Recurrent peritoneal mesothelioma with long-delayed recurrence

Our plain-English summary of Recurrent peritoneal mesothelioma with long-delayed recurrence, by A. Tandar, G. Abraham, J. Gurka, et al (Journal of Clinical Gastroenterology, 2001).

The study

• Authors: A. Tandar, G. Abraham, J. Gurka, M. Wendel, L. Stolbach
• Journal: Journal of Clinical Gastroenterology
• Published: 2001;33(3):247-50
• Type of article: Case report, Review
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peritoneal mesothelioma is a rare malignancy with a poor prognosis. Etiology is unclear and presentation of this disease is often atypical. There are very few cases of long-term survival in patients with peritoneal mesothelioma. We report the case of a patient with peritoneal mesothelioma of 19 years' duration. To the best of our knowledge, there have been no reports of recurrent peritoneal mesothelioma with such long-delayed recurrence and survival. Recurrent peritoneal mesothelioma in the current patient was confirmed by comparing the biopsies of omentum taken in 1979 with that taken in 1997. An extensive literature search was undertaken to look for previous reports of recurrent peritoneal mesothelioma. Aggressive and intensive chemotherapy appeared to provide a longer survival time. Our patient had paraneoplastic manifestations that included paraneoplastic hepatopathy and a wasting syndrome. Peritoneal mesothelioma is a rare malignancy with one to two cases per million in the United States. It is known to exhibit unusual paraneoplastic manifestations, including paraneoplastic hepatopathy. Treatment is often unsuccessful, with a median survival time of approximately 18 months from diagnosis. A better understanding and aggressive management of this disease appear to help prolong survival.

In plain English

This was a case report of one man with peritoneal mesothelioma (mesothelioma of the abdominal lining). In October 1979, aged 56, he had fluid in the abdomen and around both lungs, and a biopsy of the omentum, a fatty layer in the abdomen, showed diffuse malignant mesothelioma. He then received six cycles of intravenous cyclophosphamide with doxorubicin, followed by six cycles of cyclophosphamide, methotrexate and 5-fluorouracil, went into complete remission and stayed symptom-free for 17 years. In December 1997 he returned with abdominal pain, fever and weight loss, and a new omental biopsy showed malignant mesothelioma that looked similar to the first. He also had liver dysfunction without liver tumors, severe wasting, and a bone marrow result suggestive of myelodysplastic syndrome. Further chemotherapy brought a marginal response, and he died 1 year after the recurrence was diagnosed. The authors described the case as unrelated to asbestos exposure but gave no exposure history. They concluded that, to their knowledge, this was the first reported case of widespread peritoneal mesothelioma with survival longer than 17 years.

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 a discussion of earlier published reports
• Who was studied: One 56-year-old man first diagnosed with malignant mesothelioma in October 1979. The authors were at Saint Vincent Hospital-Worcester Medical Center, Worcester, Massachusetts, U.S.A.
• Exposure: No asbestos exposure history is described. The authors stated that this case, like an estimated 40% to 50% of mesothelioma cases, was unrelated to asbestos exposure.
• Main results:
  • In 1979 the patient had ascites and bilateral pleural effusions, all chylous. Omental biopsies at laparotomy showed diffuse malignant mesothelioma.
  • From December 1979 to May 1980 he received six cycles of intravenous cyclophosphamide and doxorubicin. He then received six cycles of cyclophosphamide, methotrexate and 5-fluorouracil, with no route stated for this second course. Follow-up confirmed complete remission, and he was symptom-free for the next 17 years.
  • In December 1997 an omental biopsy showed malignant mesothelioma histologically similar to the earlier biopsy.
  • At recurrence, a bone marrow biopsy was suggestive of a myelodysplastic syndrome. The authors said this may have been related to his earlier cyclophosphamide chemotherapy, but that a paraneoplastic cause could not be ruled out.
  • The authors described paraneoplastic manifestations: hepatopathy (non-metastatic liver dysfunction), fever, sweating, wasting and severe weight loss. The first three improved after chemotherapy, but severe wasting and weight loss continued despite total parenteral nutrition.
  • Salvage doxorubicin and then oral etoposide produced a marginal response. He died 1 year after the diagnosis of recurrence. His family declined an autopsy.
• The authors' conclusion: The authors concluded that, to the best of their knowledge, this was the first reported case of widespread peritoneal mesothelioma with survival longer than 17 years. The patient died 19 years after the initial diagnosis. They also stated that, with better understanding and treatment, survival seems to have improved.

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, Prognosis, Etiology, Omentum, Chemotherapy, Cachexia, Median Survival.

Related studies

• Recurrence of Optimally Treated Malignant Peritoneal Mesothelioma with Cytoreduction and Heated Intraperitoneal Chemotherapy — D.R. Heller, C. Chiuzan, et al. (2017)
• Preventing recurrence of diffuse malignant peritoneal mesothelioma — J.C. Leinwand, J.A. Chabot, et al. (2016)
• Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence — M. Vaira, M. Robella, et al. (2014)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• Remote Recurrence of Benign Multicystic Peritoneal Mesothelioma — C.E. Lee, A. Agrawal (2017)

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