Spontaneous urinary bladder perforation: An unusual presentation of well-differentiated papillary peritoneum mesothelioma

Our plain-English summary of Spontaneous urinary bladder perforation: An unusual presentation of well-differentiated papillary peritoneum mesothelioma, by A. Serao, F. Ambrosini, B. Cavallone, et al (Urologia, 2022).

The study

• Authors: A. Serao, F. Ambrosini, B. Cavallone, T. Borra, A. Di Stasio
• Journal: Urologia
• Published: 2022;89(4):641-644
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Well-differentiated papillary mesothelioma (WDPM) is a very rare neoplasm. Most of WDPM are asymptomatic and are often incidentally detected during surgery. This report describes a case of WDPM of the peritoneum unexpectedly diagnosed in a male with a spontaneous intraperitoneal bladder rupture.

Case Presentation: A 65-year-old male presented to our Emergency Department in November 2019 with a two-day history of anuria, abdominal pain, distention, and sepsis. The CT scan reported a large amount of extra and intraperitoneal free fluid. The CT cystogram showed bladder perforations on the dome and on the left lateral wall which was repaired through exploratory laparotomy. Intraoperatively, we encountered extensive suppurative peritonitis with large fibrino-purulent exudation. The purulent perivesical peritoneum was dissected and sent for histopathological examination which unexpectedly resulted in WDPM of the peritoneum.

Conclusion: Although we can't affirm with certainty, this case would seem to suggest that WDPM had played a role in patient's clinical presentation. However, further research is necessary to draw stronger conclusion.

In plain English

This case report from a hospital in Alessandria, Italy, described a 65-year-old man who came to the emergency department in November 2019 after two days of being unable to pass urine, with abdominal pain and swelling. Four months earlier he had had a bladder tumor removed through the urethra, followed by a dose of the drug mitomycin C placed into the bladder. A CT cystogram suggested holes in the top and the right side of the bladder. At surgery, doctors found widespread pus-forming inflammation of the abdominal lining. Tissue removed from around the bladder unexpectedly showed well-differentiated papillary mesothelioma (WDPM) of the peritoneum. After surgery the patient developed acute heart failure. He later returned with the bladder ruptured again and died of severe heart and blood-vessel disease. The authors suggested the WDPM may have weakened the bladder wall, but they said they could not affirm this with certainty. They named the earlier bladder surgery and drug treatment as confounding factors. The article did not describe any asbestos exposure for this patient.

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)
• Who was studied: One 65-year-old man treated at SS Biagio e Cesare Arrigo Hospital, Alessandria, Italy, who presented in November 2019
• Exposure: No asbestos exposure history was reported for the patient. In its introduction the article describes WDPM, citing earlier literature, as apparently unrelated to asbestos. The patient's relevant prior treatment was transurethral resection of a bladder tumor followed by intravesical mitomycin C, 4 months before presentation.
• Main results:
  • In this patient, a CT cystogram suggested bladder perforation on the dome (top) and the right lateral wall of the bladder
  • At exploratory surgery on this patient, the surgeons found extensive suppurative (pus-forming) peritonitis
  • Examination of the tissue removed from around the bladder unexpectedly showed well-differentiated papillary mesothelioma of the peritoneum
  • Under the microscope, the tissue showed fibrous papillae lined by a single layer of mesothelial cells without significant abnormal cell features, and the cells were positive for calretinin
  • After surgery, the patient developed acute heart failure, with a left ventricular ejection fraction of 22%
  • The patient returned with the bladder ruptured again. He died a few days after that admission, which the authors attributed to severe cardiovascular comorbidities.
• The authors' conclusion: The authors hypothesized, without being able to affirm it with certainty, that the WDPM played a role in the patient's presentation, possibly by weakening the bladder wall. They called for further research to reach stronger conclusions.
• Limitations the authors state:
  • The earlier bladder tumor surgery (TURBT) and mitomycin C instillation 4 months before are confounding factors for the cause of the perforation
  • The authors acknowledged that there may be other possible explanations for the bladder rupture
  • It was not known whether the perforation was at the site of the previous tumor resection, and no imaging from before or after that surgery was available
  • The authors stated that their hypothesis has limitations

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: Well-Differentiated, Peritoneum, Mesothelioma, Well-Differentiated Papillary Mesothelioma, Neoplasm, CT Scan, Laparotomy.

Related studies

• Incidental finding of multiple well-differentiated papillary mesotheliomas in peritoneum — M. Jakobsen, B. Engvad, et al. (2016)
• Clinicopathological Characteristics of Well-differentiated Papillary Mesothelioma of The Peritoneum: A Single-institutional Experience of 12 Cases — M. Kim, H.S. Kim (2019)
• Well-differentiated papillary mesothelioma of the peritoneum: a diagnostic dilemma on fine-needle aspiration cytology — J.G. Nasit, G. Dhruva (2014)
• Well-Differentiated Papillary Mesothelial Tumor: An Unusual Radiologic Presentation: A Case Report — M. Abdelghafar, K. Anand, et al. (2023)
• 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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