Spogmai S. Khan, MD1, Abdul Nadir, MD2, Wilkins Lyndie, DO1, Idress Suliman, MD1 1Midwestern University, Mesa, AZ; 2Mountain Vista Medical Center, Mesa, AZ
Introduction: Malignant peritoneal mesothelioma (MPM) is an aggressive tumor of the peritoneum. Few cases have been reported in the literature describing spontaneous regression possibly related to immune reconstitution. Here in, we report a unique case of peritoneal mesothelioma that regressed over time.
Case Description/Methods:
A case of 44 y/o female with a history of severe psoriasis (on Humira) and NASH, coccidioidomycosis in 2018 (on ketoconazole) presented with jaundice and abdominal distention in September 2020. She was diagnosed with cirrhosis secondary to NASH, and DILI with a MELD score of 30. Ketoconazole and Humira were held. She was medically managed with furosemide and spironolactone. Her MELD score improved to 18. In January 2021, an orthotopic liver transplant (OLTx) was attempted but due to incidental finding of extensive peritoneal mesothelioma, this was aborted. MPM was confirmed on biopsy with cytokeratin 7+, calretinin+, WT1+, and p53 reactivity. The patient was not considered a candidate for cytoreductive surgery/hyperthermic intraperitoneal chemotherapy. She had multiple psoriatic flares which were managed with prednisone.
A PET scan done in June 2022 revealed mild FDG uptake in sub-centimeter bilateral axillary and pelvic LN, cirrhotic liver, and splenomegaly. The patient denied the use of alternative medicine, except for the Atkins diet. She is now being considered for OLTx
Discussion: We present a unique case of spontaneous regression of MPM and its association with psoriatic flare. Previous case reports suggest a co-relation of immune-mediated response with spontaneous regression.1 The immunologically relevant cytokines IF-alpha, IF-gama, and TNF-alpha can directly inhibit the growth of mesothelioma.2These cytokines are elevated in psoriasis, which this case highlights. Trials with immunomodulatory agents e.g. CTLA-4 inhibitor have shown promising outcomes.3 However, little information is available about regression without any chemo/radiation/biologic therapy and the role of the innate immune response leading to tumor regression.
Moser, Justin C. 2015. "Spontaneous Regression of Malignant Pleural Mesothelioma in a Patient with New-Onset Inflammatory Arthropathy." AnnalsATS Volume 12 Number 9 (AnnalsATS Volume 12) 12: 1416-1417.
1.Upham, J W. 1995. "Malignant Mesothelioma: new insights into biology and immunology as bases of new treatment approaches. ." Thorax 887-892.
Guazzelli, Alice. 2015. "Tremelimumab for the treatment of malignant mesothelioma."15:12, 1819-1829 15:12
Disclosures:
Spogmai Khan indicated no relevant financial relationships.
Abdul Nadir indicated no relevant financial relationships.
Wilkins Lyndie indicated no relevant financial relationships.
Idress Suliman indicated no relevant financial relationships.
Spogmai S. Khan, MD1, Abdul Nadir, MD2, Wilkins Lyndie, DO1, Idress Suliman, MD1. E0584 - A Case of Spontaneous Resolution of Malignant Peritoneal Mesothelioma, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
