Biphasic Peritoneal Mesothelioma Is a Rare Tumor and a Diagnostic Challenge: A Case Report

Our plain-English summary of Biphasic Peritoneal Mesothelioma Is a Rare Tumor and a Diagnostic Challenge: A Case Report, by E.A. Subahi, A. Fadul, A. Mohamed, et al (Curēus, 2024).

The study

• Authors: E.A. Subahi, A. Fadul, A. Mohamed, A. Alsayed, E.A. Ali, S. Sayed, S. Mustafa, B. Wazwaz, M.H. Fadul
• Journal: Curēus
• Published: 2024;16(1):e51725
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare subtype of mesothelioma. There are three main histological subtypes of mesothelioma: epithelioid, sarcomatoid, and biphasic (mixed). Risk factors include asbestos exposure, previous radiation, and some germline mutations. Treatment includes surgical resection of amenable tumors or cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. We present a 34-year-old male who presented with weight loss, night sweats, and pleuritic chest pain and was found to have ascites with peritoneal nodularity on abdominal imaging. He had a history of tuberculosis contact, but no history of asbestos exposure. After a long challenging and interesting diagnostic process, he was subsequently diagnosed with biphasic MPM. The diagnostic challenge stems from not only the rarity of the tumor but also from the absence of risk factors, the unavailability of some special laboratory investigations, in addition to the potentially misleading effect of tuberculosis exposure history, a top differential diagnosis in the case. This is a case report of a really challenging and totally unexpected diagnosis of biphasic peritoneal mesothelioma in a patient with tuberculosis exposure, constitutional symptoms, but no history of asbestos exposure. It highlights the diagnostic process as well as the importance of early diagnosis to improve the overall survival of such malignancies.

Copyright © 2024, Subahi et al.

In plain English

This was a case report of one patient from Hamad Medical Corporation in Doha, Qatar. The patient was a 34-year-old Bangladeshi man who worked as a farmer and had ankylosing spondylitis. In May 2023 he came to hospital with chest pain, night sweats, a sense of fever and weight loss. He had recently lived with a roommate who had pulmonary tuberculosis (TB), and he had no history of asbestos exposure. Scans showed fluid and thickening in the lining of the abdomen (the peritoneum), which doctors first suspected was abdominal TB, but TB tests were negative. A first biopsy showed abnormal cells, and an overseas laboratory could not say what kind of tumor it was. After a second biopsy, the overseas laboratory diagnosed biphasic peritoneal mesothelioma, about 80% epithelioid and 20% sarcomatoid, on day 72 after he first presented. A further scan and a team meeting on treatment were planned. The report did not describe treatment or outcome. The authors concluded that doctors need a high index of suspicion to diagnose this tumor early.

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 34-year-old Bangladeshi man with ankylosing spondylitis treated with adalimumab and sulfasalazine, who worked as a farmer. He presented in May 2023 and was seen at Hamad Medical Corporation, Doha, Qatar.
• Exposure: No history of asbestos exposure, smoking, or alcohol use. He had recent contact with a roommate who had pulmonary tuberculosis.
• Main results:
  • Tests of the patient's sputum for TB (smears, PCR and culture) were all negative.
  • The patient's abdominal CT showed diffuse thickening and nodules of the peritoneum with fluid (ascites), and was reported as highly suspicious of abdominal TB.
  • On the first biopsy, an overseas laboratory reported a tumor of uncertain type.
  • After a second biopsy, the overseas laboratory concluded the patient's tumor was biphasic mesothelioma, 20% sarcomatoid and 80% epithelioid. This was reported on day 72 after his first presentation.
  • In the patient's tumor, the MTAP stain showed loss of staining and the BAP1 stain was equivocal.
  • A PET scan was ordered because pleural involvement was suspected, and a multidisciplinary team meeting was planned. No treatment or outcome was reported.
• The authors' conclusion: The authors concluded that diagnosis was difficult because the tumor is rare, risk factors were absent, some special laboratory tests were unavailable, and the TB exposure history was potentially misleading. They concluded that a high index of suspicion is necessary for early diagnosis, which may improve survival.

Topics

Medical terms in this study, explained in our Lexicon: Biphasic Mesothelioma, Peritoneal Mesothelioma, Mesothelioma, Histological Subtype, Epithelioid, Sarcomatoid, Asbestos Exposure, Germline Mutation.

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