Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure

Our plain-English summary of Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure, by S.T. Ahmed, M. Barvo, N. Kamath, et al (BMJ Case Reports, 2020).

The study

• Authors: S.T. Ahmed, M. Barvo, N. Kamath, R. Alweis
• Journal: BMJ Case Reports
• Published: 2020;13(2)
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

A 75-year-old man presented to the emergency department with 1-day history of right lower limb pain and 3-month history of vague abdominal pain. In the emergency department a thrombus was discovered in the right popliteal artery. CT scan of the abdomen and pelvis revealed high-density material in the pelvis, multiple hypodensities on the liver, ascites with omental nodularity, and high-density material along the stomach wall. He underwent thrombectomy and was started on anticoagulation therapy. The core needle biopsy revealed primary omental mesothelioma. There was no history of any known asbestos exposure. He also had to undergo therapeutic paracentesis twice due to abdominal distension. Mesothelioma treatment of carboplatin and pemetrexed was started, and the patient is currently receiving this chemotherapy treatment regimen.

© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This is a case report about one patient: a 75-year-old man with a history of high blood pressure who came to an emergency department with one day of right leg pain and about three months of vague abdominal pain. Tests found a blood clot (thrombus) in the popliteal artery, behind the knee. A CT scan showed dense material filling most of the pelvis, fluid in the abdomen (ascites) with nodules on the omentum, cyst-like spots in the liver, and dense areas along the stomach wall. A PET/CT scan showed active masses in the abdomen and pelvis. A peritoneal biopsy was diagnosed as mesothelioma. The man had no history of any known asbestos exposure. He had the clot removed, was given blood thinners, and started chemotherapy with carboplatin and pemetrexed. He needed fluid drained from his abdomen twice. When the report was written, his condition was stable. The authors concluded that physicians should consider primary peritoneal mesothelioma in patients with similar symptoms, even when there is no known asbestos exposure.

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 (one patient)
• Who was studied: One 75-year-old man with a past history of hypertension who came to an emergency department with sudden right leg pain and 3 months of abdominal pain. The authors are from Rochester Regional Health System, Rochester, New York, USA.
• Exposure: No known asbestos exposure. No fiber type or job exposure is reported.
• Main results:
  • Ultrasound found a thrombus in the right popliteal artery that extended to where the artery divides.
  • A non-contrast CT of the abdomen and pelvis showed high-density material in most of the pelvis, ascites with omental nodularity, cystic hypodensities in the liver, and hyperdensities along the stomach wall.
  • A PET/CT scan showed hypermetabolic (metabolically active) mesenteric masses in the abdomen and pelvis.
  • The pathological diagnosis from the peritoneal biopsy was mesothelioma. The tumour cells stained positive for CAM5.2, Calretinin, CK7, D2-40 and WT-1.
  • The patient was treated with carboplatin and pemetrexed. He was readmitted twice for therapeutic paracentesis (draining fluid from the abdomen). At the time of the report his condition was stable.
• The authors' conclusion: The authors concluded that physicians should consider primary peritoneal mesothelioma among possible diagnoses in patients with similar symptoms, and that it should not be missed even when there is no known asbestos exposure.

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: Discovery, Peritoneal Mesothelioma, Asbestos Exposure, CT Scan, Ascites, Needle Biopsy, Mesothelioma, paracentesis.

Related studies

• Diagnostic Dilemma: Primary Peritoneal Mesothelioma With Para-Occupational Asbestos Exposure — K.R. Qin, D. Dua (2017)
• Computed tomographic characterization of malignant peritoneal mesothelioma — T.D. Yan, N. Haveric, et al. (2005)
• Malignant peritoneal mesothelioma in a child: chemotherapy with gemcitabine and platinum was effective for the disease unresponsive to other treatments — S. Kobayashi, T. Waragai, et al. (2014)
• Concerning CT features predict outcome of treatment in patients with malignant peritoneal mesothelioma — P.H. Sugarbaker, D. Chang, et al. (2021)
• Pericardial mesothelioma presenting as left atrial thrombus in a patient with mitral stenosis — Y. Miyamoto, S. Nakano, et al. (1996)
• Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients — E.A. Levine, J.H. Stewart, et al. (2014)

Browse more research in BMJ Case Reports, or return to medical research.