What caused gastrointestinal bleeding in a woman with a history of pleural mesothelioma? Metastatic diffuse epithelioid mesothelioma.

A 72-year-old white woman was admitted to the university hospital with malaria. Her medical history highlighted a pleural mesothelioma diagnosed 2?years earlier and treated by left thoracotomy with chest wall and diaphragm resection followed by four courses of systemic chemotherapy. When the malarial infection had almost resolved, severe anaemia (haemoglobin 7.2?g/dl, normal value 13.0?g/dl) and leucocytosis (white blood count 18.6 × 109/l) developed necessitating further diagnostic examinations to search for occult bleeding. A contrast-enhanced 64-multidetector row CT (MDCT) scan showed a huge polypoid lesion (figure 1) in the ascending colon with locoregional lymphadenopathy but no evidence of pleural relapse. Colonoscopy detected a vegetating bleeding polypoid lesion in the right colon, and standard histopathological examination of biopsy specimens diagnosed a primary colon adenocarcinoma, resected by right hemicolectomy (figure 2) and regional lymphadenectomy.