Ascites as a Rare Manifestation of Malignant Peritoneal Mesothelioma: A Case Report

Our plain-English summary of Ascites as a Rare Manifestation of Malignant Peritoneal Mesothelioma: A Case Report, by S. Lief, S. Patibandla, A.Z. Ansari, et al (Curēus, 2024).

The study

• Authors: S. Lief, S. Patibandla, A.Z. Ansari, N. Bhatt, A. Gulraiz, S.M. Beauti, R. Ali
• Journal: Curēus
• Published: 2024;16(10):e70982
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm that originates from the mesothelial cells lining the parietal peritoneum or visceral peritoneum and extensively spreads within the abdominal cavity. It is a rare malignancy characterized by an insidious onset and poor prognosis. We present the case of a 79-year-old Caucasian male who experienced escalating abdominal pain for six weeks and acute abdominal distension. His medical history was significant for hypertension, gastroesophageal reflux disease (GERD), hypercholesterolemia, and prior coronary artery bypass grafting (CABG). The patient had a 30-pack-year smoking history and worked as a plumber and roofer until retirement. We also confirmed with the patient that he has never been diagnosed with asbestosis. He reported no family history of mesothelioma or related conditions. A computed tomography (CT) scan revealed a prior sternotomy, mild pleural calcifications, mild hepatic steatosis, diffuse peritoneal ascites, diffuse omental edema, and pelvic phleboliths. MPM was confirmed through histopathological examination, which revealed atypical mesothelial cells with high nucleus-to-cytoplasm ratios, prominent nucleoli, and irregular nuclear membranes. It also revealed tumor cells positive for p53, calretinin, WT1, and podoplanin (D2-40). This case highlights the importance of considering MPM in the differential diagnosis for patients with ascites and possible asbestos exposure, particularly with respect to occupational hazards, as it is a rare manifestation of the disease.

Copyright © 2024, Lief et al.

In plain English

This article is a case report about one patient. A 79-year-old Caucasian man went to an emergency department with abdominal pain worsening over six weeks, bloating, poor appetite, weakness and a swollen abdomen. He had a 30-pack-year smoking history and had worked as a plumber and roofer from his 20s until retirement. He had never been diagnosed with asbestosis. The article gives no measured asbestos exposure or fiber type. A CT scan showed mild pleural calcifications, fluid in the abdomen (ascites) and swelling of the omentum. Endoscopy and colonoscopy showed no signs of digestive-tract cancer, and normal tumor markers made a digestive or prostate primary cancer less likely. Draining the abdomen produced 3.1 liters of blood-tinged fluid. An omental biopsy showed tumor cells positive for p53, calretinin, WT1 and podoplanin (D2-40), which confirmed malignant peritoneal mesothelioma, epithelioid subtype. Given his age and other illnesses, he was judged a poor candidate for surgery or chemotherapy and chose palliative care. The authors concluded that this disease should be considered in patients with ascites and possible asbestos exposure, particularly from occupational hazards.

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)
• Who was studied: One 79-year-old Caucasian man seen in an emergency department. The article does not state the location or dates of care.
• Exposure: Work as a plumber and roofer from his 20s until retirement. Possible asbestos exposure is mentioned, but no fiber type or dose is given. He had never been diagnosed with asbestosis. He also had a 30-pack-year smoking history.
• Main results:
  • The CT scan showed mild pleural calcifications, mild hepatic steatosis, diffuse peritoneal ascites, diffuse omental edema and pelvic phleboliths, along with a prior sternotomy.
  • Esophagogastroduodenoscopy and colonoscopy were unremarkable and showed no signs of malignancy in the upper or lower gastrointestinal tracts.
  • The tumor markers CEA, PSA, CA 19-9 and AFP were within normal limits. The authors said this further reduced the likelihood of a gastrointestinal or prostate primary malignancy.
  • Ultrasound-guided paracentesis yielded 3.1 liters of blood-tinged fluid. The serum-ascites albumin gradient was less than 0.7, which the authors interpreted as ascites unrelated to portal hypertension.
  • A CT-guided omental biopsy showed tumor cells positive for p53, calretinin, WT1 and podoplanin (D2-40), confirming malignant peritoneal mesothelioma, epithelioid subtype.
  • The patient was judged a poor candidate for cytoreductive surgery or chemotherapy. He declined further active treatment and chose palliative care.
• The authors' conclusion: The authors concluded that the case shows the importance of considering malignant peritoneal mesothelioma in patients with ascites and possible asbestos exposure, particularly occupational exposure. They also stated that a thorough patient history is crucial for raising suspicion.

Topics

Medical terms in this study, explained in our Lexicon: Ascites, Peritoneal Mesothelioma, Neoplasm, Mesothelial Cells, Peritoneum, Prognosis, Mesothelioma, Pleural Calcification.

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• Malignant Peritoneal Mesothelioma: A Rare Cause of Ascites — A.M. Ibrahim, M. Al-Akchar, et al. (2018)
• Malignant Peritoneal Mesothelioma as a Rare Cause of Dyspeptic Complaints and Ascites: A Diagnostic Challenge — S. Marques de Sousa, F. Pereira, et al. (2020)
• A Rare Case of Biphasic Malignant Peritoneal Mesothelioma with Refractory Ascites — T. Komaki, H. Urata, et al. (2017)
• Tissue Xpert™ MTB/Rif assay is of limited use in diagnosing peritoneal tuberculosis in patients with exudative ascites — C. Bera, J.S. Michael, et al. (2015)
• Recurrent malignant peritoneal mesothelioma: radiological manifestations — F.F. Souza, J. Jagganathan, et al. (2010)

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