Simultaneous occurrence of a rectal carcinoma and a diffuse well differentiated papillary mesothelioma of the peritoneum

Our plain-English summary of Simultaneous occurrence of a rectal carcinoma and a diffuse well differentiated papillary mesothelioma of the peritoneum, by G.R. Jatzko, J. Jester (International Journal of Colorectal Disease, 1997).

The study

• Authors: G.R. Jatzko, J. Jester
• Journal: International Journal of Colorectal Disease
• Published: 1997;12(6):326-8
• Type of article: Case report
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Diffuse well differentiated papillary mesothelioma is a rare neoplasms of the peritoneal cavity which has generally been regarded as a tumor with low-grade malignant potential [1-4]. The well differentiated papillary mesotheliomas reported in recent literature are considered as border line lesions with a long term benign clinical course. There are however, only few studies with small numbers of diffuse well differentiated mesotheliomas [1, 2, 5, 6]. The synchronous appearance of such a lesion with a second malignancy therefore is a very rare event. Such a clinical scenario would suggest diffuse tumor spread to the peritoneum resulting in an inappropriate palliative procedure alone-being undertaken. To our knowledge this is the first report of the simultaneous occurrence of a rectal carcinoma in combination with a diffuse well differentiated papillary mesothelioma of the peritoneum.

In plain English

This was a case report from Austria about one patient, a 55-year-old woman with a rectal adenocarcinoma. Scans before surgery showed no spread, but at operation the surgeons found tumor deposits across the omentum and peritoneum. Samples taken during surgery suggested a separate tumor, so the rectal cancer and all involved peritoneum were removed, followed by one hour of heated chemotherapy in the abdomen. Laboratory examination identified the deposits as a diffuse well-differentiated tubulo-papillary mesothelioma of epithelial type. The rectal cancer was early stage (UICC stage I, Dukes A), with all 19 examined lymph nodes free of cancer. Questioning after surgery revealed many years of home exposure from an asbestos shield around a living room heater. At 6 months there was no sign of recurrence. The authors noted that peritoneal mesotheliomas, unlike pleural ones, do not appear closely related to asbestos, but that in this case the connection was present as long-term domestic exposure. They stated this was, to their knowledge, the first report of these two tumors together, and warned that surgeons may mistake such deposits for spread of the bowel cancer.

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 (a single patient)
• Who was studied: One 55-year-old woman treated at a surgical department in St. Veit an der Glan, Austria; the article was published in 1997
• Exposure: Long-term household exposure from an asbestos shield around a living room heater, found by questioning after surgery. The fiber type and the dose were not given.
• Main results:
  • At operation, although tests before surgery had shown no spread, the surgeons found tumor deposits ('peritoneal seedings') in the omentum and less distinctly on the peritoneum.
  • Tissue examined during surgery suggested either a diffuse well-differentiated papillary mesothelioma or a serous papillary carcinoma.
  • The patient had resection of the rectal cancer with removal of the omentum and all involved peritoneum, plus one hour of heated abdominal chemotherapy with Mitomycin C and 5-Fluorouracil.
  • Pathology identified the peritoneal deposits as a diffuse well-differentiated tubulo-papillary mesothelioma of epithelial type.
  • In the rectal adenocarcinoma, all 19 examined lymph nodes were free of cancer. The staging was pT2, G2-G3, pN0(19), pM0, which is UICC stage I and Dukes A.
  • The ovaries and Fallopian tubes showed no evidence of a malignant tumor.
  • The authors noted that peritoneal mesotheliomas, unlike pleural mesotheliomas, do not appear closely related to asbestos exposure (citing another study), but that in this case the connection was present as long-term domestic exposure.
  • At follow-up 6 months after surgery there was no evidence that the tumor had come back.
• The authors' conclusion: The authors considered this, to their knowledge, the first report of a rectal carcinoma occurring together with a diffuse well-differentiated papillary peritoneal mesothelioma. They warned that a surgeon may mistake such peritoneal deposits for spread of the colorectal cancer, which could lead to palliative surgery only.
• Limitations the authors state:
  • The authors stated that the effectiveness of different treatment strategies cannot be assessed, because tumor behavior is inconsistent and few such tumors are 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: Carcinoma, Well-Differentiated Papillary Mesothelioma, Peritoneum, Neoplasm, Peritoneal Cavity, Mesothelioma, Palliative Care.

Related studies

• A Case of Solitary Well-Differentiated Papillary Mesothelioma with Invasive Foci in the Pleura — S. Shimizu, H.E. Yoon, et al. (2017)
• Combined adenomatoid tumor and well differentiated papillary mesothelioma of the omentum — Y. Hatano, Y. Hirose, et al. (2011)
• Well-differentiated papillary mesothelioma: peritoneal implants are not always metastases in the presence of cancer — G.W. Irwin, A. Ervine, et al. (2014)
• Peritoneal well-differentiated papillary mesothelioma coexisting with endometrial adenocarcinoma mimicking peritoneal carcinomatosis: A case report — Y.Y. Chen, P.C. Li, et al. (2020)
• Well-differentiated papillary mesothelioma of the peritoneum is genetically defined by mutually exclusive mutations in TRAF7 and CDC42 — M. Stevers, J.T. Rabban, et al. (2019)
• Well-differentiated papillary mesothelioma of the female peritoneum: a clinicopathologic study of 26 cases — A. Malpica, S. Sant'Ambrogio, et al. (2012)

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