Incidental Diagnosis of Malignant Peritoneal Mesothelioma During Liver Transplantation Surgery: A Case Report

Our plain-English summary of Incidental Diagnosis of Malignant Peritoneal Mesothelioma During Liver Transplantation Surgery: A Case Report, by S. Khan, A. Malik, S. Qureshi, et al (The American Journal of Case Reports, 2024).

The study

• Authors: S. Khan, A. Malik, S. Qureshi, B. Cohen, A. Nadir
• Journal: The American Journal of Case Reports
• Published: 2024;25:e943787
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare, lethal tumor of serous membranes. The most common factor reported in association with MPM is asbestos exposure, while viral infections, genetic predisposition, paraneoplastic syndrome, and altered immunity have been described as well. The diagnosis can be challenging among those with lower tumor burden as well as nonspecific symptoms, and it is not unusual to discover the diagnosis incidentally. CASE REPORT A middle-aged woman with decompensated cirrhosis underwent extensive pre-transplant workup, showing no evidence of malignancy. She had a personal history of asbestos exposure and family history of MPM in the extended family. During transplant surgery, a few peritoneal nodules were noted, leading to termination of the procedure. Pathological analysis confirmed malignant MPM. A multidisciplinary discussion led to following a conservative treatment approach without any intervention, due to higher risk of worsening hepatic decompensation associated with peritonectomy and intraperitoneal chemotherapy. The patient's hepatic decompensation resolved 6 months after the aborted liver transplant operation. Since the diagnosis of MPM, positron emission tomography scans have shown no recurrence of MPM for 3 consecutive years. CONCLUSIONS This is the first case of MPM diagnosed incidentally during a liver transplantation surgery. This case highlights the challenges in the diagnosis and management of MPM in a patient with decompensated liver disease. A multidisciplinary approach and following a consensus decision led to prolonged survival in the described patient.

In plain English

This article was a case report about one patient. A 44-year-old woman with cirrhosis and failing liver function was referred for a liver transplant, and scans before surgery showed no tumor. During the transplant operation, surgeons found several small nodules on the lining of the abdomen under the right diaphragm, the largest under 0.5 cm, and stopped the operation. A biopsy showed malignant peritoneal mesothelioma of the epithelioid subtype, with a very low tumor load. She reported that her college dormitories had been found to have high asbestos levels in the walls, and a maternal cousin had been diagnosed with peritoneal mesothelioma at age 70. The article did not name a fiber type. Because of the risk of worsening her liver disease, a team of doctors advised against surgery to remove the abdominal lining and against chemotherapy given inside the abdomen. Her liver function later recovered without a transplant, and scans showed no return of the cancer for 3 years. The authors concluded that careful observation can sometimes do better than aggressive treatment. They cautioned that this single case should not be generalized to the care of peritoneal mesothelioma.

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 44-year-old woman with decompensated cirrhosis from metabolic dysfunction associated steatohepatitis, who was undergoing liver transplant evaluation; the authors' affiliations are in Arizona, USA
• Exposure: Self-reported asbestos exposure: she said her college dormitories were found to have high asbestos levels in the walls. No fiber type was named. She also had a family history of malignant peritoneal mesothelioma (a maternal cousin diagnosed at age 70).
• Main results:
  • Extensive imaging before the transplant did not show the mesothelioma
  • The transplant was stopped when several peritoneal nodules, the largest under 0.5 cm, were found under the right diaphragm
  • Pathology showed a low-grade epithelioid mesothelioma, with partial loss of BAP1 nuclear staining
  • The peritoneal cancer index was 1, representing a very low tumor load
  • The multidisciplinary team did not recommend intraperitoneal chemotherapy or peritoneal stripping because of the risk of worsening liver failure
  • According to the article's abstract, her liver decompensation resolved 6 months after the stopped transplant operation
  • PET scans showed no recurrence of the mesothelioma for 3 consecutive years
• The authors' conclusion: The authors described this as the first case of malignant peritoneal mesothelioma found by chance during liver transplant surgery. They reported that the patient did well for 3 years under close observation and multidisciplinary care. In their view, careful observation can sometimes give better results than aggressive therapy.
• Limitations the authors state:
  • The authors stated that this is a single, anecdotal case and should not be generalized to the overall care of malignant peritoneal mesothelioma

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, Asbestos Exposure, Tumor Burden, Chemotherapy, Multidisciplinary Team.

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