Primary Peritoneal Mesothelioma Resulting in Small Bowel Obstruction: A Case Report and Review of Literature

Our plain-English summary of Primary Peritoneal Mesothelioma Resulting in Small Bowel Obstruction: A Case Report and Review of Literature, by S.C. Frontario, A. Loveitt, A. Goldenberg-Sandau, et al (The American Journal of Case Reports, 2015).

The study

• Authors: S.C. Frontario, A. Loveitt, A. Goldenberg-Sandau, J. Liu, D. Roy, L.W. Cohen
• Journal: The American Journal of Case Reports
• Published: 2015;16:496-500
• Type of article: Case report, Review
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Peritoneal mesothelioma is a rare malignancy that affects the serosal surfaces of the peritoneum. The peritoneum is the second most common site of mesothelium affected following the pleura. The aggressive nature and vague presentation pose many obstacles in not only diagnosis but also the treatment of patients with this disease.

Case Report: We present a case of a 76-year-old woman who presented with small bowel obstruction secondary to carcinomatosis secondary to primary peritoneal mesothelioma. The patient had multiple risk factors with asbestos exposure and prior therapeutic radiation.

Conclusions: We discuss the highly varied and elusive presentation of peritoneal mesothelioma. Cumulative asbestos exposure, either directly or indirectly, remains the leading cause of mesothelioma. However, there are other non-asbestos etiologies. Small bowel obstruction often is a late-presenting symptom of widespread tumor burden. A concise review of the current diagnostic and surgical treatment of primary peritoneal mesothelioma demonstrates that early diagnosis and implementation remains vital.

In plain English

This article is a report on one patient, followed by the authors' discussion of earlier published studies on peritoneal mesothelioma. A 76-year-old woman came to hospital with nausea, bilious vomiting, abdominal pain, alternating diarrhea and constipation, and a 40-pound weight loss. Her history included cervical and uterine cancer, later treated with chemoradiation, as well as pleural effusions and recurrent ascites. She recalled being exposed to asbestos at home, and her husband was a longtime shipyard worker. A CT scan showed ascites, stomach and small bowel wall thickening, and dilated small bowel loops. Fluid from her chest and abdomen contained atypical mesothelial cells, and tissue stains pointed to a mesothelial origin. Tube decompression did not relieve the blockage after 2 days, so surgeons operated. They found widespread tumor on the peritoneum causing the obstruction and took biopsies without major tumor removal. Pathology confirmed epithelioid-type primary peritoneal mesothelioma. She refused treatment and chose palliative care. The authors concluded that cumulative asbestos exposure, direct or para-occupational, remains the most common factor related to mesothelioma, that other causes exist, and that early diagnosis and treatment remain paramount.

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 of a single patient, with a discussion reviewing published literature
• Who was studied: One 76-year-old woman admitted to hospital; the article does not give the dates of her care
• Exposure: Asbestos exposure at home, as the patient recalled it. The article notes that her husband was a longtime shipyard worker, and the authors call her exposure non-industrial. The fiber type is not named. She also had prior gynecological cancer treated with therapeutic chemoradiation, which the authors list as a non-asbestos risk factor.
• Main results:
  • The patient had progressive weight loss of 40 pounds, along with nausea, bilious vomiting, abdominal pain and alternating diarrhea and constipation
  • Her tumor markers were a CA 125 of 4094.4 U/mL and a CEA below 0.50 ng/mL
  • CT showed ascites, thickening of the stomach and small bowel wall, and dilated small bowel loops
  • Fluid from a right pleural effusion showed atypical mesothelial cells, and abdominal fluid showed similar findings
  • Immunohistochemical stains were positive for calretinin, CK5/6, CK7 and WT1, and negative for CK20, CEA and MOC-31
  • At exploratory laparotomy, the small bowel obstruction was due to multiple areas of carcinomatosis and peritoneal metastasis
  • Final pathologic examination of the excisional biopsy supported a diagnosis of primary epithelioid-type mesothelioma
  • The authors judged that the patient almost certainly had the 'mixed type' presentation: diffuse ascites, significant abdominal pain and solid masses in the omentum
  • After the diagnosis, the patient refused treatment and chose palliative care
• The authors' conclusion: The authors concluded that cumulative asbestos exposure, either direct or para-occupational, remains the most common factor related to mesothelioma. They wrote that when there is no asbestos exposure, other causes such as therapeutic irradiation, chronic peritonitis or oncogenic viruses should be considered. They also concluded that definitive diagnosis requires tissue biopsy with immunohistological staining and that early diagnosis and treatment remain paramount.

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, Serosal Surface, Peritoneum, Mesothelium, Pleura, Asbestos Exposure, Mesothelioma, Tumor Burden.

Related studies

• Mucin-positive epithelial mesothelioma of the peritoneum: small bowel involvement — J.H. Kim, K.Y. Kwon, et al. (2011)
• Diffuse malignant peritoneal mesothelioma presenting as intestinal obstruction — J. Griniatsos, S. Sougioultzis, et al. (2009)
• Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands — T.R. van Oudheusden, V.E. Lemmens, et al. (2015)
• Diffuse malignant peritoneal mesothelioma presenting as small bowel obstruction — A.R. Tagliaferri, G. Melki, et al. (2023)
• Malignant peritoneal mesothelioma giving rise to multiple intestinal polyps — F.G. Mayall, A.R. Gibbs (1991)
• Small bowel metastasis from pancreatic cancer in a long-term survival patient with synchronous advanced malignant pleural mesothelioma: A case report and literature review — M. Fasano, C.M. Della Corte, et al. (2016)

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