Peritoneal mesothelioma with invasion of the urinary bladder 20 years post radiation therapy for colon adenocarcinoma

Our plain-English summary of Peritoneal mesothelioma with invasion of the urinary bladder 20 years post radiation therapy for colon adenocarcinoma, by N. Ong Mingjing, A.S. Asamu, K. Pace, et al (Journal of Surgical Case Reports, 2021).

The study

• Authors: N. Ong Mingjing, A.S. Asamu, K. Pace, S. Bugeja
• Journal: Journal of Surgical Case Reports
• Published: 2021;2021(9):rjab392
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We present the case of a 66-year-old male with a history of iatrogenic bladder injury and radiation therapy for colon adenocarcinoma 20 years prior. A computed tomography of the thorax, abdomen and pelvis, reported a presacral mass with invasion to the bladder, ureters and lymph nodes. An initial bladder biopsy was histologically inconclusive. A later biopsy taken during emergency bypass surgery for small bowel obstruction, while the patient was positive for coronavirus disease of 2019, concluded that the mass was a peritoneal mesothelioma of epithelioid origin. The combination management of cytoreductive surgery with intraperitoneal chemotherapy has been a near universal standard of care for epithelioid peritoneal mesothelioma provided that the patient is an appropriate candidate for surgical interventions. To the best of our knowledge, this is the first case report of malignant peritoneal mesothelioma as a second primary carcinoma, many years after exposure to radiation therapy for colon adenocarcinoma.

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

In plain English

This case report from Malta's Mater Dei Hospital described a 66-year-old man. He was a heavy smoker, reported to have no asbestos exposure. Twenty years earlier, surgery for colon adenocarcinoma injured his bladder, and he then had radiotherapy. Afterwards he had a reduced bladder volume and kidney problems needing permanent drainage tubes in both kidneys. A CT scan later showed a large mass in front of the lower spine invading the bladder and both ureters. A first bladder biopsy was inconclusive. During treatment for a urinary infection, after testing positive for the coronavirus that causes COVID, he developed a small bowel blockage caused by the mass. He had emergency bypass surgery, and a biopsy taken then showed epithelioid peritoneal mesothelioma. A UK referral center judged it could not be removed surgically with the aim of cure. He was offered palliative chemotherapy but chose symptom-based care. Three months after first presenting, he had needed a second bowel bypass. The authors stated that, to their knowledge, this was the first reported case of peritoneal mesothelioma as a second primary cancer many years after radiotherapy for colon adenocarcinoma.

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 (one patient)
• Who was studied: One 66-year-old man, a heavy smoker reported to have no asbestos exposure, described by authors from Mater Dei Hospital, Msida, Malta; dates of care not given beyond occurring during the COVID pandemic
• Exposure: Radiotherapy given after surgery for colon adenocarcinoma 20 years earlier (dose not reported); the patient was described as having no asbestos exposure and as a heavy smoker
• Main results:
  • CT showed an extensive presacral mass invading the urinary bladder and both ureters, with enlarged lower para-aortic and pelvic lymph nodes
  • The first bladder biopsy, taken at rigid cystoscopy, showed an indeterminate invasive carcinoma
  • While in the COVID ward being treated for urosepsis, the patient developed a mechanical small bowel obstruction caused by a loop of small bowel caught in the pelvic mass, and had an ileo-ascending colon bypass, during which the mass was biopsied
  • Immunohistochemistry of the pelvic mass biopsy confirmed a mesothelial phenotype, consistent with epithelioid mesothelioma without sarcomatoid differentiation
  • After an opinion from a UK tertiary referral center, the disease was judged surgically unresectable with curative intent; palliative chemotherapy was offered, but the patient chose symptomatic and conservative management
  • Three months after initial presentation, the patient still had bilateral nephrostomies and had recently had another small bowel bypass for a further obstruction
• The authors' conclusion: The authors stated that, to their knowledge, this is the first case report of malignant peritoneal mesothelioma as a second primary carcinoma many years after radiation therapy for colon adenocarcinoma
• Limitations the authors state:
  • No images were taken during the bypass operation because of restrictions in the COVID operating theatre

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Adenocarcinoma, Thorax, Biopsy, Epithelioid, Cytoreductive Surgery, Chemotherapy, Carcinoma.

Related studies

• Colon cancers and peritoneal mesothelioma occurring 29 years after abdominal radiation for testicular seminoma. A case report and review of the literature — D. Tassile, A.D. Roth, et al. (1998)
• Compensator-based intensity-modulated radiation therapy for malignant pleural mesothelioma post extrapleural pneumonectomy — K. Javedan, C.W. Stevens, et al. (2008)
• Rare confounder: benign multicystic peritoneal mesothelioma in a patient with mucinous colon adenocarcinoma — K.K. Patel, G.P. Stinson, et al. (2024)
• Occupational cancer of the urinary bladder in dyestuffs operatives and of the lung in asbestos textile workers and iron-ore miners — G.M. Bonser, J.S. Faulds, et al. (1955)
• Occupational asbestos exposure and urinary bladder cancer: a systematic review and meta-analysis — N. Franco, A. Godono, et al. (2023)
• Occupational exposure to asbestos and urinary bladder cancer — R. Molinini, L. Paoletti, et al. (1992)

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