Difficult to Identify: Malignant Primary Peritoneal Mesothelioma

Our plain-English summary of Difficult to Identify: Malignant Primary Peritoneal Mesothelioma, by B.S. Zha, M. Flanagan, C. Coulson, et al (The American Journal of Medicine, 2015).

The study

• Authors: B.S. Zha, M. Flanagan, C. Coulson, K.W. Garvin
• Journal: The American Journal of Medicine
• Published: 2015;128(11):1191-4
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This case report described a 59-year-old woman, a veteran and retired journalist who had never smoked. She presented with a 3-month history of abdominal pain, constipation and anorexia and a 40-pound (18.1 kg) weight loss. Ten years earlier she had undergone total hysterectomy with bilateral oophorectomy for endometriosis. Abdominal CT showed infiltrative opacities of the omentum, liver surface implants and a distended gallbladder, which raised concern for peritoneal carcinomatosis. Carbohydrate antigen 125 was elevated at 464 U/mL. Carcinoembryonic antigen and carbohydrate antigen 19-9 were normal. Attempts to obtain tissue failed. Ascites was scant, laparoscopy was advised against because of her low functional status, and a planned liver biopsy was not done after she became somnolent. She developed hypoxemic respiratory failure, was moved to comfort measures and died. Autopsy showed extensive tumor throughout the peritoneal cavity, with less involvement of the diaphragmatic pleura. Histology showed sarcomatoid high-grade cells with a smaller epithelioid component. The cells stained positive for calretinin, vimentin and pan-keratin, and rare cells stained for Wilms tumor-1 protein. No asbestos fibers were found. The diagnosis was primary malignant peritoneal mesothelioma. The authors noted that the causal role of asbestos in peritoneal mesothelioma in women is not clear. They concluded that patient histories should cover asbestos and other exposures, that the disease should be considered in patients with significant prolonged symptoms without a definitive diagnosis, and that laparoscopic biopsy is the gold standard for obtaining diagnostic tissue.

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 case report described a 59-year-old woman, a veteran and retired journalist who had never smoked. She had 3 months of abdominal pain, constipation, poor appetite and a 40-pound (18.1 kg) weight loss. CT scans showed changes in the omentum and implants on the liver surface that were concerning for cancer spread through the abdominal lining. A blood marker, CA 125, was elevated at 464 U/mL. No tissue sample could be obtained while she was alive. A planned liver biopsy was not done, and she developed respiratory failure, was moved to comfort care, and died. An autopsy found extensive tumor throughout the peritoneal cavity, with much less on the pleural surfaces of the diaphragm. Microscopy showed mainly sarcomatoid tumor with a smaller epithelioid part, and staining was consistent with mesothelioma. No asbestos fibers were found. The diagnosis was primary malignant peritoneal mesothelioma. The authors concluded that this disease should be considered in any patient with significant prolonged symptoms and no definitive diagnosis, and that laparoscopic biopsy is the gold standard for obtaining diagnostic tissue.

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, with autopsy)
• Who was studied: One 59-year-old woman, a veteran and retired journalist who lived alone and had never smoked. The authors are from University of Washington and Puget Sound Veterans Affairs medical centers in Seattle. No dates are given.
• Exposure: The article reports no asbestos exposure history for this patient. At autopsy, no asbestos fibers were found in the tissue examined.
• Main results:
  • The first abdominal CT showed infiltrative opacities of the omentum, several liver surface implants and a very distended gallbladder. These findings were concerning for peritoneal carcinomatosis.
  • CA 125 was 464 U/mL, which was elevated but nonspecific given her gynecologic history. CEA (4 ng/mL) and CA 19-9 (less than 3 U/mL) were within normal limits.
  • No tissue diagnosis was obtained during life. The planned image-guided liver biopsy was not done, she developed hypoxemic respiratory failure requiring intubation, was transitioned to comfort measures, and died.
  • At autopsy, tumor was found throughout the peritoneal cavity, involving the stomach, bowel, liver, spleen, abdominal wall and diaphragm. There was significantly less involvement of the pleural surfaces of the diaphragm.
  • Microscopy showed sarcomatoid spindled high-grade neoplastic cells with a smaller epithelioid component. Stains were strongly positive for calretinin, vimentin and pan-keratin, with rare cells positive for Wilms tumor-1 protein, consistent with mesothelioma. The diagnosis was primary malignant peritoneal mesothelioma.
• The authors' conclusion: The authors argued that malignant peritoneal mesothelioma should be considered in any patient with significant prolonged symptoms and no previous definitive diagnosis. They stated that a CT scan should be obtained, tissue sampling is essential if malignancy is suspected, and laparoscopic biopsy is the gold standard and often the only option for diagnostic tissue.

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, Bilateral, Omentum, Carcinoembryonic Antigen (CEA), Ascites, Biopsy, Autopsy, Peritoneal Cavity.

Related studies

• The difficult diagnostic approach of the intraperitoneal mesothelioma — S.M. Yoo, A.J. ten Tije, et al. (2000)
• Primary peritoneal mesothelioma: case series and literature review — H. Sharma, I. Bell, et al. (2011)
• Radiology-pathology conference: primary peritoneal mesothelioma — A.S. Baadh, X. Xiong, et al. (2013)
• From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation — A.D. Levy, J. Arnáiz, et al. (2008)
• Treatment of primary peritoneal mesothelioma by continuous hyperthermic peritoneal perfusion (CHPP) — B.J. Park, H.R. Alexander, et al. (1999)
• Primary malignant peritoneal mesothelioma. A report of seven cases and a review of the literature — J.A. Asensio, P. Goldblatt, et al. (1990)

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