Acute severe abdominal pain in a young woman caused by a well-differentiated papillary mesothelioma of the peritoneum

Our plain-English summary of Acute severe abdominal pain in a young woman caused by a well-differentiated papillary mesothelioma of the peritoneum, by J.E. Bousema, K.M. van de Luijtgaarden, S. Wilhelmus, et al (BMJ Case Reports, 2019).

The study

• Authors: J.E. Bousema, K.M. van de Luijtgaarden, S. Wilhelmus, M.M. Poelman
• Journal: BMJ Case Reports
• Published: 2019;12(8)
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Acute abdominal pain is a common symptom in young women. We describe a patient with acute illness and severe lower abdominal pain. Laboratory tests were normal except for mildly deranged inflammatory markers. No abnormalities were reported on abdominal ultrasonography and MRI, whereas diagnostic laparoscopy revealed a tumour located dorsally from the uterus. We resected the tumour and pathology results showed a well-differentiated papillary mesothelioma of the peritoneum (WDPMP). Microscopy showed evidence of acute ischaemia in the resected lesion, which was likely the cause of the acute abdominal pain. WDPMP is a rare disease that arises from the serous membranes which does not seem to have a relation to asbestos exposure. Generally, WDPMP has a mild clinical course and good long-term prognosis.

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In plain English

This case report from Rotterdam, the Netherlands, described a 25-year-old otherwise healthy woman who came to the emergency department with severe pain in the right lower abdomen that had lasted 24 hours. She had no history of asbestos exposure. Her C reactive protein, a marker of inflammation, rose from 21 to 45 to 60 mg/L over the following days. Ultrasound and MRI did not show the cause, although in hindsight the radiologist could locate the tumour on the MRI. Diagnostic laparoscopy found a tumour in the pouch of Douglas, attached by a cord to the peritoneum of the greater omentum. Surgeons removed the tumour and cord together. Her pain resolved, and she went home the day after surgery. After an outside consultation, the pathologists diagnosed a well-differentiated papillary mesothelioma of the peritoneum (WDPMP). The authors hypothesised that twisting of the cord caused the pain. Citing earlier literature, they wrote that WDPMP seems to have no clear relation to asbestos exposure, because possible exposure had been described in only three patients in one earlier case series.

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 (a single patient)
• Who was studied: One 25-year-old otherwise healthy woman seen at the emergency department of a hospital in Rotterdam, the Netherlands
• Exposure: None. The patient had no history of asbestos exposure.
• Main results:
  • The patient's C reactive protein was 21 mg/L at first, 45 mg/L on re-evaluation after 1 day, and 60 mg/L the next day, when diagnostic laparoscopy was performed.
  • The MRI was initially read as showing a normal appendix and only a trace of free fluid. In hindsight, the radiologist was able to locate the tumour on the MRI.
  • Laparoscopy found a lobulated purple/white tumour in the pouch of Douglas, connected to the peritoneum of the greater omentum by a cord. The tumour and cord were removed together.
  • After surgery the pain resolved, and the patient was discharged on the first postoperative day.
  • The specimen was a 5 by 1.8 cm haemorrhagic, irregular tissue fragment with a 5 cm cord-like structure. The lining cells were strongly positive for keratin and calretinin, which fits mesothelial cells. After external consultation the diagnosis was WDPMP.
• The authors' conclusion: The authors hypothesised that the patient's severe pain was caused by torsion (twisting) of the cord between the tumour and the peritoneum. Citing an earlier case series, they stated that WDPMP seems to have no clear relation to asbestos exposure.

Topics

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

Medical terms in this study, explained in our Lexicon: Well-Differentiated Papillary Mesothelioma, Peritoneum, Diagnostic Laparoscopy, Pathology, Asbestos Exposure, Prognosis.

Related studies

• A multicystic tumor causing intermittent pain in a young man — E.V. Madsen, I.H. de Hingh (2014)
• Abdominal pain and bloating in an auto mechanic — L. Neshatian, M. Halland, et al. (2014)
• 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)
• Well-differentiated papillary mesothelioma of the peritoneum: a separate entity — K. Hoekman, G. Tognon, et al. (1996)

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