Diagnostic Dilemma: Primary Peritoneal Mesothelioma With Para-Occupational Asbestos Exposure

Our plain-English summary of Diagnostic Dilemma: Primary Peritoneal Mesothelioma With Para-Occupational Asbestos Exposure, by K.R. Qin, D. Dua (Journal of Global Oncology, 2017).

The study

• Authors: K.R. Qin, D. Dua
• Journal: Journal of Global Oncology
• Published: 2017;3(6):828-832
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This is a case report of one patient, a 62-year-old woman seen at a hospital in rural Australia with abdominal pain, bloating, shortness of breath and a dry cough. She recalled domestic exposure to asbestos from her husband, an insulation worker. The fiber type involved in her exposure was not reported. CT scans showed a right-sided pleural effusion (fluid around the lung) and thickening of the omentum in the abdomen with fine nodules. Chest fluid drained four times over 6 weeks contained atypical mesothelial cells but no malignant cells. Laparoscopy found numerous peritoneal nodules. Biopsies, including stains positive for calretinin, CK5/6 and WT1, were consistent with epithelioid-type primary malignant peritoneal mesothelioma, and peritoneal fluid contained malignant cells. The authors judged para-occupational exposure the likely cause. They wrote that laparoscopy was needed because imaging was inconclusive. After four cycles of carboplatin and pemetrexed she was alive and her condition had stabilized. The authors noted that p16 gene testing could have sped up diagnosis. A single case does not show how often this happens.

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 62-year-old woman seen at a hospital in rural Australia, with left lower abdominal pain, bloating, shortness of breath (dyspnea) and dry cough
• Exposure: Domestic (para-occupational) asbestos exposure from her husband, who was an insulation worker. No fiber type, duration or dose is given for her exposure.
• Main results:
  • Abdominal CT showed thickening of the omentum with fine nodularity in the left flank. Chest CT showed right-sided pleural effusion with right lower lobe atelectasis.
  • Pleural fluid, drained on four occasions over 6 weeks (more than 1 L each time), showed atypical mesothelial cells but no malignant cells.
  • Laparoscopy found numerous peritoneal nodules. Biopsies were taken from 12 nodules measuring 2 to 9 mm.
  • Biopsy specimens stained positive for calretinin, CK5/6 and WT1. The tissue findings were consistent with epithelioid-type malignant peritoneal mesothelioma.
  • Peritoneal fluid obtained at laparoscopy contained clumps of malignant cells.
  • The authors considered para-occupational exposure the likely cause in this case. One example they gave is wives contacting asbestos while laundering their husbands' work clothing.
  • After four cycles of carboplatin and pemetrexed, the patient was alive and her condition had stabilized.
• The authors' conclusion: The authors concluded that, because imaging was inconclusive, direct laparoscopic examination of the abdomen was necessary to establish the diagnosis in this case.
• Limitations the authors state:
  • Studies supporting negative BAP1 staining as a diagnostic aid were published after this patient's diagnosis had been made.
  • The authors note that FISH testing for p16 gene deletion could have been used to speed up the diagnosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

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

Related studies

• Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure — S.T. Ahmed, M. Barvo, et al. (2020)
• Well-differentiated papillary mesothelioma of the peritoneum: a diagnostic dilemma on fine-needle aspiration cytology — J.G. Nasit, G. Dhruva (2014)
• Benign cystic mesothelioma: a diagnostic dilemma — T.S. Usha Kiran, A. Agboola, et al. (2002)
• Evaluation of take home (para-occupational) exposure to asbestos and disease: a review of the literature — E.P. Donovan, B.L. Donovan, et al. (2012)
• Para-occupational exposures to asbestos: lessons learned from Casale Monferrato, Italy — L.T. Stayner (2016)
• Commentary on 'evaluation of take home (para-occupational) exposure to asbestos and disease: a review of the literature', Donovan et al.1 — D.S. Egilman, N.M. Druar (2013)

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