A Rare Case of Biphasic Malignant Peritoneal Mesothelioma with Refractory Ascites

Our plain-English summary of A Rare Case of Biphasic Malignant Peritoneal Mesothelioma with Refractory Ascites, by T. Komaki, H. Urata, K. Mori, et al (Internal Medicine, 2017).

The study

• Authors: T. Komaki, H. Urata, K. Mori, A. Iwashita, K. Ikeda, S. Haraoka
• Journal: Internal Medicine
• Published: 2017;56(7):861-864
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

An 81-year-old man was admitted to our hospital with abdominal distension due to refractory ascites of unknown origin. He subsequently died of aspiration pneumonia. Autopsy revealed a diagnosis of biphasic malignant peritoneal mesothelioma (MPM) containing both epithelioid and sarcomatous components. The diagnosis of MPM is often difficult because serum tumor markers, imaging studies, and the cytology of ascites may not provide enough information. Accordingly, peritoneal biopsy is necessary in order to diagnose MPM based on the histological and immunohistochemical findings.

In plain English

This article is a case report about one patient: an 81-year-old man admitted to a hospital in Japan with a swollen abdomen. CT scans showed massive fluid in the abdomen (ascites) and thickening of the abdominal lining (peritoneum). Tests on the fluid did not settle the cause. One cell test was class III, which raised suspicion of cancer, but three repeat tests were class II, and two blood tumor markers were normal. The fluid built up again quickly and had to be drained weekly. He died of aspiration pneumonia on day 52 in hospital. At autopsy, microscope and staining tests led to a diagnosis of biphasic malignant peritoneal mesothelioma, meaning the tumor had both epithelioid and sarcomatous parts. He had no work history of asbestos exposure, and no asbestos bodies were found in his lungs. The authors suggested he may have been exposed from the surrounding environment. The authors concluded that this cancer should be considered in unexplained ascites even without obvious asbestos exposure, and that a peritoneal biopsy is necessary for diagnosis.

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), with discussion of the literature
• Who was studied: One 81-year-old man admitted with abdominal distension due to refractory ascites of unknown origin, at Fukuoka University Chikushi Hospital, Japan; dates of care not stated
• Exposure: No occupational history of asbestos exposure; he had worked as a bank employee from age 20 to 57. Asbestos bodies were not detected in his lungs at autopsy. The authors suggested he may have been exposed to asbestos from the surrounding environment; no fiber type or measurement is given.
• Main results:
  • CT showed massive ascites, thickening of the anterior peritoneum, and shortening of the mesentery, with no abdominal lymph node enlargement or abnormalities of the solid organs
  • Tests before death did not establish the diagnosis. The first cytology of the ascitic fluid was class III, but three repeat examinations were class II. Serum tumor markers carcinoembryonic antigen and carbohydrate antigen 19-9 were normal.
  • Ascites re-accumulated rapidly after drainage of about 3 L, and weekly drainage was required
  • The patient died of aspiration pneumonia secondary to paralytic ileus on the 52nd day of hospitalization
  • At autopsy the abdominal cavity held 3,200 mL of clear yellowish ascites, and the entire peritoneum was thickened with scattered small granules and nodules
  • Tissue showed both epithelioid and sarcomatous tumor components. The tumor cells were positive for mesothelioma markers (HBME-1, calretinin, cytokeratin, CAM 5.2, cytokeratin 5/6) and negative for carcinoembryonic antigen. Biphasic malignant peritoneal mesothelioma was diagnosed.
  • A direct Coombs test was positive and warm antibody was detected, but there was no obvious hemolysis (serum haptoglobin 461 mg/dL)
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma should be considered in unexplained ascites even without an obvious history of asbestos exposure. They said a peritoneal biopsy is necessary to investigate the cause, and they recommended ultrasound-guided percutaneous peritoneal biopsy for diagnosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Biphasic Mesothelioma, Peritoneal Mesothelioma, Ascites, Autopsy, Epithelioid, Tumor Marker, Cytology, Biopsy.

Related studies

• Metastatic peritoneal mesothelioma in the setting of recurrent ascites: a case report — V. Samedi, S. White, et al. (2010)
• The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience — L. Orgiano, F. Pani, et al. (2016)
• "Signet-ring" cells--a caveat in the diagnosis of a diffuse peritoneal mesothelioma occurring in a lady presenting with recurrent ascites: an unusual case report — B. Rekhi, S. Pathuthara, et al. (2010)
• An unusual case of ascites: pitfalls in diagnosis of malignant peritoneal mesothelioma — J.R. Clark, W.B. Ross (2000)
• Challenging and uncommon diagnosis of long-evolution ascites — M. Gravito-Soares, E. Gravito-Soares, et al. (2017)
• Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites — R.W. Randle, K.R. Swett, et al. (2014)

Browse more research in Internal Medicine, or return to medical research.