Synchronous presentation of muscle-invasive urothelial carcinoma of bladder and peritoneal malign mesothelioma

ABSTRACT Introduction Cancer is one of the most important leading cause of death in man and woman in the world. The occurrence of new cancer has become more frequent in recent years due to strict screening protocols and occupational and environmental exposure to carcinogens. The incidence of secondary malignancies has also increased due to close medical follow-up and advanced age. Herein, we report a case and its management diagnosed as synchronous peritoneal malignant mesothelioma and muscle-invasive urothelial carcinoma. Case Description A 71-year-old male presented with macroscopic hematuria and abdominal distension increasing gradually. A contrast enhanced computerized tomography demonstrated bladder mass and diffuse ascites with nodular peritoneal thickening and umbilical mass. He was treated with the multidisciplinary team working including urologist, medical oncologist and general surgeon. Conclusions To our knowledge, this is the first case of peritoneal malign mesothelioma with synchronous muscle-invasive urothelial carcinoma. Because of the rarity of this condition, there is still no consensus on the definitive treatment protocols, yet. Individualized treatment with multidisciplinary close follow-up might improve the survival outcomes.

Mesotelioma Peritoneal Maligno. Presentación de un caso / Malignant Peritoneal Mesothelioma. Case presentation

El mesotelioma es un tumor poco frecuente, sobretodo en localización peritoneal. Originado en las células mesoteliales de superficies serosas. Su etiología es desconocida, aunque en muchos casos se relaciona con exposición a asbestos. Su frecuencia va en aumento en los últimos años, tiene mayor incidencia en varones de edad media. Se presentó un paciente de 73 años diabético e hipertenso que llevaba 21 días con sensación de llenura, aumento de volumen del abdomen, decaimiento marcado, pérdida del apetito. En este período presentó una pérdida de peso corporal de 10 kilos. Por todo lo anterior se decidió su ingreso para estudio y tratamiento (AU).

The mesothelioma is a little frequent tumor, especially in peritoneal location, originated in the mesothelial cells of serous surfaces. Its etiology is unknown, although in many cases it is related with exposition to asbestos. Its frequency increases in the last years, showing higher incidence in medium-age male people. The case of a diabetic, hypertensive patient aged 73 years was presented. He was already 21 days feeling bloating, having increase of the abdominal volume, remarked weakness, appetite loss. In this period he had a body weight loss of 10 kg. For that all, his admission was decided for study and treatment (AU).

Mesotelioma bem diferenciado (benigno) de túnica vaginal: relato de um caso e revisão da literatura / Well-differentiated (benign) mesothelioma of the tunica vaginalis: report of a case and literature review

Mesoteliomas são tumores oriundos das células mesoteliais da pleura, peritônio, pericárdio ou túnica vaginal, sendo a exposição prolongada ao asbesto o principal fator de risco. Neoplasias mesoteliais benignas da região paratesticular são raras. Relata-se um caso de Mesotelioma de Túnica Vaginal associado à hidrocele, destacando a utilidade da ecografia na avaliação das massas escrotais (AU)

Mesotheliomas are tumors originating from the mesothelial cells of the pleura, peritoneum, pericardium or tunica vaginalis, with prolonged exposure to asbestos the main risk factor. Benign mesothelial neoplasms of the paratesticular region are rare. Here we report a case of tunica vaginalis mesothelioma associated with hydrocele, highlighting the usefulness of ultrasound in the evaluation of scrotal masses (AU)

Mesotelioma pleural sarcomatoide, con diseminación masiva a peritoneo y pericardio. Un caso de autopsia / Malignant pleural mesothelioma, with generalized dissemination to peritoneum and pericardium: a descriptive autopsy report

El mesotelioma maligno es una neoplasia originada a partir de las células mesoteliales de las membranas serosas (pleura, peritoneo, pericardio y otros). Es 5 veces más frecuente en la cavidad pleural que en la peritoneal, y puede observarse en ambas por extensión directa a través del diafragma(1). Se presenta el caso de autopsia en una mujer de 83 años, sin antecedentes de exposición al asbesto, oligosintomática, con mesotelioma pleural maligno tipo sarcomatoide, en estadio avanzado (Estadio IV). El mesotelioma es una neoplasia letal, su diagnóstico a veces resulta dificultoso debido al crecimiento lento, las manifestaciones clínicas tardías y el diagnóstico en estadios avanzados. En primer lugar debe descartarse secundarismo y ante clínica e imágenes compatibles debe plantearse su diagnóstico.

