A Case of Well-Differentiated Papillary Mesothelioma of the Male Peritoneum: Successful Treatment by Systemic Chemotherapy

Our plain-English summary of A Case of Well-Differentiated Papillary Mesothelioma of the Male Peritoneum: Successful Treatment by Systemic Chemotherapy, by A. Bazine, M. Fetohi, T. Namad, et al (Curēus, 2017).

The study

• Authors: A. Bazine, M. Fetohi, T. Namad, A. Benzekri, B. Zainoun, R. Tanz, M. Ichou
• Journal: Curēus
• Published: 2017;9(3):e1104
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Well-differentiated papillary mesothelioma of the peritoneum (WDPMP) is a rare subtype of epithelioid mesothelioma, which is usually seen in young women without a history of asbestos exposure, and generally, has an indolent course. The relative rarity of this neoplasm in males prompted us to report this case of a well-differentiated papillary mesothelioma of the peritoneum in a 36-year-old man. The patient, who had no history of asbestos exposure, presented with abdominal pain and ascites of unknown etiology. Computed tomography showed abundant ascites with nodules of the peritoneal cavity. Laparoscopic examination revealed a large number of white miliary nodules diffusely covering the peritoneum. Pathology revealed a diagnosis of well-differentiated papillary mesothelioma of the peritoneum, based on histomorphology and immunohistochemistry. The patient started chemotherapy with cisplatin and pemetrexed. After six cycles of chemotherapy, the effectiveness of this chemotherapy was checked by only the computed tomography. PET scan was not used because it is not routinely recommended in WDPMP. Few data are currently available in the literature regarding the performance of the PET scan in WDPMP. Nine months later, the patient was free of symptoms. Based on reviewing the literature and our observations in this case, consultation of other pathologists is highly recommended to discern WDPMP from other disseminated peritoneal diseases, in order to offer the most effective and safe therapeutic strategy. Chemotherapy should be strongly considered if the tumor is unresectable and accompanied by symptoms. Cisplatin and pemetrexed chemotherapy could be a promising therapeutic choice.

In plain English

This Moroccan case report describes one 36-year-old man with well-differentiated papillary mesothelioma of the peritoneum (WDPMP), a rare mesothelioma of the abdominal lining. The authors describe it as usually seen in young women without a history of asbestos exposure. This patient had no history of asbestos exposure. He had two months of abdominal pain and a swelling abdomen from fluid (ascites). Fluid tests found no cancer cells, and bacterial, fungal and mycobacterial cultures were negative. CT showed much fluid and small nodules on the abdominal lining. Diagnostic laparoscopy, with biopsies, found many white nodules up to 5 mm across. Tissue examination and staining led to a diagnosis of WDPMP, confirmed by an external panel of expert pathologists. He did not have surgery to remove the tumor and received cisplatin and pemetrexed chemotherapy. After six cycles, CT showed complete regression of the fluid and nodules. Nine months later he was still in clinical and radiological remission. The authors concluded that chemotherapy should be strongly considered for unresectable tumors causing symptoms, and that cisplatin and pemetrexed could be a promising choice. The report describes one patient's outcome.

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 (single patient)
• Who was studied: One 36-year-old man treated at a military hospital in Meknès, Morocco, with no history of asbestos exposure
• Exposure: No asbestos exposure was reported. The treatment described was systemic chemotherapy with cisplatin and pemetrexed, without surgery to remove the tumor. The patient had earlier undergone diagnostic laparoscopy with biopsies and fluid drainage.
• Main results:
  • Paracentesis removed four liters of fluid. The fluid had elevated total protein (4.7 g/dl) and a low serum-to-ascites albumin gradient (0.5 g/dL). Cytology was negative for malignancy, and bacterial, fungal and mycobacterial cultures were negative.
  • CT showed a large peritoneal effusion with small (micronodular) implants on the peritoneum. Diagnostic laparoscopy showed many white miliary nodules up to 5 mm spread throughout the parietal peritoneum. Biopsies were taken and six liters of fluid were drained.
  • The tumor cells were positive for CTK7, CTK5/6, CTK19 and calretinin, and negative for CTK20 and Cdx2. WDPMP was diagnosed from the tissue appearance and these staining results.
  • After six cycles of cisplatin and pemetrexed, CT showed complete regression of both the ascites and the peritoneal micronodules. Nine months later the patient remained in clinical and radiological remission.
• The authors' conclusion: The authors recommended consulting other pathologists or pathology panels to tell WDPMP apart from other widespread peritoneal diseases. They concluded that chemotherapy should be strongly considered if the tumor is unresectable and causes symptoms, and that cisplatin and pemetrexed could be a promising treatment choice.

Topics

Medical terms in this study, explained in our Lexicon: Well-Differentiated Papillary Mesothelioma, Peritoneum, Chemotherapy, Epithelioid, Mesothelioma, Asbestos Exposure, Neoplasm, Ascites.

Related studies

• Well-differentiated papillary mesothelioma of the peritoneum is genetically defined by mutually exclusive mutations in TRAF7 and CDC42 — M. Stevers, J.T. Rabban, et al. (2019)
• Well-differentiated papillary mesothelioma of the female peritoneum: a clinicopathologic study of 26 cases — A. Malpica, S. Sant'Ambrogio, et al. (2012)
• Well-differentiated papillary mesothelioma of the peritoneum: a pathological analysis and review of the literature — A.V. Hoekstra, M.W. Riben, et al. (2005)
• Aberrant Pax-8 expression in well-differentiated papillary mesothelioma and malignant mesothelioma of the peritoneum: a clinicopathologic study — D. Xing, N. Banet, et al. (2018)
• Well-differentiated papillary mesothelioma of the peritoneum: a separate entity — K. Hoekman, G. Tognon, et al. (1996)
• Therapeutic strategies for well-differentiated papillary mesothelioma of the peritoneum — Y.K. Lee, H.J. Jun, et al. (2013)

Browse more research in Curēus, or return to medical research.