Malignant peritoneal mesothelioma as a secondary cancer following radiotherapy for cervical cancer: a case report and literature review

Our plain-English summary of Malignant peritoneal mesothelioma as a secondary cancer following radiotherapy for cervical cancer: a case report and literature review, by M. Otsubo, M. Aichi, Y. Kawashima, et al (Gynecologic Oncology Reports, 2025).

The study

• Authors: M. Otsubo, M. Aichi, Y. Kawashima, S. Yamanaka, Y. Imai, E. Miyagi, T. Mizushima
• Journal: Gynecologic Oncology Reports
• Published: 2025;62:101979
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant peritoneal mesothelioma (MPM) as a secondary malignancy following radiotherapy is extremely rare. We report a case of MPM that developed as a secondary malignancy after initial concurrent chemoradiotherapy (CCRT) for cervical cancer.Case Presentation.A 52-year-old woman with no history of asbestos exposure underwent definitive CCRT for stage IIB cervical cancer, as classified by the International Federation of Gynecology and Obstetrics (FIGO) staging system. Over 10 years after initial treatment, she developed ascites. Diagnostic laparoscopy led to a pathological diagnosis of peritoneal mesothelioma. Given the absence of asbestos exposure and her medical history, the tumor was considered a radiation-induced secondary cancer. The patient received two lines of chemotherapy, but her performance status progressively declined, and she was transitioned to best supportive care. She died 1 year and 8 months after the MPM diagnosis.

Discussion: This case highlights the importance of long-term surveillance following radiotherapy for cervical cancer. Including this case, only four reports exist of MPM developing as a secondary malignancy following pelvic radiotherapy for cervical cancer. In all cases, patients presented with abdominal symptoms and ascites. The case findings underscore the need for clinicians to consider secondary malignancies such as MPM when ascites is detected during follow-up and to pursue a thorough diagnostic workup.

© 2025 The Authors. Published by Elsevier Inc.

In plain English

This article was a case report with a short review of earlier published cases. A 52-year-old Japanese woman with no known asbestos exposure was treated for stage IIB cervical cancer with combined radiotherapy and chemotherapy. When the cancer returned in lymph nodes, she was treated again with radiotherapy and chemotherapy. At 140 months after her first treatment, she developed abdominal swelling and a large build-up of fluid in the abdomen (ascites). Tissue removed during laparoscopy was diagnosed as malignant peritoneal mesothelioma. Because she had no asbestos exposure, the authors considered it a cancer caused by her earlier radiation. She received two lines of chemotherapy and died 1 year and 8 months after diagnosis. Including this one, the authors found four reported cases of this cancer after radiotherapy for cervical cancer, and none of the patients had a history of asbestos exposure. The authors concluded that the case underscores the need for long-term follow-up after radiotherapy and thorough investigation when ascites is found.

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 with literature review
• Who was studied: One 52-year-old Japanese woman treated for stage IIB cervical cancer at Yokohama City University, Japan, with no significant medical history or known asbestos exposure; the literature review covered four reported cases in total, including this one
• Exposure: Radiation therapy, not asbestos. For the initial cancer she received 61.2 Gy of pelvic irradiation with weekly cisplatin, followed by an additional 30.0 Gy of brachytherapy. When the cancer recurred in the para-aortic lymph nodes, she received a second course of 56 Gy with cisplatin. No asbestos exposure was known.
• Main results:
  • At 140 months after the initial treatment and 115 months after the treatment for recurrence, the patient presented with abdominal distention. CT showed massive ascites and peritoneal thickening.
  • Tissue from laparoscopy stained positive for calretinin and D2-40 and negative for PAX8 and ER, and the patient was diagnosed with malignant peritoneal mesothelioma.
  • Because asbestos exposure was absent, radiation-induced secondary cancer was considered as the cause.
  • She first received pemetrexed with cisplatin and had a clinical complete response. The disease recurred 8 months after that treatment ended. She then received pemetrexed with carboplatin, moved to best supportive care, and died 1 year and 8 months after the diagnosis.
  • In the literature review of four cases in total (including this one) of peritoneal mesothelioma after radiotherapy for cervical cancer, none of the patients had a history of asbestos exposure.
  • The authors stated that all four reported cases, including theirs, presented with ascites.
  • This was the only one of the four cases given radiation for both the primary cancer and its recurrence. The authors suggested that the extended radiation field to the para-aortic region may have exposed more normal tissue to low-dose radiation, potentially increasing the risk of a secondary cancer.
• The authors' conclusion: The authors concluded that the case underscores the importance of long-term follow-up after radiotherapy and of thorough investigation, including the possibility of a secondary cancer, when ascites is detected during surveillance.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure, Staging, Ascites, Diagnostic Laparoscopy, Chemotherapy, Performance Status.

Related studies

• A case of peritoneal malignant mesothelioma following radiation therapy for cervical cancer — M. Yano, Y. Ikeda, et al. (2018)
• Malignant peritoneal mesothelioma following radiotherapy for seminoma of the testis — R.J. Stock, Y.S. Fu, et al. (1979)
• Malignant peritoneal mesothelioma associated with deep vein thrombosis following radiotherapy for seminoma of the testis — F. Sato, H. Yamazaki, et al. (2000)
• Resolution of Right Hemidiaphragm Paralysis following Cervical Foraminotomies — N. Singleton, M. Bowman, et al. (2018)
• Pleural mesothelioma secondary to radiotherapy: a rare association — T. Lourido-Cebreiro, V. Leiro-Fernández, et al. (2012)
• Two cases of secondary soft tissue sarcomas after radiotherapy and radiochemotherapy — C. Saggia, G. Forti, et al. (2004)

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