Malignant mesotheliomas are tumors derived from mesothelial cells that form the serous membranes. The incidence of mesotheliomas show a rate 5 times greater in the pleural cavity than in the peritoneum; but they can be detected in both, as a result of direct invasion through the diaphragm. A case out from an autopsy is reported, of a 83 years old female patient, with no previous history of exposure to asbestos, oligosymptomatic, with malignant pleural mesothelioma of sarcomatoideal type, at an advanced stage (Stage IV). Malignant mesotheliomas are relatively rare being a highly lethal neoplasia its diagnosis is sometimes difficult because the have a gradual development and growth, with late clinical manifestions, and with diagnosis at an advanced evolutive stages. First of all, secondarism must be discarged, and in presence of compatibles images, its diagnosis must be hypothesized.

Epithelioid malignant mesothelioma of tunica vaginalis with deciduoid features: An unusual malignancy clinically masquerading an inguinal hernia.

Paratesticular/scrotal and inguinal canal mass lesions in elderly patients may pose a diagnostic challenge to both the surgeon as well as the pathologist. In most cases, these represent hernial sacs with their contents, and true neoplasms like lipomas, rhabdomyosarcomas, and fibrous pseudotumors are infrequent. Malignant mesotheliomas arising from the tunica layers are rare cause of inguinal and paratesticular tumors. Herein, we report a case of an elderly patient who presented with an inguinal hernia which pathologically had features of deciduoid malignant mesothelioma.

Mesotelioma primario del pericardio / Primary pericardium mesothelioma

Introducción: El mesotelioma primario de pericardio (MPP) es una neoplasia extremadamente rara, que se origina de las células mesoteliales del pericardio. Esta neoplasia tiene la capacidad de invadir estructuras adyacentes y de originar metástasis a distancia; sin embargo, por su localización, generalmente es mortal en forma precoz. Hasta el momento se han informado alrededor de 200 casos en el mundo. Objetivo: Describir un caso de MPP diagnosticado por autopsia y realizar una discusión de este tema. Caso clínico: Mujer de 56 años de edad, quien ingresa por anorexia, pérdida de peso, disfagia y disnea de un año de evolución, posteriormente se acompaña de masa cervical supraclavicular derecha. Además, se evidenció esfuerzo respiratorio. La radiografía y TAC de tórax documentaron aumento mediastinal, y derrame pleural y pericárdico. El estudio citológico del aspirado con aguja fina de la masa cervical y la citología de líquido pleural, fueron compatibles con neoplasia maligna. La paciente presentó deterioro progresivo y muerte. Se realizó autopsia donde se encontró corazón encarcelado totalmente por neoplasia multinodular, con múltiples áreas de necrosis. El estudio histopatológico documentó un MPP. Conclusión: El MPP es una neoplasia poco frecuente, la cual es generalmente fatal debido a la sensibilidad de los órganos que compromete. Por este motivo, este tumor es generalmente diagnosticado en autopsia, posterior a una muerte desencadenada, en la mayoría de los casos, por taponamiento cardíaco.

