Primary malignant mesothelioma of the appendix

Our plain-English summary of Primary malignant mesothelioma of the appendix, by K. Hayashi, M. Takamura, Y. Sato, et al (Internal Medicine, 2012).

The study

• Authors: K. Hayashi, M. Takamura, Y. Sato, K. Takahashi, H. Sato, K. Youkou, H. Yokoyama, M. Nomoto, C. Inoue, G. Hasegawa, Y. Aoyagi
• Journal: Internal Medicine
• Published: 2012;51(9):1027-30
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

We report a case of primary malignant mesothelioma of the appendix. A 35-year-old man without any history of asbestos exposure was admitted to our hospital for further examination following the discovery of multiple liver tumors, an ileocecal tumor, and abdominal lymph node swelling. An ultrasound-guided liver tumor biopsy revealed malignant mesothelioma. Despite receiving systemic chemotherapy, he died 3 months after the initial diagnosis. At autopsy, a diagnosis of multiple organ metastases from a malignant biphasic mesothelioma of the appendix was made. To our knowledge, this is only the second reported case of primary malignant mesothelioma of the appendix.

In plain English

This case report from Japan described a 35-year-old man with primary malignant mesothelioma of the appendix. The authors stated that he had no history of asbestos exposure. He was admitted in March 2010 after multiple liver tumors, an ileocecal (lower bowel) tumor and swollen abdominal lymph nodes were found. A liver biopsy led to a diagnosis of malignant mesothelioma. First-line chemotherapy with pemetrexed and cisplatin did not work: the liver tumors grew after 2 courses. During second-line chemotherapy he developed a widespread clotting disorder and an extensive stroke, and he died 3 months after diagnosis. Autopsy found a 5 cm tumor at the far end of the appendix made of epitheloid and sarcomatoid parts (biphasic mesothelioma). It had spread to the liver, lungs, right kidney and lymph nodes. Autopsy found no evidence of asbestos in the pleura or peritoneum. The authors concluded that, to their knowledge, this was only the second reported case of this tumor, and that more cases are needed to understand how it develops and behaves.

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 (one patient, including autopsy)
• Who was studied: One 35-year-old man admitted to a university hospital in Niigata, Japan, in March 2010 with right lower abdominal pain
• Exposure: The patient had no history of asbestos exposure. At autopsy, no evidence of asbestos was found in the pleura or peritoneum.
• Main results:
  • Liver biopsy tumor cells were positive for calretinin and mesothelin, and the patient was diagnosed with malignant mesothelioma.
  • The patient's serum soluble mesothelin-related peptides (SMRP) level on admission was 4.0 nmol/L (reference 1.5 nmol/L).
  • After 2 courses of first-line pemetrexed plus cisplatin, the patient's liver tumors had enlarged.
  • The patient died 3 months after the initial diagnosis despite systemic chemotherapy. During second-line chemotherapy he developed disseminated intravascular coagulation and extensive cerebral infarction, and died 4 days later.
  • At autopsy, the cause of death was confirmed as Trousseau syndrome.
  • At autopsy, a tumor measuring 5 cm in greatest dimension had arisen from the distal end of the appendix. It was composed of epitheloid and sarcomatoid components.
  • At autopsy, metastases were found in the liver, lungs, right kidney, and the mediastinal, abdominal and pelvic lymph nodes.
• The authors' conclusion: The authors concluded that this was a rare case of primary malignant biphasic mesothelioma of the appendix and, to their knowledge, only the second reported case. They stated that further cases are needed to clarify how this tumor develops and behaves. They also suggested that affected patients be treated as intensively as those with diffuse malignant peritoneal mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Asbestos Exposure, Discovery, Ultrasound, Biopsy, Chemotherapy, Autopsy, Biphasic Mesothelioma.

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