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Peritoneal Mesothelioma in a Patient with Long-Standing Crohn's Disease: Cause or Coincidence?
Rita Prata1, Pedro Lages Martins1, Verónica P Borges1
1Department of Gastroenterology, Unidade Local de Saúde de São José, Lisbon, Portugal.
Introduction:
Peritoneal mesothelioma (PeM) is a rare cancer of the peritoneal lining. Unlike pleural mesothelioma, PeM is less frequently linked to asbestos exposure. Chronic serosal inflammation, as seen in Crohn's disease (CD), has been proposed as a contributing factor in its carcinogenesis.
Case Presentation:
A male with a long-standing history of ileal CD presented with recurrent episodes of intestinal subocclusion. Imaging showed complex active ileal CD, new-onset ascites, and peritoneal densification. Intraoperatively, a small bowel mass adherent to the sigmoid colon and millimetric nodules of the peritoneum were identified. Histology of the resected segment showed CD-related changes and multiple areas of epithelioid mesothelioma, despite no asbestos exposure. He received cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, with no signs of recurrence after 15 months.
Discussion/Conclusion:
We present a rare case of non-asbestos-related PeM in a patient with long-standing active CD, highlighting the diagnostic challenges and possible link between chronic serosal inflammation and PeM.
Insights
This study presents a rare case of peritoneal mesothelioma (PeM) in a patient with Crohn's disease (CD). It suggests chronic inflammation from CD may contribute to PeM development, independent of asbestos exposure.
Area of Science:
- Oncology
- Gastroenterology
- Pathology
Background:
- Peritoneal mesothelioma (PeM) is a rare malignancy of the peritoneum.
- Unlike pleural mesothelioma, PeM has a less established link to asbestos exposure.
- Chronic serosal inflammation, such as that seen in Crohn's disease (CD), is a potential factor in PeM development.
Purpose of the Study:
- To report a rare case of non-asbestos-related PeM.
- To highlight the diagnostic challenges in such cases.
- To explore the potential association between chronic inflammation in CD and PeM.
Main Methods:
- Case report of a male patient with a history of ileal Crohn's disease.
- Clinical presentation included recurrent intestinal subocclusion, ascites, and peritoneal changes.
- Diagnostic workup involved imaging and intraoperative findings, confirmed by histology of resected tissue.
Main Results:
- The patient presented with symptoms of active ileal CD and new-onset ascites.
- Histological examination revealed epithelioid mesothelioma alongside CD-related changes.
- No history of asbestos exposure was identified in this patient.
Conclusions:
- This case highlights a rare instance of non-asbestos-related peritoneal mesothelioma.
- It underscores the potential role of chronic inflammation in Crohn's disease as a contributing factor to PeM.
- The findings emphasize the diagnostic complexities and the need to consider inflammatory conditions in PeM etiology.
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