title: Small bowel metastasis from pancreatic cancer in a long-term survival patient with synchronous advanced malignant pleural mesothelioma: A case report and literature review.
abstract: Diffuse malignant pleural mesothelioma (MPM) is an aggressive tumor that originates from the surface of the pleura. Approximately 70% of cases are associated with chronic asbestos exposure. MPM is regarded as an incurable disease, with a median survival of ~2 years following intensive multimodality treatment. Pancreatic cancer is a malignancy also associated with a poor prognosis, with only 2% of patients surviving for 5 years. The majority of patients with pancreatic cancer are diagnosed with an advanced stage of disease and experience a poor response to therapy. The development of synchronous MPM and other types of cancer is rare. The present study describes a patient with synchronous, biphasic MPM and pancreatic adenocarcinoma, who was treated with a multimodal therapeutic approach with stereotactic body radiation therapy. Due to a suspected diagnosis of 'acute abdomen', an emergency small intestine resection was performed and a subsequent diagnosis of moderately-differentiated adenocarcinoma was confirmed. During a further immunohistochemical examination, pathologists determined that the small bowel metastasis descended from pancreatic cancer. The onset of bowel metastasis is an event rarely associated with MPM, and has not been previously described in the literature for cases of pancreatic cancer. Therefore, to the best of our knowledge, the present study describes the first case of intestinal metastasis from pancreatic cancer in a long-term survival patient with biphasic MPM.
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi e A. Lanzara', Second University of Naples, I-80131 Naples, Italy.
authors.forename: Morena
authors.initials: M
authors.lastname: Fasano
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi e A. Lanzara', Second University of Naples, I-80131 Naples, Italy.
authors.forename: Carminia Maria
authors.initials: CM
authors.lastname: Della Corte
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, I-80131 Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vicidomini
authors.affiliation: Malzoni Radiosurgery Center, Neuromed Group, Agropoli, I-84100 Salerno, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Scotti
authors.affiliation: Department of Nuclear Medicine Division, Second University of Naples, I-80131 Naples, Italy.
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Rambaldi
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, I-80131 Naples, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fiorelli
authors.affiliation: Department of Morphopathology, Second University of Naples, I-80131 Naples, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Accardo
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi e A. Lanzara', Second University of Naples, I-80131 Naples, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: De Vita
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, I-80131 Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Santini
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi e A. Lanzara', Second University of Naples, I-80131 Naples, Italy.
authors.forename: Fortunato
authors.initials: F
authors.lastname: Ciardiello
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi e A. Lanzara', Second University of Naples, I-80131 Naples, Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Morgillo
keywords: diffuse malignant pleural mesothelioma; multimodal chemoradiotherapic approach; pancreatic cancer; stereotactic body radiation therapy; synchronous tumors