The vast majority of malignant mesothelioma (MM) cases are caused by asbestos exposure, but reports have suggested that chronic inflammation may also lead to development of this cancer. In a recent study, University of Vermont researchers found a link between the the chronic inflammation associated with Crohn’s disease, an inflammatory bowel disease (IBD), and peritoneal mesothelioma.
Their study, “Malignant peritoneal mesothelioma and Crohn disease,” published in the Journal of Clinical Pathology, provides new insights on possible mechanisms that may lead to MM.
Malignant mesothelioma arising from conditions that cause chronic inflammation in serosal membranes, which are composed of mesothelial cells, is a rare but reported event. Although this type of inflammation is a hallmark of Crohn’s disease, MM had not been reported in this patient population.
The research team led by Victor Roggli retrospectively examined data from nearly 3,800 patients with MM, 500 of which had peritoneal MM, to assess whether there was a link with Crohn’s disease. Of the patients studied, three were found to have Crohn’s disease, but only one had any known exposure to asbestos.
This was the first report showing that MM may arise in the setting of IBD, but interestingly, none of the MM patients was found to have ulcerative colitis, the other major type of IBD. The researchers believe that this occurs because, contrary to Crohn’s disease, ulcerative colitis does not cause transmural and serosal inflammation.
It is noteworthy that all three patients with Crohn’s disease had peritoneal MM, suggesting that Crohn’s disease increases the risk of this particular type of malignant mesothelioma. This is relevant because although peritoneal MM is extremely rare, IBDs affect more than 1.5 million people in the U.S., and patients with IBD, particularly those with Crohn’s disease, and their physicians should be aware of a possible increased risk for peritoneal MM.
Although it remains to be studied how Crohn’s-related inflammation might give rise to peritoneal MM, the researchers note that each of the diseases can occasionally mimic the signs and symptoms of the other, suggesting there may exist common pathways, particularly inflammatory pathways, that are activated in both diseases.