An unusual presentation of acute abdomen: infarcted peritoneal cyst-a probable asbestos-related benign cystic mesothelioma

Our plain-English summary of An unusual presentation of acute abdomen: infarcted peritoneal cyst-a probable asbestos-related benign cystic mesothelioma, by V. Muralidhar (Journal of Surgical Case Reports, 2021).

The study

• Author: V. Muralidhar
• Journal: Journal of Surgical Case Reports
• Published: 2021;2021(4):rjab129
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

This is a report of a rare case of an infarcted pelvic intra-abdominal cyst, having no mesenteric connection presenting as an acute abdomen. The patient had significant asbestos exposure. The cyst was treated successfully by surgical excision. Histopathology showed an infarcted cyst; the lining was destroyed, precluding marker studies. A diagnosis of benign cystic peritoneal mesothelioma (BCPM) was made by excluding other causes of solitary pelvic intra-abdominal cysts. BCPM has been classified as an asbestos-related neoplasm and is usually seen in the pelvis adjunct to the urinary bladder. One-year post-surgery, there was no recurrence. The case report shows that infarcted pelvic mesothelial cysts can present as an acute abdomen and can be treated successfully by total excision with no recurrence.

Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2021.

In plain English

This case report described one patient: a 42-year-old male non-smoker who had worked for 15 years as a construction worker, mixing cement with asbestos and putting up asbestos sheets. He had handled asbestos daily for more than 10 years. The article did not name the asbestos fiber type. He came to hospital with right lower abdominal pain, vomiting, painful urination and fever. Scans showed a single fluid-filled cyst in the pelvis pressing on the urinary bladder. At surgery the cyst was not attached to nearby structures. Its wall looked blackish, suggesting infarction (tissue death), and it was removed completely. Culture of the cyst fluid grew no bacteria. Under the microscope the cyst wall was infarcted. Because the lining was destroyed, tests to confirm a mesothelial origin could not be done. The author diagnosed benign cystic peritoneal mesothelioma by ruling out other cyst types, with asbestos as a probable cause. He had no recurrence at one year. The author concluded that such cysts can present as an acute abdomen and can be treated by total excision.

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 42-year-old male non-smoker who worked as a construction worker. The article does not say where or when he was treated. The author's affiliation is the Department of General Surgery, Chettinad Medical College, Chennai, Tamil Nadu, India.
• Exposure: Occupational asbestos exposure as a construction worker for 15 years (8-hour shifts, 6 days a week, throughout the year). His main job was mixing cement with asbestos and erecting asbestos sheets, and he handled asbestos daily for more than 10 years. Fiber type not specified.
• Main results:
  • Computed tomography showed a single well-defined cyst inside the abdominal cavity, in the pelvis, compressing the urinary bladder
  • At laparotomy the cyst wall was blackish, suggesting infarction
  • The cyst fluid was clear and the cyst was completely excised; fluid culture grew no bacteria
  • Histopathology showed infarction of the cyst wall with inflammatory cells; the lining was destroyed, so marker studies could not be done
  • After excluding other causes of a solitary cyst, the author considered the case probably a benign cystic peritoneal mesothelioma, with asbestos as a probable cause
  • The patient was discharged on the 10th day after surgery and had no recurrence at 1 year of follow-up
• The authors' conclusion: The author concluded that infarcted pelvic mesothelial cysts can present as an acute abdomen and can be treated successfully by total excision with no recurrence. The diagnosis of benign cystic peritoneal mesothelioma was reached by excluding all other possible diagnoses.
• Limitations the authors state:
  • Immunohistochemistry to confirm mesothelial origin was not possible because the cyst lining was destroyed. The diagnosis therefore rested on excluding other causes.
  • The author noted that BCPM has been suggested to be a non-neoplastic cyst unrelated to asbestos exposure. More recently it has been classified as a neoplastic lesion that could be causally related to asbestos.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Histopathology, Peritoneal Mesothelioma, Neoplasm.

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