Fever, hepatic lesions and ascites

Our plain-English summary of Fever, hepatic lesions and ascites (The American Journal of Medicine, 1979).

The study

• Journal: The American Journal of Medicine
• Published: 1979;67(1):105-12
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002074).

In plain English

This article was a published clinicopathologic conference from Barnes and Wohl Hospitals, St. Louis, discussing one patient. A 54-year-old man was admitted in August 1978 with unexplained fever after weeks of headache, abdominal discomfort and weight loss. An earlier laparoscopy elsewhere had shown small white masses on the liver, but the biopsy slides showed only normal liver. Lung scans were read as recurrent pulmonary emboli, and ascites developed; cytology of the fluid was negative. At exploratory operation, multiple nodules covered the peritoneal surface and mesentery. Microscopy, negative mucin stains and electron microscopy supported a diagnosis of peritoneal mesothelioma. The Missouri State Geologist told a discussant there was no asbestos in the quarry where the patient had worked. When asked in general terms, the patient denied asbestos exposure. Only specific questions revealed World War II Navy work repairing pipes with asbestos insulation, and later work stripping ships in Navy shipyards. A discussant concluded this showed the need for a systematic, detailed history in patients who might have industrial-related diseases.

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: Clinicopathologic conference: discussion of a single patient's case (case report format)
• Who was studied: One 54-year-old man admitted to Barnes Hospital, St. Louis, in August 1978 and readmitted in October 1978
• Exposure: Navy service in World War II in the engine room of a warship, repairing pipes by stripping and relining them with asbestos insulation; after the war, work stripping ships in Navy shipyards. No fiber type was named. The patient also worked 23 years in a rock quarry, which was judged not to contain asbestos.
• Main results:
  • At exploratory laparotomy, multiple nodules studded the peritoneal surface and mesentery
  • Stains for epithelial mucins were negative, which supports but does not by itself establish mesothelioma
  • On electron microscopy, the tumor cells lacked secretory granules and contained many microfilaments
  • The tumor was identified as peritoneal mesothelioma
  • The laparoscopic liver biopsy slides from the other hospital showed only normal liver
  • Lung scans were interpreted as showing recurrent pulmonary emboli
  • Paracentesis yielded 600 ml of exudative fluid, and cytology of the fluid was negative
  • The Missouri State Geologist stated that there was no asbestos in the northern Missouri quarry where the patient worked
  • When asked in general terms, the patient did not link his Navy years to asbestos and denied exposure
• The authors' conclusion: A discussant (Dr. John Daniels) concluded that the case showed how hard it is to obtain a good history of asbestos or other toxic exposure. The discussant also concluded that patients who might have industrial-related diseases need a systematic, detailed history.

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: Ascites.

Related studies

• Malignant peritoneal mesothelioma presenting with persistent high fever — L.Y. Chen, L.X. Huang, et al. (2011)
• Benign cystic mesothelioma of the liver: A rare hepatic cyst — W. Wang, H.Y. Lai, et al. (2021)
• Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites — R.W. Randle, K.R. Swett, et al. (2014)
• Palliation of malignant ascites with a Tenckhoff catheter — D.A. Lomas, P.J. Wallis, et al. (1989)
• The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience — L. Orgiano, F. Pani, et al. (2016)
• "Signet-ring" cells--a caveat in the diagnosis of a diffuse peritoneal mesothelioma occurring in a lady presenting with recurrent ascites: an unusual case report — B. Rekhi, S. Pathuthara, et al. (2010)

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