Small bowel metastasis from pancreatic cancer in a long-term survival patient with synchronous advanced malignant pleural mesothelioma: A case report and literature review

Our plain-English summary of Small bowel metastasis from pancreatic cancer in a long-term survival patient with synchronous advanced malignant pleural mesothelioma: A case report and literature review, by M. Fasano, C.M. Della Corte, G. Vicidomini, et al (Oncology Letters, 2016).

The study

• Authors: M. Fasano, C.M. Della Corte, G. Vicidomini, V. Scotti, P.F. Rambaldi, A. Fiorelli, M. Accardo, F. De Vita, M. Santini, F. Ciardiello, F. Morgillo
• Journal: Oncology Letters
• Published: 2016;12(6):4505-4509
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Diffuse malignant pleural mesothelioma (MPM) is an aggressive tumor that originates from the surface of the pleura. Approximately 70% of cases are associated with chronic asbestos exposure. MPM is regarded as an incurable disease, with a median survival of ~2 years following intensive multimodality treatment. Pancreatic cancer is a malignancy also associated with a poor prognosis, with only 2% of patients surviving for 5 years. The majority of patients with pancreatic cancer are diagnosed with an advanced stage of disease and experience a poor response to therapy. The development of synchronous MPM and other types of cancer is rare. The present study describes a patient with synchronous, biphasic MPM and pancreatic adenocarcinoma, who was treated with a multimodal therapeutic approach with stereotactic body radiation therapy. Due to a suspected diagnosis of 'acute abdomen', an emergency small intestine resection was performed and a subsequent diagnosis of moderately-differentiated adenocarcinoma was confirmed. During a further immunohistochemical examination, pathologists determined that the small bowel metastasis descended from pancreatic cancer. The onset of bowel metastasis is an event rarely associated with MPM, and has not been previously described in the literature for cases of pancreatic cancer. Therefore, to the best of our knowledge, the present study describes the first case of intestinal metastasis from pancreatic cancer in a long-term survival patient with biphasic MPM.

In plain English

This case report from Naples, Italy, also briefly discussed earlier published cases. It described a 59-year-old man with a professional history of asbestos exposure. He was diagnosed in 2011 with locally advanced biphasic malignant pleural mesothelioma; a pancreatic lesion was later diagnosed as undifferentiated pancreatic adenocarcinoma. Treatment included cisplatin-pemetrexed, then gemcitabine, pleural radiotherapy, and stereotactic body radiation therapy to the pancreas and later the pleura. In March 2014 he had emergency small intestine surgery for suspected 'acute abdomen'. Pathologists found adenocarcinoma in the bowel, excluded intestinal and mesothelial origins, and attributed it to the pancreatic cancer. The authors noted, however, that the origin was extremely difficult to identify with certainty and that staining suggested a pancreatic origin. He then received gemcitabine plus nab-paclitaxel. The article reports his death after about 2 months of supportive care, but also says he was still being treated at the time of writing. The authors attributed his 33-month survival to the combined treatments. To their knowledge, this was the first reported case of intestinal metastasis from pancreatic cancer in a long-term survivor with biphasic mesothelioma.

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 one patient, with a brief discussion of previously published cases
• Who was studied: One 59-year-old man in Naples, Italy, diagnosed with locally advanced malignant pleural mesothelioma in 2011 and followed to 2014
• Exposure: Occupational (professional) asbestos exposure. Fiber type, job and amount are not reported.
• Main results:
  • A pleural biopsy confirmed biphasic mesothelioma
  • During first-line chemotherapy the pleural disease was stable, but the pancreatic lesion grew from 18 mm to 40 mm in diameter
  • After pleural stereotactic body radiation therapy for chest pain, the patient had significant symptom relief
  • The small intestine sample removed in emergency surgery showed moderately differentiated adenocarcinoma
  • Based on staining tests, pathologists excluded an intestinal origin and a mesothelial origin, and attributed the bowel metastasis to the pancreatic cancer
  • In the discussion, the authors wrote that the bowel lesion's origin was extremely difficult to identify with certainty, and that the staining profile suggested a pancreatic origin
  • The patient received 3 cycles of gemcitabine plus nab-paclitaxel, then about 2 months of supportive care only, until death from the disease
  • The authors reported survival of 33 months for this patient
• The authors' conclusion: The authors concluded that, to their knowledge, this is the first described case of intestinal metastasis from pancreatic cancer in a long-term survivor with biphasic mesothelioma. They considered that the long survival resulted from combined chemotherapy and stereotactic body radiation therapy to the pancreatic lesions.
• Limitations the authors state:
  • The authors stated that it was extremely difficult to determine with certainty whether the bowel lesion came from the mesothelioma or the pancreatic cancer

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Pleura, Asbestos Exposure, Median Survival, Prognosis, Biphasic Mesothelioma, Adenocarcinoma.

Related studies

• Long-term survival after lung-sparing total pleurectomy for locally advanced (International Mesothelioma Interest Group Stage T3-T4) non-sarcomatoid malignant pleural mesothelioma — A. Nakas, E. von Meyenfeldt, et al. (2012)
• Primary Peritoneal Mesothelioma Resulting in Small Bowel Obstruction: A Case Report and Review of Literature — S.C. Frontario, A. Loveitt, et al. (2015)
• Tract metastasis in patients with long-term pleural catheter-computed tomography diagnosis and longitudinal assessment — F. Hamad, C. Souza, et al. (2021)
• Characteristics and long-term outcomes of advanced pleural mesothelioma in Latin America (MeSO-CLICaP) — L. Rojas, A.F. Cardona, et al. (2019)
• Severe diffuse small airways abnormalities in long term chrysotile asbestos miners — J.L. Wright, A. Churg (1985)
• A preliminary study of biochemical changes in the rat small intestine following long-term ingestion of chrysotile asbestos — R. Jacobs, K.S. Dodgson, et al. (1977)

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