A case of mesothelioma masquerading pre-operatively as ovarian cancer and brief review of the literature

Our plain-English summary of A case of mesothelioma masquerading pre-operatively as ovarian cancer and brief review of the literature, by K.L. Hancock, C.M. Clinton, H.E. Dinkelspiel, et al (Gynecologic Oncology Reports, 2016).

The study

• Authors: K.L. Hancock, C.M. Clinton, H.E. Dinkelspiel, J. Saab, B. Schneider, T.A. Caputo
• Journal: Gynecologic Oncology Reports
• Published: 2016;17:26-8
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant peritoneal mesothelioma (MPM) can masquerade as an ovarian epithelial neoplasm, with very similar presenting clinical symptoms and imaging findings. The gold standard in differentiating between these two diagnoses lies in tissue pathology.

Case Report: This is a case of MPM that was initially misdiagnosed as ovarian cancer based on family history, imaging, and surgical findings. Tissue diagnosis preoperatively would have changed the planned procedure. Retrospectively, after the diagnosis of MPM, the patient was found to have had an indirect exposure to asbestos through her father.

Conclusions: This case highlights the importance of keeping a broad differential when diagnosing ovarian malignancies, collecting both family and social histories (including screening for exposure to asbestos), and the benefit of obtaining tissue diagnosis when MPM is suspected.

In plain English

This is a case report with a brief literature review, written by doctors in New York and Michigan. It described one 51-year-old postmenopausal woman, whose sister had ovarian cancer. Her scans showed a mass in the area of the right ovary and widespread growths on the lining of the abdomen. Ovarian cancer was suspected, and she had surgery. Final tissue examination instead showed malignant peritoneal mesothelioma (MPM). Staining was strongly positive for the mesothelial markers calretinin and CK 5/6 and negative for the ovarian marker PAX-8. She then had chemotherapy and a second surgery with heated chemotherapy inside the abdomen (HIPEC). Scans showed no disease at three and six months, but the disease progressed ten months later, and she was still in treatment at the time of the report. Her history was re-examined only after diagnosis. Her father had been a seaman who developed lung asbestosis, so she had household exposure to asbestos. No fiber type was named. The authors concluded that the case highlights collecting family and social histories, including screening for asbestos exposure, and obtaining tissue diagnosis when MPM is suspected.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of a single patient, with a brief review of the literature
• Who was studied: One 51-year-old asymptomatic, postmenopausal woman whose sister had been diagnosed with ovarian cancer at age 49, seen by gynecologic oncology at Weill Cornell Medical College / New York-Presbyterian Hospital, New York
• Exposure: Household (indirect) exposure to asbestos through her father, a seaman who developed lung asbestosis; identified only after the diagnosis. No fiber type or dose is given.
• Main results:
  • Before surgery, tumor markers were within normal limits and primary ovarian cancer was suspected
  • In this patient, final pathology after surgery showed malignant peritoneal mesothelioma
  • The patient's tumor stained strongly for the mesothelial markers calretinin and CK 5/6, and staining for the ovarian marker PAX-8 was negative
  • Psammoma bodies, described by the authors as more common in ovarian cancer, were seen in this patient's mesothelioma
  • After chemotherapy and cytoreductive surgery with HIPEC, scans at three and six months showed no disease, but a scan ten months later showed progression in the peritoneum and new ascites
  • At the time of the report the patient was still receiving treatment
  • The authors stated that MPM was low on the list of possible diagnoses in this case, and that suspecting it before surgery would have allowed HIPEC during the first surgery
• The authors' conclusion: The authors concluded that the case highlights keeping a broad differential diagnosis, collecting both family and social histories (including screening for asbestos exposure), and the benefit of obtaining tissue diagnosis when MPM is suspected

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Ovarian Cancer, Peritoneal Mesothelioma, Neoplasm, Pathology.

Related studies

• Malignant mesotheliomas in spermatic cords: reports of two cases and a brief review of literature — X. Meng, T.J. Guzzo, et al. (2013)
• Does exposure to asbestos cause ovarian cancer? A systematic literature review and meta-analysis — A. Reid, N. de Klerk, et al. (2011)
• Primary Ovarian Mesothelioma: A Case Series with Electron Microscopy Examination and Review of the Literature — L. Vimercati, D. Cavone, et al. (2021)
• Diffuse intrapulmonary malignant mesothelioma masquerading as interstitial lung disease: a distinctive variant of mesothelioma — B.T. Larsen, J.R. Klein, et al. (2013)
• Desmoplastic malignant mesothelioma masquerading as sclerosing mediastinitis: a diagnostic dilemma — T.B. Crotty, T.V. Colby, et al. (1992)
• Pericardial mesothelioma masquerading as a benign pericardial effusion — N.L. Coplan, A.J. Kennish, et al. (1984)

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