Synchronous Jejunal Sarcomatoid Carcinoma and Incidentally Associated Localized Peritoneal Malignant Mesothelioma

Our plain-English summary of Synchronous Jejunal Sarcomatoid Carcinoma and Incidentally Associated Localized Peritoneal Malignant Mesothelioma, by M. Tachibana, M. Nozawa, K. Kamimura, et al (Curēus, 2022).

The study

• Authors: M. Tachibana, M. Nozawa, K. Kamimura, Y. Tsutsumi
• Journal: Curēus
• Published: 2022;14(6):e26270
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Sarcomatoid carcinoma (SCA) of the small bowel is a rare aggressive variant of small intestinal cancer accompanying a poor prognosis. The tumor primarily affects middle-aged and elderly patients. We report herein a 67-year-old Japanese male who manifested anemia. He had a history of asbestos exposure 30 years earlier. An abdominal computed tomography (CT) scan showed a 6.5-cm aneurysmal, dilated mass of the small intestine. Capsule endoscopy revealed a large circumferential hemorrhagic ulcerative lesion in the jejunum. Biopsy indicated sarcomatoid carcinoma, and partial resection of the small bowel and adjacent transverse colon and omentum was performed. In addition to the T3N0M0 jejunal giant sarcomatoid carcinoma (SCA), a 3-mm small localized peritoneal (omental) malignant mesothelioma (LMM) was also incidentally included. Synchronous presentation of small intestinal and mesothelial malignancies is extremely rare, and the avoidance of incorrect clinical staging is critically important. Surgical resection is still considered the best first-line therapy, because of a poor response to chemotherapy and radiotherapy. Dual-color fluorescent in situ hybridization (FISH) for p16/CDKN2A and chromosome 9 indicated homologous deletion of p16/CDKN2A in SCA and a normal pattern in LMM. Methylthioadenosine phosphorylase (MTAP) was negative in SCA but positive in LMM. Both tumors consistently expressed BRCA1-associated protein 1 (BAP1). Tumor necrosis factor receptor-associated factor 7 (TRAF7) was suppressed, and neural cell adhesion molecule L1 precursor (NCAML1/L1CAM) was agitated in both tumors. Diffuse and strong expression of programmed death-ligand 1 (PD-L1) and the association of tumor-infiltrating lymphocytes in SCA may indicate a potential for PD-L1-targeted immunotherapy for treating this type of aggressive cancer. PD-L1 was focally expressed in LMM. The postoperative course was uneventful for two years.

Copyright © 2022, Tachibana et al.

In plain English

This case report described one 67-year-old Japanese man treated at Shimada General Medical Center in Japan. He had a history of asbestos exposure in plumbing work 30 years earlier. The article did not name a fiber type and did not analyze the exposure further. A biopsy of a mass in his jejunum (part of the small intestine) showed sarcomatoid carcinoma, a rare type of small-bowel cancer. Part of the small bowel, colon and omentum was removed. The jejunal tumor measured 65 by 55 mm and was staged T3N0M0, with no cancer found in 13 lymph nodes. Unexpectedly, a separate 3-mm nodule in the omentum was diagnosed as localized peritoneal malignant mesothelioma, epithelial type. Genetic testing found a p16 gene deletion in 84% (109/129) of the carcinoma cells examined. The mesothelioma showed a normal p16 pattern in 94% (101/107) of its cells. A protein called PD-L1 was found in 100% of carcinoma cells and 5% of mesothelioma cells. The patient received no chemotherapy or radiotherapy and was alive without recurrence two years after surgery. The authors concluded that detailed tissue testing allowed definite diagnoses and correct staging 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 (single patient)
• Who was studied: one 67-year-old Japanese man admitted to Shimada General Medical Center, Shimada, Shizuoka, Japan
• Exposure: history of asbestos exposure in plumbing work 30 years earlier; no fiber type or dose given
• Main results:
  • Endoscopic biopsy of the jejunal mass showed sarcomatoid carcinoma
  • In the resected jejunum, the tumor was an ulcerated mass measuring 65 × 55 mm
  • No metastatic carcinoma was found in 13 regional lymph nodes; the jejunal carcinoma was staged T3N0M0
  • A separate 3-mm nodule was unexpectedly found in the omentum
  • The omental nodule had a pattern compatible with malignant mesothelioma, epithelial type, and the diagnosis of localized malignant mesothelioma was confirmed by an outside mesothelioma pathology specialist
  • In the sarcomatoid carcinoma, deletion of the p16 gene was detected in 84% (109/129) of atypical cells
  • In the localized mesothelioma, most cells showed a normal p16 pattern: 94% (101/107)
  • In the sarcomatoid carcinoma, PD-L1 was strongly expressed in 100% of tumor cells; the authors stated this indicated a potential for PD-L1-targeted immunotherapy
  • In the localized mesothelioma, PD-L1 was expressed in 5% of tumor cells
  • No chemotherapy or radiotherapy was given
  • The patient was alive without recurrence or distant metastasis two years after surgery
• The authors' conclusion: The authors concluded that detailed histopathological, immunohistochemical and molecular analyses allowed definite diagnoses of both tumors and accurate staging of the small bowel cancer

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Carcinoma, Malignant Mesothelioma, Prognosis, Asbestos Exposure, Endoscopy, Biopsy, Omentum.

Related studies

• Synchronous breast carcinoma and peritoneal mesothelioma — S. Prathibha, H. Beckwith, et al. (2021)
• Sarcomatoid malignant peritoneal mesothelioma presenting as a localized mesenteric tumor with no previous asbestos exposure — Y.A. Notue, U.I. Mbessoh, et al. (2020)
• Synchronous diffuse malignant mesothelioma and carcinomas in asbestos-exposed individuals — R.L. Attanoos, D.H. Thomas, et al. (2003)
• Spontaneous pneumothorax and lung carcinoma: should one consider synchronous malignant pleural mesothelioma? — T.A. Flood, H.S. Sekhon, et al. (2009)
• Well-Differentiated Papillary Mesothelioma With Two Synchronous Serous Gynaecologic Carcinomas in a 62-Year-Old Woman: Lessons Learned for the Gynaecologic Surgeon — J.M. McGinnis, V. Bloomfield, et al. (2020)
• Localized malignant pleural sarcomatoid mesothelioma misdiagnosed as benign localized fibrous tumor — K.C. Kim, H.P. Vo (2016)

Browse more research in Curēus, or return to medical research.