Peritoneal mesothelioma presenting as a skin nodule

Our plain-English summary of Peritoneal mesothelioma presenting as a skin nodule, by C. Abban, M. Viglione (Journal of Cutaneous Pathology, 2009).

The study

• Authors: C. Abban, M. Viglione
• Journal: Journal of Cutaneous Pathology
• Published: 2009;36(6):675-9
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesothelioma is a malignancy of the pleura, pericardium and peritoneum that is rarely seen in cutaneous biopsies. We present a case of a 75-year-old man with significant occupational exposure to asbestos who developed peritoneal mesothelioma that presented as a skin nodule in an old appendectomy scar. The patient presented with a complaint of increased hardness along his appendectomy scar. Physical examination revealed an anterior abdominal wall mass overlying the appendectomy scar, which was subsequently biopsied. Histologic examination of the abdominal wall mass revealed an infiltrating epithelioid and papillary neoplasm within the dermis and subcutaneous tissue. Immunohistochemical stains showed immunoreactivity for cytokeratin (CK) 7, CK 5/6, calretinin and vimentin. CK 20, monoclonal carcinoembryonic antigen, prostate-specific antigen and prostate-specific acid phosphatase were negative. The profile supported the diagnosis of mesothelioma. Cutaneous presentation of mesothelioma is rare but should be considered in the differential diagnosis of patients with significant asbestos exposure.

In plain English

This was a case report about one patient. A 75-year-old man went to his physician with recurrent abdominal pain over the past year and increasing hardness along the scar from an appendectomy done about 50 years earlier. He had significant asbestos exposure during his military service in World War II. The article did not name the fiber type. A firm mass with reddish-blue skin discoloration was found over the scar, although none had been detected at a routine exam 3 months earlier. A CT scan showed widespread nodular disease in the abdomen, severe ascites and seeding of the peritoneum. The removed nodule was an infiltrating papillary tumor in the skin and the tissue beneath it. Stains were positive for CK 7, CK 5/6, vimentin and calretinin and negative for PSAP, PSA, CEA and CK 20. The authors diagnosed peritoneal mesothelioma of the epithelial type. The patient died of the mesothelioma within 6 months of diagnosis. The authors concluded that mesothelioma should be considered in the diagnosis of skin tumors, especially in older people with potential asbestos exposure.

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 75-year-old man. His history included an appendectomy about 50 years earlier, surgery for bladder carcinoma 5 years before presentation, and a subtotal colectomy 2 years before presentation. The article does not state the patient's location or the dates of care.
• Exposure: Significant asbestos exposure during military service in World War II. No fiber type, product or dose was given.
• Main results:
  • A mass was found in the front abdominal wall over the appendectomy scar, with marked firmness and reddish-blue discoloration of the skin. No mass had been found at a routine exam 3 months earlier.
  • CT of the abdomen and pelvis showed diffuse nodular disease, herniation of the caked omentum into the umbilical region, severe ascites, and seeding of the peritoneum.
  • CT also showed extensive calcifications of the anterior right diaphragmatic pleura, unchanged from a CT taken 2 years earlier.
  • Under the microscope, the excised nodule showed an infiltrating papillary tumor in the dermis and subcutaneous tissue, with areas of epithelioid cells.
  • The tumor cells stained positive for CK 7, CK 5/6, vimentin and calretinin.
  • The tumor cells stained negative for PSAP, PSA, CEA and CK 20.
  • The authors classified the tumor as an epithelial type mesothelioma, and the patient as having the wet form of peritoneal mesothelioma.
  • The patient died of the mesothelioma within 6 months of diagnosis.
• The authors' conclusion: The authors concluded that the patient's asbestos exposure history, the tumor's features and the staining profile established peritoneal mesothelioma. They found the case unusual because the skin nodule led the patient to seek care and provided the diagnosis. They concluded that mesothelioma should be considered in the diagnosis of skin tumors, especially in older people with potential asbestos exposure.
• Limitations the authors state:
  • Electron microscopy, which the authors describe as a possible aid to diagnosis, could not be done because only formalin-fixed tissue was available.

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: Peritoneal Mesothelioma, Mesothelioma, Pleura, Pericardium, Peritoneum, Occupational Exposure, Hardness (Mohs Scale), Epithelioid.

Related studies

• Peritoneal malignant mesothelioma with multiple distant skin metastases — N.G. Ordóñez, J.L. Smith (1983)
• Epithelioid malignant mesothelioma metastatic to the skin: A case report and review of the literature — R.E. Ward, S.A. Ali, et al. (2017)
• NLRP3 promotes inflammation-induced skin cancer but is dispensable for asbestos-induced mesothelioma — M.T. Chow, J. Tschopp, et al. (2012)
• Primary pleural epithelioid haemangioendothelioma with metastases to the skin. A case report and literature review — M. Al-Shraim, B. Mahboub, et al. (2005)
• Initiation-promotion versus complete skin carcinogenesis in mice: importance of dark basal keratinocytes (stem cells) — T.J. Slaga, A.J. Klein-Szanto (1983)
• beta-Carotene fails to act as a tumor promoter, induces RAR expression, and prevents carcinoma formation in a two-stage model of skin carcinogenesis in male Sencar mice — R.M. Ponnamperuma, Y. Shimizu, et al. (2000)

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