Background: Primary pericardial mesothelioma (PPM) is an extremely rare neoplasm originated from pericardium mesothelial cells. This tumor has the ability to invade adjacent structures and cause distant metastases, but its location, is usually fatal early. About 200 cases are worldwide reported. Aim: A case of PPM diagnosed by autopsy is presented. Case report: 56-years-old Female, who was admitted for anorexia, weight loss, dysphagia, and dyspnea of one year of evolution, later accompanied by right supraclavicular neck mass. Was evident respiratory effort. The chest radiograph and CT scan documented increased mediastinal space and pleural and pericardial effusion. The cytological analyses of the fine needle aspiration of neck mass and pleural fluid were compatible with malignancy. The patient had progressive deterioration and death. Autopsy was performed which was found completely incarcerated heart by a multinodular tumor with multiple areas of necrosis. The histopathological study show a PPM. Conclusion: PPM is a rare malignancy, which is usually fatal because of the sensitivity of organs compromised. Therefore, this tumor is usually diagnosed at autopsy after death, in most cases secondary to cardiac tamponade.

Mesotelioma maligno: experiencia clínico-patológica de 247 casos / Malignant mesothelioma: clinical and pathological features from 247 cases

Objective: This study describes the frequency, occupational, clinical, and pathological features in a large cohort of cases of Malignant Mesothelioma (MM) from the National Institute of Respiratory Diseases (INER), in México. Methods: A retrospective and transversal study was carried out in medical records of patients diagnosed with MM between the years 1991 to 2007. Results: Of the 247 patients, 184 were male and 63 were female with an average age of 51-60 years. Dyspnea and chest pain were the presenting symptoms in most of the patients. Exposure to asbestos was referred only in 34 percent of cases but direct exposition only was documented in five of them. Clinical features of MM patients were similar in asbestos related and non-asbestos related malignant mesothelioma. Conclusion: Although a growing tendency is observed in, the number of cases with MM, in many of them was not possible to establish the source of asbestos exposure.

Objetivo: Este estudio describe la frecuencia, características patológicas, ocupación y exposición a asbesto en una cohorte grande de casos de mesotelioma maligno (MM) admitidos en el Instituto Nacional de Enfermedades Respiratorias (INER), en México. Método: Se llevó a cabo un estudio retrospectivo y transversal en los registros médicos de pacientes diagnosticados con MM entre los años 1991-2007. Resultados: De los 247pacientes, 184 fueron hombres y 63 fueron mujeres con un promedio de edad de 51 y 60 años. Disnea y dolor torácico fueron los principales síntomas observados. Exposición a fibras de asbesto fue referida sólo en 34 por ciento) de los casos, aunque una exposición directa sólo puedo ser documentada en cinco de ellos. Las características clínicas de los pacientes con MM fueron similares en aquellos con y sin exposición a asbesto reconocida. Conclusión: Aunque se observa una tendencia creciente en el número de casos con MM, en muchos de ellos no fue posible establecer una fuente de exposición a asbesto como la causa de contaminación para el desarrollo de la enfermedad.

Mesotelioma pleural maligno: experiência multidisciplinar em hospital público terciário / Malignant pleural mesothelioma: multidisciplinary experience in a public tertiary hospital

OBJETIVOS: Avaliar a experiência com o diagnóstico e a terapêutica do mesotelioma pleural maligno (MPM) acumulada durante 5 anos em um hospital público terciário. MÉTODOS: Avaliação retrospectiva dos prontuários dos pacientes com diagnóstico de MPM entre janeiro de 2000 e fevereiro de 2005. RESULTADOS: Foram analisados 17 pacientes, 14 homens e 3 mulheres, com idade média de 54,1 (13-75) anos. Os espécimes de biópsia para exame histopatológico foram obtidos por meio de pleuroscopia em 9 pacientes (53 por cento), agulha de Cope em 5 (29,5 por cento) e biópsia pleural aberta em 3 (17,5 por cento). Os tipos histológicos foram: epitelial em 14 pacientes (82 por cento), sarcomatóide em 1 (6 por cento) e bifásico em 2 (12 por cento). As terapêuticas instituídas foram: multimodal (pleuropneumonectomia com radioterapia e quimioterapia adjuvante) em 6 pacientes (35 por cento), quimioterapia e radioterapia em 6 (35 por cento), radioterapia exclusiva em 3 (17,5 por cento) e quimioterapia exclusiva em 2 (12 por cento). A sobrevida média foi de 11 (1-26) meses. CONCLUSÕES: Na presente experiência foi empregada a abordagem multidisciplinar integrada, e contou-se com uma estrutura hospitalar de alta complexidade para o diagnóstico e tratamento do MPM, como preconizado na literatura. Apesar disso, a sobrevida média observada foi de apenas 11 meses, refletindo a agressividade da doença.

