Best cases from the AFIP. Malignant peritoneal mesothelioma

Our plain-English summary of Best cases from the AFIP. Malignant peritoneal mesothelioma, by J.M. Busch, J.B. Kruskal, B. Wu, et al (Radiographics, 2002).

The study

• Authors: J.M. Busch, J.B. Kruskal, B. Wu, Armed Forces Institute of Pathology
• Journal: Radiographics
• Published: 2002;22(6):1511-5
• Type of article: Case report
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This article, from the Armed Forces Institute of Pathology 'Best Cases' series, reported one case of malignant peritoneal mesothelioma and correlated the imaging and pathology. A 70-year-old retired male food broker had several weeks of intermittent, poorly localized abdominal discomfort and a 15-pound weight loss. Abdominal CT showed a single large heterogeneous mass in the left upper quadrant with a small amount of ascites and no pleural or pulmonary abnormalities. Percutaneous biopsy showed mostly spindle cells, consistent with the desmoplastic variant of malignant mesothelioma. The patient had no known exposure to asbestos. Repeat CT after referral showed a 20 by 7 cm enhancing mass replacing much of the omentum. It had invaded the colon and spleen, surrounded the stomach fundus, and extended into the liver, with enhancing peritoneal plaques and nodules and moderate ascites. He underwent debulking omentectomy and partial colectomy. The resected specimen weighed 1,740 g. Histology showed malignant mesothelioma with epithelial and sarcomatoid components. Tumor cells were positive for keratin and calretinin and negative for B72.3, carcinoembryonic antigen and Leu-M1. The discussion reviewed epidemiology, clinical patterns, CT features, differential diagnosis, immunohistochemistry and treatment. It noted that asbestos exposure, mainly crocidolite, has been implicated, and that about half of reported cases have no history of asbestos exposure. The authors concluded that the diagnosis should be considered when solid peritoneal masses are present, that percutaneous sampling should be done to confirm it, and that CT is critical for preoperative assessment.

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 article was a case report describing one patient with malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. A 70-year-old retired male food broker had several weeks of vague abdominal discomfort and a 15-pound weight loss. The article states that he had no known exposure to asbestos. CT scans showed a large mass in the upper left abdomen that replaced much of the omentum, invaded the colon and spleen, surrounded part of the stomach and reached the liver. Nodules lined the abdomen and fluid had collected there. No pleural or lung abnormalities were seen. A needle biopsy suggested the desmoplastic variant of malignant mesothelioma. Surgeons removed the omentum and part of the colon. The removed tissue weighed 1,740 g and contained both epithelial and sarcomatoid tumor. Chemotherapy after surgery was planned. The article did not report how the patient fared afterward. The authors concluded that this diagnosis should be considered when solid peritoneal masses are present. They recommended taking tissue samples through the skin to confirm it and said CT is critical before surgery. The discussion summarized other published studies.

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, radiologic-pathologic correlation, followed by a discussion of published literature)
• Who was studied: One 70-year-old retired male food broker, referred to the authors' institution (the authors are from Beth Israel Deaconess Medical Center and Harvard Medical School, Boston). Dates of care are not stated.
• Exposure: The patient had no known exposure to asbestos
• Main results:
  • Initial CT showed a single large heterogeneous mass in the left upper quadrant with a small amount of ascites. There were no pleural or pulmonary parenchymal abnormalities.
  • Percutaneous biopsy showed a neoplasm of predominantly spindle cells, consistent with the desmoplastic variant of malignant mesothelioma
  • Repeat CT showed the tumor extending into the colon and spleen and encasing the stomach, with multiple enhancing peritoneal plaques
  • The mass had invaded the distal transverse colon and proximal descending colon
  • The patient underwent a debulking omentectomy and partial colectomy, and postoperative chemotherapy was planned
  • The resected specimen weighed 1,740 g. Histologic analysis was consistent with malignant mesothelioma containing both epithelial and sarcomatoid components.
  • Tumor cells were positive for keratin and calretinin and negative for B72.3, carcinoembryonic antigen, and Leu-M1
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma is a rare but highly malignant abdominal tumor. They said it is important to consider the diagnosis when solid peritoneal masses are present, and they recommended performing percutaneous sampling to confirm the diagnosis. They also said CT is critical in preoperative analysis to determine prognosis and whether cytoreductive surgery should be performed.

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: Peritoneal Mesothelioma, Pathology, Ascites, Biopsy, Spindle Cell, Desmoplastic Mesothelioma, Malignant Mesothelioma, Omentum.

Related studies

• Benign Multicystic Peritoneal Mesothelioma: AIRP Best Cases in Radiologic-Pathologic Correlation — R. Lee, A. Tong, et al. (2016)
• From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation — A.D. Levy, J. Arnáiz, et al. (2008)
• CT imaging of peritoneal carcinomatosis and its mimics — A.D. Diop, M. Fontarensky, et al. (2014)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• CT differentiation of diffuse malignant peritoneal mesothelioma and peritoneal carcinomatosis — Y.F. Liang, G.Q. Zheng, et al. (2016)
• CT differentiation of malignant peritoneal mesothelioma and tuberculous peritonitis — W.J. Yin, G.Q. Zheng, et al. (2016)

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