A rare case of benign multicystic peritoneal mesothelioma misdiagnosed as hydatid cyst found in the liver parenchyma and abdomen cavity of a male with asbestos exposure

Our plain-English summary of A rare case of benign multicystic peritoneal mesothelioma misdiagnosed as hydatid cyst found in the liver parenchyma and abdomen cavity of a male with asbestos exposure, by A.B. Kelarji, M.S. Alshutaihi, A. Ghazal, et al (BMC Gastroenterology, 2021).

The study

• Authors: A.B. Kelarji, M.S. Alshutaihi, A. Ghazal, N. Mahli, S. Agha
• Journal: BMC Gastroenterology
• Published: 2021;21(1):374
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Benign Multicystic Peritoneal Mesothelioma (BMPM) is one of the rarest diseases in medicine with only more than 200 cases worldwide. This paper aims to report a case of Benign Multicystic Peritoneal Mesothelioma that strangely arose from the liver and was long treated as Hydatid cyst. The case also had many risk factors including asbestos exposure that had not yet been linked with Benign Multicystic Peritoneal Mesothelioma.

Case Presentation: We report a case of a 62 years old male with a history of a perforated peptic ulcer and a cystic mass in the liver that was misdiagnosed as hydatid cyst 7 years ago. He presented with generalized abdominal pain and bloating. Image studies showed many cystic formations filled with clear fluid. An en bloc surgery was performed and a pathologic study showed a multiloculated mass lined by flat or cuboidal epithelium leading to the diagnosis of BMPM. A follow up was scheduled after 3 months revealed total recurrence.

Conclusion: BMPM resembles many other cystic lesions in the abdomen and should be taken into consideration when dealing with nontypical cystic formations. Its diagnostic and treatment methods are still hazy making this disease difficult to approach.

© 2021. The Author(s).

In plain English

This article was a case report about one 62-year-old man found to have benign multicystic peritoneal mesothelioma (BMPM), a rare benign growth made of many cysts in the lining of the abdomen. Seven years earlier he had a liver cyst that he reported as a hydatid cyst. He had worked as a firefighter. The authors described this as possible asbestos exposure. The article gave no asbestos measurements and named no fiber type. He came to the emergency department with abdominal pain. Ultrasound showed many thin-walled cysts filling the abdomen, but the Weinberg test was negative. At surgery, cysts were found across the peritoneum and omentum, and a 10-cm cyst was found inside the liver. Only the large cysts that could be reached were removed. Tissue tests confirmed BMPM. A CT scan three months after surgery showed recurrence. Citing earlier literature, the authors noted that this benign form, unlike the malignant form, is not associated with asbestos exposure. They concluded that BMPM resembles many other abdominal cystic lesions and should be considered when cysts look unusual.

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
• Who was studied: One 62-year-old man with a past perforated peptic ulcer and a liver cyst seen 7 years earlier that he reported as a hydatid cyst
• Exposure: Possible asbestos exposure, inferred only from his past work as a firefighter. No fiber type, product, or dose was reported. The authors noted that, according to the literature, this benign form of the tumor is not associated with asbestos exposure, and that their case was one of few in which the patient had possibly been exposed.
• Main results:
  • Ultrasound suggested polycystic echinococcosis (hydatid disease), but the Weinberg test was negative
  • At surgery, multiple cysts were found throughout the peritoneum and omentum. Only the large accessible cysts were removed in one piece (en bloc).
  • A 10-cm cyst was found within the tissue of the right lobe of the liver
  • Pathology showed a mass with many cavities measuring 6 by 20 by 30 cm, lined by flat or cuboidal epithelium
  • Immunohistochemistry was positive for WT1 and Calretinin and negative for CD34. This confirmed the tumor came from mesothelial cells and led to the diagnosis of BMPM.
  • A contrast CT scan three months after surgery showed recurrence
• The authors' conclusion: The authors concluded that BMPM resembles many other cystic lesions in the abdomen and should be considered when dealing with cystic formations that do not look typical.
• Limitations the authors state:
  • The lesion is little known, and there is no proven guideline for its diagnosis and treatment
  • Pandemic and war circumstances made it extremely difficult to use all diagnostic tools
  • Limited resources prevented frequent follow-up of the liver cyst, which delayed the correct diagnosis

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Parenchyma, Asbestos Exposure, Epithelium.

Related studies

• Benign cystic mesothelioma of the liver: A rare hepatic cyst — W. Wang, H.Y. Lai, et al. (2021)
• Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management — A.M.C. Rapisarda, A. Cianci, et al. (2018)
• Benign multicystic peritoneal mesothelioma: a rare cause of intra-abdominal cystic disease — B. Campbell, D. Mehanna, et al. (2017)
• Benign multicystic peritoneal mesothelioma presenting as a ghost abdominal mass — H. Jerraya, W. Ghariani, et al. (2016)
• A Case of Abdominal Discomfort Caused by Benign Multicystic Peritoneal Mesothelioma — T.G. Cotter, J.S. Van Arnam, et al. (2016)
• Loose mesothelial cysts in the peritoneal cavity — Y. Ramirez, J. Rosai, et al. (2010)

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