| 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 Abstract
  Salvatore Maugeri Foundation, and University of Pavia 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. Key words: calretinin, cisplatin, HBME-1, intraperitoneal chemotherapy, occupational cancer, peritonectomy. Environ Health Perspect 112:616-619 (2004) . doi:10.1289/ehp.6542 available via http://dx.doi.org/ [Online 1 December 2003]
Address correspondence to S.M. Candura, Division of Occupational Medicine, Salvatore Maugeri Foundation, Work and Rehabilitation, IRCCS, Scientific Institute of Pavia, Via Ferrata 8, I-27100 Pavia, Italy. Telephone: 39 0382 592740. Fax: 39 0382 592096. E-mail: scandura@fsm.it The authors declare they have no competing financial interests. Received 24 June 2003 ; accepted 1 December 2003. Figure legends were corrected 16 March 2004.
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