Peritoneal Mesothelioma with Residential Asbestos Exposure. Report of a Case with Long Survival (Seventeen Years) Analyzed by Cgh-Array

Our plain-English summary of Peritoneal Mesothelioma with Residential Asbestos Exposure. Report of a Case with Long Survival (Seventeen Years) Analyzed by Cgh-Array, by G. Serio, F. Pezzuto, A. Marzullo, et al (International Journal of Molecular Sciences, 2017).

The study

• Authors: G. Serio, F. Pezzuto, A. Marzullo, A. Scattone, D. Cavone, A. Punzi, F. Fortarezza, M. Gentile, A.L. Buonadonna, M. Barbareschi, L. Vimercati
• Journal: International Journal of Molecular Sciences
• Published: 2017;18(8)
• Type of article: Case report
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Unlabelled: Malignant mesothelioma is a rare and aggressive tumor with limited therapeutic options. We report a case of a malignant peritoneal mesothelioma (MPM) epithelioid type, with environmental asbestos exposure, in a 36-year-old man, with a long survival (17 years). The patient received standard treatment which included cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods And Results: Molecular analysis with comparative genomic hybridization (CGH)-array was performed on paraffin-embedded tumoral samples. Multiple chromosomal imbalances were detected. The gains were prevalent. Losses at 1q21, 2q11.1→q13, 8p23.1, 9p12→p11, 9q21.33→q33.1, 9q12→q21.33, and 17p12→p11.2 are observed. Chromosome band 3p21 (BAP1), 9p21 (CDKN2A) and 22q12 (NF2) are not affected. Conclusions: the defects observed in this case are uncommon in malignant peritoneal mesothelioma. Some chromosomal aberrations that appear to be random here, might actually be relevant events explaining the response to therapy, the long survival and, finally, may be considered useful prognostic factors in peritoneal malignant mesothelioma (PMM).

In plain English

This was a case report about one man. In May 1999, at age 36, he was admitted to hospital in Bari, southern Italy, and was diagnosed with malignant peritoneal mesothelioma, a cancer of the lining of the abdomen, of the epithelioid type. His asbestos exposure was found to be residential. For 36 years he had lived less than 15 metres from a source of asbestos pollution: military barracks with asbestos (eternit) in the roofs and chimneys. At a specialist centre in France he had six cycles of raltitrexed and oxaliplatin chemotherapy. He then had surgery to remove all visible tumors larger than 2 mm, combined with heated chemotherapy (oxaliplatin) inside the abdomen. At follow-up in November 2016, more than 17 years after diagnosis, he was alive and free of disease. A genetic test of tumor tissue (CGH-array) found 27 gains and 7 losses of chromosome segments. The regions containing the BAP1, CDKN2A and NF2 genes were not altered. The authors said the test failed to identify a compelling alteration that explains his outcome. They suggested that some changes might still explain his response and survival, and they called for systematic molecular studies.

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 molecular analysis of tumor tissue by comparative genomic hybridization (CGH)-array
• Who was studied: One 36-year-old man admitted in May 1999 to a hospital in Bari, Apulia Region, southern Italy, with ascites, abdominal pain and weight loss; diagnosed with malignant peritoneal mesothelioma, epithelioid type
• Exposure: Residential (environmental) asbestos exposure: lived less than 15 m from a source of asbestos pollution in buildings for 36 years. The fiber type is not stated.
• Main results:
  • The asbestos source was military barracks near his home; asbestos (eternit) was confirmed in their roofs and chimneys
  • Tumor histology: mesothelioma with a solid epithelial pattern (60%, predominant) and a pseudotubular pattern (40%)
  • Tumor tissue showed strong to moderate BAP1 nuclear expression
  • Treatment: six cycles of raltitrexed and oxaliplatin before surgery, then cytoreductive surgery with hyperthermic intraperitoneal chemotherapy using oxaliplatin, at Institute Gustave Roussy, France
  • The surgery achieved complete cytoreduction of all macroscopic tumors larger than 2 mm, together with peritonectomy, omentectomy and organ resection
  • The CGH-array found 27 gains and 7 losses of chromosome segments in the patient's tumor
  • The chromosome bands containing BAP1 (3p21), CDKN2A (9p21) and NF2 (22q12) were not altered in this tumor
  • The tumor showed loss at 8p23, a region the authors link to the PinX1 gene
  • The tumor showed loss at 9q33, which the authors describe as the putative site of the gelsolin (GSN) tumor suppressor gene
  • At follow-up in November 2016, more than 17 years after diagnosis, the patient was alive and disease-free without recurrence, but had chronic diarrhea and chronic abdominal pain
• The authors' conclusion: The authors concluded that some chromosomal changes that appear random in this case might be relevant to the patient's response to therapy and long survival, and might be useful prognostic factors in peritoneal malignant mesothelioma. They also said their analysis did not identify a compelling alteration to explain the outcome.
• Limitations the authors state:
  • The analysis failed to identify a compelling genetic alteration to explain the patient's outcome
  • The authors state that CGH-array is not the method to detect the status of genes involved in tumor progression
  • The authors state that systematic molecular analyses are needed to understand the chromosomal changes in these tumors

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure, Malignant Mesothelioma, Epithelioid, Cytoreductive Surgery, HIPEC, BAP1, CDKN2A.

Related studies

• Genomic copy number alterations in 33 malignant peritoneal mesothelioma analyzed by comparative genomic hybridization array — P. Chirac, D. Maillet, et al. (2016)
• High Wilms' tumour gene (WT1) expression and low mitotic count are independent predictors of survival in diffuse peritoneal mesothelioma — A. Scattone, G. Serio, et al. (2012)
• Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma — H.R. Alexander, D.L. Bartlett, et al. (2013)
• Long term survival and perioperative propensity score matched outcomes of diaphragmatic resections compared to stripping in cytoreductive surgery + intra-peritoneal chemotherapy — B. Singh, G. Singh, et al. (2020)
• Long-term Survival and Propensity Score Matched Outcomes of Bilateral vs. Unilateral Diaphragm Interventions in Cytoreductive Surgery plus Intra-peritoneal Chemotherapy — B. Singh, G. Singh, et al. (2018)
• ASO Author Reflections: Long-Term Survival Is Feasible After Complete CRS/HIPEC for Biphasic Peritoneal Mesothelioma — K. Chouliaras, K.I. Votanopoulos (2018)

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