Peritoneal Mesothelioma May Be Linked to Crohn's Disease

Chronic abdominal inflammation, typical of Crohn's disease, could be a contributing factor in the development of peritoneal mesothelioma, according to a recent study.

Pathologists from the University of Vermont and Duke University studied the link between the two diseases, raising the possibility of a previously underreported connection.

The Journal of Clinical Pathology earlier this month published the retrospective study, providing insights on new inflammatory pathways that may lead to one type of the rare asbestos-related cancer.

“The observations in this study prompt consideration of chronic serosal inflammation secondary to CD [Crohn's disease] as a possible inducing factor in rare cases of malignant mesothelioma,” lead author and University of Vermont Medical Center pathologist Dr. Kelly Butnor wrote in the report.

A university spokesperson told Asbestos.com that Butnor declined to comment about the study.

Details of Peritoneal Mesothelioma and Crohn's Disease Study

Duke University School of Medicine pathologist Dr. Victor Roggli, who specializes in asbestos-related diseases, provided the study's researchers with a database of 3,800 mesothelioma cases from 1982 to present.

That database included 500 patients with peritoneal mesothelioma, three of which were receiving treatment for Crohn's - an inflammatory bowel disease (IBD) - at the time of the cancer diagnosis.

The ages of the three patients in the study with peritoneal mesothelioma and CD ranged from 56 to 65.

Two patients had the epithelial cell type of mesothelioma, and one had the biphasic cell type. Survival times for all three ranged from two months to 30 months after diagnosis. Only one of them had a documented history of asbestos exposure.

“Our three cases suggest an increased prevalence of CD in individuals with peritoneal mesothelioma,” the researchers wrote. “It is interesting to note that individuals with active CD show significantly increased serum concentrations of interleukin-6 and overproduction of this same cytokine has been implicated in the development of a number of malignancies, including malignant mesothelioma.”

Mesothelioma and Crohn's Disease Share Similar Symptoms

The Centers for Disease Control and Prevention shows IBD affects an estimated 1.3 million people in the U.S. In contrast, doctors diagnose about 800 cases annually of peritoneal mesothelioma, a rare cancer typically caused by the ingestion of microscopic asbestos fibers.

Both diseases share similar symptoms: Constant diarrhea, constipation, abdominal pain and swelling.

“Peritoneal mesothelioma is apt to be clinically mistaken for CD, with which it overlaps in signs and symptoms. This has occurred in cases with an established diagnosis of CD,” the study shows. “Conversely, CD occasionally mimics peritoneal mesothelioma.”

Asbestos diseases, including peritoneal and pleural mesothelioma, are marked by an inflammation of cells that leads to scarring. A mesothelioma diagnosis may come 20-50 years after exposure to asbestos.

The authors claim their study is the first to report peritoneal mesothelioma arising in the setting of IBD: “The occurrence of peritoneal [mesothelioma] in patients with CD suggests that Crohn-associated transmural inflammation may be a possible inducing factor for the development of mesothelioma.”

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