of exposure were described, though lung analysis at autopsy found chrysotile and amphibole fibers (amosite, crocidolite and unclassified amphiboles)
• Main results:
  • During life, skin and subcutaneous papules and nodules developed on the back of the neck, right side of the chest, right flank and left abdominal wall, and were believed to be metastases. They were not biopsied at that time.
  • Methotrexate and fluorouracil chemotherapy brought temporary improvement in abdominal pain and some shrinking of the subcutaneous papules.
  • The patient's condition deteriorated, and he died in October 1981.
  • At autopsy, the skin nodules measured 0.1 to 0.6 cm across. The tumor looked similar under the microscope in all locations, including the skin, with a tubular-papillary pattern.
  • Electron microscopy showed tumor cells surrounded by a basal lamina, with desmosomes between cells and numerous well-developed microvilli. These are features the authors describe as supporting a diagnosis of mesothelioma.
  • Microscopic metastases were also found in the pleura, lungs, kidneys, thyroid and adrenal glands, and many lymph nodes were infiltrated by tumor.
  • The authors interpreted tumor cells in the skin's lymphatic vessels as the route by which the tumor spread to the skin.
  • Bilateral basal pleural plaques were present at autopsy.
  • Numerous asbestos bodies were found in uninvolved lung tissue and lymph nodes but none in the tumor. The asbestos body count was 266,000 per gram of wet lung.
  • Lung fiber analysis found chrysotile and amphibole fibers, with the amphiboles divided into amosite, crocidolite and unclassified amphiboles. The fiber concentrations cannot be reported because their powers of ten are unreadable in the scanned text.
• The authors' conclusion: The authors stated they were unable to find any previous report of skin metastases from mesothelioma. They suggested that skin metastases could become more frequent as therapy improves and survival lengthens. They concluded that awareness of this possibility, and use of special histochemical stains and electron microscopy, may help pathologists avoid mistaking these tumors for more common carcinomas.

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, Mesothelioma, Metastasis, Adenocarcinoma.

Related studies

• Peritoneal mesothelioma presenting as a skin nodule — C. Abban, M. Viglione (2009)
• Primary pleural epithelioid haemangioendothelioma with metastases to the skin. A case report and literature review — M. Al-Shraim, B. Mahboub, et al. (2005)
• An autopsy case of serous papillary carcinoma of peritoneum with distant metastases but no peritoneal dissemination — O. Miyaishi, K. Iida, et al. (1994)
• Multiple distant metastases in a case of malignant pleural mesothelioma — K.C. Tertemiz, A. Ozgen Alpaydin, et al. (2014)
• Distant cutaneous metastasis of malignant epithelioid mesothelioma — K. Collins, P. Nagarajan, et al. (2021)
• NLRP3 promotes inflammation-induced skin cancer but is dispensable for asbestos-induced mesothelioma — M.T. Chow, J. Tschopp, et al. (2012)

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