OBJECTIVE: To evaluate the experience in diagnosing and treating malignant pleural mesothelioma (MPM) accumulated over 5 years in a tertiary public hospital. METHODS: The medical charts of the patients diagnosed with MPM between January of 2000 and February of 2005 were evaluated retrospectively. RESULTS: Of the 17 patients analyzed, 14 were male and 3 were female. The mean age was 54.1 years (range, 13-75 years). The biopsy specimens for histopathological examination were obtained through thoracoscopy in 9 patients (53 percent), Cope needle in 5 (29.5 percent), and open pleural biopsy in 3 (17.5 percent). The following histological types were identified: epithelial, in 14 patients (82 percent); sarcomatoid, in 1 (6 percent); and biphasic, in 2 (12 percent). The therapeutic approaches used were as follows: multimodal (pleuropneumonectomy and adjuvant radiotherapy and chemotherapy) in 6 patients (35 percent); chemotherapy and radiotherapy in 6 (35 percent); radiotherapy alone in 3 (17.5 percent); and chemotherapy alone in 2 (12 percent). The mean survival was 11 months (range, 1-26 months). CONCLUSIONS: In the cases studied, an integrated multidisciplinary approach was used, and a highly complex hospital infrastructure was available for the diagnosis and treatment of MPM, as recommended in the literature. However, the mean survival was only 11 months, reflecting the aggressiveness of the disease.

Mesotelioma invasivo de un canino: citología, clínica y hallazgos patológicos / Invasive mesothelioma of canine: cytology, clinical and pathology's Findings

Este reporte describe los hallazgos macro y microscópicos de un mesotelioma invasivo epitelial y mesotelioma bifásico (mixto) maligno en un canino macho de 8 años de edad, raza Pit Bull, que llegó a la Clínica Veterinaria de la Escuela de Medicina Veterinaria y Zootecnia de la Facultad de Ciencias Agropecuarias y Recursos Naturales de la Universidad de los Llanos, cuyo motivo de consulta fue aumento del tamaño del abdomen, ascitis, anorexia, pérdida de peso, depresión, dificultad respiratoria y vómito. Según lo reportado por el propietario, el animal había recibido tratamiento para una falla renal que venía presentando meses atrás. Por el pobre pronóstico y orden del propietario, el animal fue eutanasiado y se remitió para necropsia al Laboratorio de Histopatología Veterinaria de la Universidad, siendo realizada la examinación post mortem. A la necropsia, se halló un tumor que comprometió el pericardio con dos neoplasias ulceradas, el mediastino y peritoneo, con numerosas multifocales o, a menudo, confluentes masas neoplásicas blanquecinas, las cuales estaban esparcidas a través del omento y superficies serosas de los órganos de la cavidad abdominal, como en el riñón derecho, páncreas e igualmente dos masas bilobuladas de color rojo de 1 x 1,5 cm en el tejido subcutáneo de la región inguinal, por extensión directa a través del peritoneo, implantación e invasión del tejido subyacente. Por histopatología, se diagnosticó un mesotelioma invasivo epitelial y mesotelioma bifásico maligno, con metástasis a riñón y páncreas, en los que se encontraron células mesoteliales neoplásicas con figuras mitóticas frecuentes, binucleación e invasión de tejidos submesoteliales infiltrados. En hemograma realizado previo a la necropsia, se encontró en el frotis sanguíneo, células blásticas y núcleos desnudos, hallazgos compatibles con una leucemia mielomonocítica.

