An unusual case of ascites: pitfalls in diagnosis of malignant peritoneal mesothelioma

Our plain-English summary of An unusual case of ascites: pitfalls in diagnosis of malignant peritoneal mesothelioma, by J.R. Clark, W.B. Ross (The Australian and New Zealand Journal of Surgery, 2000).

The study

• Authors: J.R. Clark, W.B. Ross
• Journal: The Australian and New Zealand Journal of Surgery
• Published: 2000;70(5):384-8
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

The authors, from hospitals in New South Wales, Australia, described a case showing how hard it can be to confirm malignant peritoneal mesothelioma, and reviewed the literature. A 64-year-old man had a 10-month history of vague right upper abdominal pain, nausea and increasing abdominal girth. He was an ex-smoker and, 35 years earlier, had worked for 6 months for the Australian Asbestos Company packing asbestos cloth, rope and gaskets. Earlier tests elsewhere found exudative ascites with negative cytology, fatty liver and right lower lobe lung fibrosis on chest CT. A laparoscopy with peritoneal and liver biopsies showed no malignancy. Colonoscopy then found a large adenoma in the transverse colon, and colectomy was planned. Before surgery the ascites increased greatly. CT showed no mass, and cytology showed only reactive mesothelial cells. A second laparoscopy showed no lesions. At laparotomy, however, the omentum was nodular and 'caked' and there were peritoneal plaques. Histopathology, reviewed by two pathologists, and immunohistochemistry (strong epithelial membrane antigen staining, no significant LeuM1 or CEA staining) were consistent with epithelial mesothelioma. No resection was performed, and the patient was referred for palliative chemotherapy. The authors concluded that, with mesothelioma incidence rising in Australia, suspicion should be high in asbestos-exposed patients with non-specific abdominal symptoms and ascites. They added that laparoscopy with multiple biopsies is the investigation of choice, with laparotomy when laparoscopy is not diagnostic.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was a case report from New South Wales, Australia, about a 64-year-old man. He had a 10-month history of vague right upper abdominal pain, nausea and a growing abdomen caused by fluid (ascites). About 35 years earlier he had worked for 6 months for the Australian Asbestos Company packing asbestos cloth, rope and gaskets. The article does not name the fiber type. Earlier tests elsewhere, including laparoscopy (keyhole surgery) with biopsies, found no malignancy. Later fluid testing showed only reactive mesothelial cells. A chest scan showed right lower lobe fibrosis, and a colonoscopy found a tubulovillous adenoma (a growth) in the colon. At a later operation, laparoscopy again showed no lesions, but open surgery found nodular, 'caked' omentum and peritoneal plaques. On review by two independent pathologists, the tissue pattern was consistent with epithelial mesothelioma. He was referred for palliative chemotherapy. The authors concluded that the case illustrated the difficulty of diagnosing malignant peritoneal mesothelioma. They also concluded that laparoscopy with multiple biopsies was the investigation of choice, with open surgery when laparoscopy gave no adequate explanation.

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 64-year-old man seen at hospitals in New South Wales, Australia (St George Hospital, Sydney and Coffs Harbour Base Hospital); no dates given
• Exposure: Six months of work, about 35 years before presentation, for the Australian Asbestos Company packing asbestos cloth, rope and gaskets; fiber type not stated. He was also an ex-smoker.
• Main results:
  • A laparoscopy with peritoneal and liver biopsies, done six months before this presentation, showed no gross evidence of malignancy
  • Chest CT showed right lower lobe fibrosis
  • Colonoscopy found a tubulovillous adenoma in the transverse colon
  • Repeat ascitic fluid cytology showed only reactive mesothelial cells
  • At the second laparoscopy no peritoneal, omental or liver lesions were seen
  • At open surgery (laparotomy) there was nodularity and 'caking' of the omentum and several peritoneal plaques
  • Tissue stained strongly for epithelial membrane antigen but not significantly for LeuM1 or CEA
  • The histology, reviewed by two independent pathologists, was consistent with epithelial mesothelioma
  • The patient was referred for palliative chemotherapy and paracentesis (fluid drainage) as required
• The authors' conclusion: The authors concluded that laparoscopy with multiple biopsies is the investigation of choice for suspected malignant peritoneal mesothelioma, with progression to laparotomy where laparoscopy does not provide an adequate explanation.

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: Ascites, Peritoneal Mesothelioma, Gasket, Cytology, Fibrosis, Reactive Mesothelial Cells, Laparotomy, Omentum.

Related studies

• "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)
• Challenging and uncommon diagnosis of long-evolution ascites — M. Gravito-Soares, E. Gravito-Soares, et al. (2017)
• Metastatic peritoneal mesothelioma in the setting of recurrent ascites: a case report — V. Samedi, S. White, et al. (2010)
• The role of peritoneal biopsy in the diagnosis of ascites — P.F. Jenkins, M.J. Ward (1980)
• 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)
• A Rare Case of Biphasic Malignant Peritoneal Mesothelioma with Refractory Ascites — T. Komaki, H. Urata, et al. (2017)

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