A case report recently published in The Kaohsiung Journal of Medical Sciences describes a patient with malignant pleural mesothelioma with an isolated metastasis to the pancreas, a rare occurrence for this condition.
Typical metastatic tumors associated with malignant pleural mesothelioma include regional lymph nodes, the opposing lung, liver, adrenal glands and kidneys. Prior to this case report, no other report of pancreatic metastasis with primary malignant pleural mesothelioma has been documented in medical literature.
The 40-year-old patient (male) initially reported intermittent back pain in the upper right region. The patient previously worked in an asbestos factory for two months at the age of 17 before becoming a public officer. This patient was a heavy smoker, with a smoking history of three packs per day for 20 years.
Although smoking does not cause malignant mesothelioma, it can compromise the lungs of those previously exposed to asbestos and thus impairs the body’s ability to fight the effects of asbestos exposure. Smoking does not increase your risks of developing mesothelioma if you have been exposed to asbestos, but it does greatly increase your risk of developing asbestos-caused lung cancer by 50 to 84 times.
The patient underwent surgery to remove the lung tumor and right lower lobe of the lung via thoracotomy in August 2002. Between August and December 2002, the patient went through four courses of adjuvant concurrent chemoradiation (CCRT) (which included a regimen of dacarbazine, cyclophosphamide, epirubicin and vincristine. Following the completion of the CCRT, the patient did not return to the clinic for follow-up between 2003 and 2005, and he denied having any symptoms during this time.
In October 2006 the patient reported abdominal distention and hunger pain. Eventually, a palpable mass lesion was found and prompted an abdominal CT. The CT scan revealed a mass over the pancreas without any evidence of peritoneal carcinomatosis or lymph node metastasis.
The patient underwent a subtotal pancreatectomy in November 2006 and the tumor shared similar morphological features with the original mesothelioma tumor and tested positive for the same immunohistochemical compounds. This confirmed the pancreatic tumor was in fact a metastasis of primary malignant pleural mesothelioma.
The authors of the case report note, “In conclusion, local control of pleural mesothelioma improves the survival rate. Thus, an increasing number of patients presenting with spread of the disease to unusual sites is much more likely. The possibility of pancreatic metastatic lesions should be considered in patient with malignant pleural mesothelioma in the presence of epigastric discomfort.”
Additional information on mesothelioma may be found through the mesothelioma Center.