This report describes the gross, microscopic features of an invasive epithelioid malignant mesothelioma and biphasic (mixed) malignant mesothelioma in an 8 ¡year ¡old male Pit ¡Bull, arrives to the Veterinary Clinic of the School of Veterinary Medicine and Zootecnia of the Faculty of Agricultural Sciences and Natural Resources of the Universidad de los Llanos, whose consultation reason was a increased of the size of abdomen, ascites, anorexia, weight lost, depression, breathing difficulty, vomit, according to the report of the owner, the animal had received treatment for the renal fail which occurred some months ago. The tumor involved the pericardium with two ulceratived neoplastic masses, pleura, mediastinum, and peritoneum with numerous, multiple foci, white neoplastic masses scattered through the peritoneum, and serous surfaces of the organs of the abdominal cavity as the right kidney, pancreas, and equality two bilobed masses with red color of 1 X 1,5cm in the subcutaneous tissue of the inguinal region by direct invaded through the peritoneum, implantation and direct invasion of the subjacent tissue. By histopathology was diagnosed a invasive epithelioid malignant mesothelioma and biphasic (mixed) malignant mesothelioma, with metastasis to kidney and pancreas, the neoplastic cells with frequent mitotic figures and binucleation that infiltrated submesothelial tissues. In the hemogram realized before the necropsy, we found blastic blood cell frotis and naked shared gross with a mielomonocitic leukaemya.

Pseudomesotheliomatous lung carcinoma of poorly differentiated large cell type: a case report and review of the literature

A 46-year-old female presented with a 20-day history of right pleuritic chest pain and progressive shortness of breath. She was found to have a right pleural based malignancy initially thought to be a malignant mesothelioma but staining with the mesothelioma tumor markers calretinin, HBME-1 and CK5/6, was negative. Some epitheial markers were positive and microscopically it was consistent with a poorly differentiated large-cell carcinoma. The case was diagnosed as a pseudomesotheliomatous lung carcinoma of poorly differentiated large-cell type

Marcadores morfológicos de prognóstico no mesotelioma maligno: um estudo de 58 casos / Morphological aspects as prognostic factors in malignant mesothelioma: a study of 58 cases

OBJETIVO: Diversos marcadores têm se mostrados promissórios como preditores do diagnóstico e prognóstico do mesotelioma maligno (MM). MÉTODO: Mediante estudo morfométrico e inmunomarcação de componentes estromais (calretinina, CEA, Leu-M1 e trombomodulina) e nucleares (p53 e Ki-67), avaliamos a sobrevida após o diagnóstico de 58 pacientes com tumores malignos de pleura. RESULTADOS: O padrão histológico típico do mesotelioma maligno foi encontrado em 50 casos e o padrão atípico em 8 casos. Imunohistoquimicamente foram confirmados 40 casos como sendo mesoteliomas, 11 como adenocarcimonas e 7 casos do padrão atípico não puderam ser classificados. A análise multivariavel do Cox demonstrou a coexistência de um maior fator de risco de morte (476.2), nos pacientes com idade avançada, subtipo histológico bifásico e componentes de expressão nuclear. CONCLUSÃO: A calretinina foi o marcador inmunohistoquímico (IHQ) mais útil para o diagnóstico do mesotelioma e o CEA para o de adenocarcinoma. A quantificação por IHQ da trombomodulina foi fundamental na diferenciação do mesotelioma quando este foi positivo tanto para calretinina e como para o CEA. A informação prognostica mais valiosa foi a fornecida pela análise rotineira histopatológica do tipo histológico tumoral. Um ponto importante, divisor natural, foi a idade com uma media de 55 anos e 30.5 por cento de componentes nucleares de marcação IHQ, separando os pacientes em dois grupos: pacientes com uma sobrevivência curta contra pacientes com uma sobrevivência mais longa que a esperada. Assim, a análise histopatológica oferece uma arma poderosa e de elevado potencial para guiar no tratamento adjuvante de quimioterápicos após a retirada cirúrgica do mesotelioma.

