Intussusception caused by small intestine metastasis of malignant pleural mesothelioma: a case report

Our plain-English summary of Intussusception caused by small intestine metastasis of malignant pleural mesothelioma: a case report, by M. Hamaoka, M. Nakagawa, H. Nakahara, et al (Journal of Surgical Case Reports, 2021).

The study

• Authors: M. Hamaoka, M. Nakagawa, H. Nakahara, R. Yamamoto, T. Nishisaka, T. Itamoto
• Journal: Journal of Surgical Case Reports
• Published: 2021;2021(2):rjab003
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive form of malignant tumor that originates in the pleural mesothelioma and presents as a local disease in the affected hemithorax. Small intestine metastasis is a rare complication. Herein, the case of a patient with jejunal intussusception caused by small intestine metastasis of MPM has been reported. A 72-year-old man with MPM was admitted to our hospital for abdominal pain. Computed tomography revealed small intestine intussusception. An emergency surgery was performed, and the tumor and intussusception were located in the upper jejunum. Histopathological examination of the resected jejunum revealed that the tumor was a small intestinal metastasis of the MPM from the chest wall. This case showed that MPM may metastasize to the small intestine, and metastatic tumors may cause intussusception.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2021.

In plain English

This was a case report from Hiroshima Prefectural Hospital in Japan, together with the authors' review of earlier published cases. It described a 72-year-old man diagnosed 18 months earlier with stage IV epithelioid malignant pleural mesothelioma (MPM) that had invaded the right chest wall. He was first treated with pemetrexed and cisplatin. After the cancer spread to the lung, he received nivolumab. He had vague abdominal pain for about two months, and endoscopy found nothing. He was then admitted with worsening pain. A CT scan showed intussusception, meaning part of the small intestine had folded into itself. In emergency surgery, surgeons found a tumor in the upper jejunum and removed that section of bowel. Under the microscope, the 35 mm tumor matched the chest-wall mesothelioma, and the authors concluded it was a metastasis of MPM. He went home on day 9 after surgery. The authors found seven earlier published cases of MPM spreading to the small intestine. They concluded that MPM can spread to the small intestine. The article does not mention asbestos or the patient's exposure history.

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 review of seven previously published cases
• Who was studied: One 72-year-old man with stage IV (cT4N0M0) epithelioid malignant pleural mesothelioma invading the right chest wall, treated at Hiroshima Prefectural Hospital, Japan
• Exposure: Not reported. The article does not mention asbestos or any occupational or other exposure.
• Main results:
  • Before the abdominal problem, the patient had been treated with pemetrexed and cisplatin for 12 months, then with nivolumab as second-line therapy for 6 months after lung metastasis appeared
  • A CT scan showed intussusception of the small intestine
  • At emergency surgery, the tumor causing the intussusception was in the upper jejunum, 120 cm beyond the ligament of Treitz
  • At surgery, there was no thickening of the mesentery and no disseminated nodules
  • The tumor measured 35 mm and extended from the mucosal to the subserosal layer of the jejunum
  • The tumor was made of epithelioid cells with a high nuclear grade. It tested positive for vimentin, calretinin, WT-1, D2-40 and CK7 and negative for CEA, CD34, c-kit, CK5/6 and CK20, matching the chest-wall MPM
  • The patient was discharged on day 9 after the operation
  • In their literature review, the authors found seven earlier cases of small intestine metastasis from MPM
• The authors' conclusion: The authors concluded that MPM can metastasize to the small intestine and that, if a patient with MPM develops abdominal pain, small intestine metastasis should be considered

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Hemithorax.

Related studies

• Small intestinal intussusception in an adult — K. Takada, N. Fujimoto, et al. (2019)
• 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)
• Solitary malignant mesothelioma of the small intestine: radiological appearances — N. Gourtsoyiannis, D. Bays, et al. (1996)
• Toxic effect on the rat small intestine of chronic administration of asbestos in drinking water — T.J. Delahunty, D. Hollander (1987)
• Distribution of 6-6(n)-3[H]sucrose and its radiolabeled degradation products from isolated, perfused rat small intestine loops following prolonged ingestion of chrysotile asbestos — R. Jacobs, R.J. Richards (1980)
• The mesotheliomas of the small intestine — M. Paul, G. Panabokke, et al. (1965)

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