Mesothelioma Types

Asbestos-Induced Peritoneal Mesothelioma in a Construction Worker

Rodolfo Fonte,1 Salvatore Gambettino,1 Mario Melazzini,1 Mario Scelsi,2 Claudio Zanon,3 and Stefano M. Candura1,4

1Division of Occupational Medicine and 2Laboratory of Pathology and Cytodiagnostics, Salvatore Maugeri Foundation, Work and Rehabilitation, IRCCS, Scientific Institute of Pavia, Pavia, Italy; 3Division of Oncological Surgery and Medical Technology, S. Giovanni Battista Hospital, Turin, Italy; 4Department of Preventive, Occupational and Community Medicine, University of Pavia, Pavia, Italy

Occupational and environmental asbestos exposure continues to represent a public health problem, despite increasingly restrictive laws adopted by most industrialized countries. Peritoneal mesothelioma is a rare and aggressive asbestos-related malignancy. We present the case of a 65-year-old man who developed recurrent ascites after having been exposed to asbestos in the building industry for > 40 years. Liver function and histology were normal. Abdominal computed tomography initially excluded the presence of expansive processes, and no abnormal cells were found in the ascitic fluid. Laparoscopy showed diffuse neoplastic infiltration of the peritoneum. Histopathology of bioptic samples revealed epithelioid neoplastic proliferation with a tubulopapillary pattern, falsely suggesting metastatic adenocarcinomatosis. In consideration of the occupational history, and after further diagnostic procedures had failed to identify the hypothetical primitive tumor, immunostaining of the neoplastic tissue was performed. Results were negative for carcinoembrionary antigen and the epithelial glycoprotein Ber-EP4, whereas results were positive for the mesothelial markers cytokeratins, calretinin, epithelial membrane antigen, and HBME-1, thus leading to the correct diagnosis of peritoneal epithelial mesothelioma. The Italian Workers' Compensation Authority recognized the occupational origin of the disease. Cytoreductive surgery associated with continuous hyperthermic peritoneal perfusion (cisplatin at 42°C, for 1 hr) was performed. The disease relapsed after 4 months and was later complicated by a bowel obstruction requiring palliative ileostomy. The patient died 23 months after diagnosis. This case illustrates the insidious diagnostic problems posed by peritoneal mesothelioma, a tumor which often simulates other malignancies (e.g., metastatic carcinomas) at routine histopathological examination. Occupational history and immunohistochemistry are helpful for the correct diagnosis, which, in turn, is important in relation to prognosis and treatment (adoption of new integrated procedures that seem to promise prolonged survival and increased quality of life), and in relation to medicolegal issues and occupation-related compensation claims following asbestos exposure.

To receive a FREE information packet, please fill out the following form (U.S. only please):

Name:
Phone Number:
E-mail:
Street Address:
City, State, Zip:
Comments or Questions:
**(Packet includes information on treatment, clinical trials, cancer links, how to access legal and financial resources, and frequently asked legal questions with answers provided by The David Law Firm, P.C.). By filling out the above form you consent to being contacted by The David Law Firm regarding potentially retaining legal services.

This website is sponsored by Jonathan David* of The David Law Firm. The David Law Firm is located in The Woodlands, Texas (Greater Houston Area) and can be reached toll free at 1-800-998-9729 for more information on mesothelioma. Jonathan David is not a medical doctor. The information on these pages is for the education of mesothelioma patients and their families regarding potential medical and legal options. Patients are advised to consult with a medical doctor. * Licensed by the Supreme Court of Texas.