OBJECTIVE: Various markers have shown promise as diagnostic markers and prognostic predictors in malignant mesothelioma (MM). METHODS: Through morphometric and immunological studies of markers in stromal components (calretinin, CEA, Leu-M1 and thrombomodulin) and nuclear components (p53 and Ki-67), we evaluated post-diagnosis survival in 58 patients with MM. RESULTS: The histologic pattern of the MM was typical in 50 cases and atypical in 8. Through immunohistochemistry, we confirmed 40 cases of mesothelioma and 11 cases of adenocarcinoma, although we were unable to classify 7 of the 8 cases presenting atypical histologic patterns. Cox multivariate analysis revealed that the risk factor for death was higher (476.2) among patients of advanced age, presenting the biphasic subtype and testing positive for components expressed at the nuclear level. CONCLUSION: The most useful immunohistochemical markers were was calretinin (for mesothelioma) and CEA (for adenocarcinoma). Immunohistochemical quantification of thrombomodulin facilitated the diagnosis of mesothelioma in patients testing positive for both calretinin and CEA. The most useful prognostic information was that provided by the routine histopathological analysis of the tumor type. It is of note that the combination of a mean age of 55 years and 30.5 percent immunohistochemical markers in nuclear components created a natural dividing point between patients in which survival was shorter than expected and those in which it was longer than expected. Therefore, histopathological analysis offers a powerful weapon with great potential to inform decisions regarding the use of adjuvant chemotherapy after surgical excision of a mesothelioma.

Diagnósticos histopatológicos das pneumoconioses / Histopathological diagnosis of pneumoconiosis

As doenças asbesto-induzidas constituem um grave problema de saúde em decorrência de um grande número de trabalhadores expostos ao asbesto ao longo dos últimos 50 anos. Processos judiciais contra indústrias que lidam com asbesto somam centenas, com crescente adição de novos casos. O assunto relativo à asbestose é complexo, e muito embora a história natural das doenças induzidas esteja bem estabelecida, muitas áreas importantes, como a patologia, permanecem ainda pouco compreendidas. No Brasil, desde 1940, o asbesto é explorado comercialmente, sendo que nos últimos anos sua produção é da ordem de 200.000 toneladas por ano, estimando-se que na atividade de mineração cerca de 10.000 trabalhadores foram expostos a essa fibra, desconhecendo-se a estimativa do número de pessoas expostas na produção de fibrocimento, especialmente telhas e caixas d'água. Um estudo, de cunho inter-institucional, com metodologia de investigação científica apropriada, para avaliar as repercussões sobre a saúde dos trabalhadores nas minas de asbesto, em nosso país foi elaborado e intitulado "Moralidade e Mortalidade Entre Trabalhadores Expostos ao Asbesto na Atividade de Mineração 1940-1996". O objetivo deste trabalho foi fornecer uma visão ampla das doenças asbesto-induzida, com ênfase às dificuldades no diagnóstico histopatológico, através da experiência adquirida com o desenrolar desse projeto.

Asbestos-related diseases constitute a major health problem due to the great number of workers exposed to asbestos over the past 50 years. Personal injury lawsuits against industries that deal with asbestos number in the hundreds, and new cases continue to be filed. The scientific issues related to asbestos are complex, and, although the broad outlines of asbestos-related diseases have been well-established, many significant aspects (such as the pathology involved) are poorly understood. In Brazil, asbestos has been mined commercially since 1940, with production levels recently approaching 200,000 tons/year, resulting in the asbestos exposure of approximately 10,000 workers in the mining activity, and an unknown number of workers in asbestos-cement industry, primarily roofers and concrete rooftop water tank installers. One study, using appropriate methods of scientific investigation to evaluate the effects of such exposure on the health of asbestos mine workers in Brazil was conducted as part of a multicenter study and entitled "Morbidity and Mortality Among Workers Exposed to Asbestos in Mining Activities, 1940-1996". Drawing upon the experience acquired during the course of that study, the objective of the current report was to give an overview of asbestos-related diseases, with a special focus on the difficulties involved in establishing the histopathological diagnosis.

Giant mesenteric cyst of abdomen herniating into scrotum.

Cystic mesenteric tumors are rare abdominal neoplasms. We report a 55-year-old man with recurrent benign mesothelioma arising from the left colonic mesentery and extending into the scrotal sac. He recovered well after excision of the abdominal and scrotal mass.