Malignant Peritoneal Mesothelioma: A Case Report

Our plain-English summary of Malignant Peritoneal Mesothelioma: A Case Report, by B. Sousa, J. Silva, N. Monteiro, et al (Curēus, 2023).

The study

• Authors: B. Sousa, J. Silva, N. Monteiro, M. Romano, E. Araújo
• Journal: Curēus
• Published: 2023;15(8):e42902
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare tumor of the serous membranes of the peritoneum and has been linked to exposure to asbestos and other risk factors. The clinical manifestations are vague, with a wide clinical spectrum, predominantly related to the abdominal involvement of the disease. Localized mesothelioma is an uncommon manifestation of the disease. Common symptoms include abdominal pain or abdominal distention, nausea, anorexia, and weight loss. Rarely, patients present with paraneoplastic syndrome. Due to the nonspecific symptoms, many patients already have advanced disease at the time of diagnosis. The authors report a case of a 75-year-old female patient who presented with symptoms of asthenia, anorexia, progressive paleness, and weight loss lasting five months. She reports later new-onset symptoms of diffuse abdominal pain and diarrhea associated with nausea. Laboratory tests showed anemia, mild leukocytosis, thrombocytosis, elevated C-reactive protein (CRP), and elevated liver enzymes. An abdominal and pelvic computed tomography (CT) scan revealed marked tissue thickening of an irregular and striated configuration of the leaflets and peritoneal reflections in an omental cake pattern, and a chest CT scan showed multiple bilateral pulmonary nodules, suggesting diffuse malignant disease. A CT-guided biopsy of a peritoneal implant was performed, establishing the diagnosis of malignant peritoneal mesothelioma. Due to rapid clinical deterioration, the patient did not receive any systemic treatment, surgery, or radiotherapy and was transitioned to comfort care. As in the presented case, most cases of MPM have diffuse peritoneal involvement at the time of diagnosis, although extra-abdominal involvement is very rare. This disease presentation is associated with high morbidity and mortality compared to cases of localized disease. There is no specific imaging diagnostic modality or valuable tumor markers for MPM. Although a CT scan remains important in the diagnostic approach, the changes found are not specific. Radiographically, MPM may present as mesenteric or parietal peritoneal nodules, visceral peritoneal thickening, ascites, or omental masses. Although these features may raise suspicion of MPM, a biopsy is necessary to confirm the diagnosis. Therefore, due to the rarity of this disease and its nonspecific signs or symptoms, MPM is difficult to diagnose, and the prognosis remains poor.

Copyright © 2023, Sousa et al.

In plain English

This article is a case report from internal medicine doctors at the Unidade Local de Saúde do Alto Minho in Portugal. It describes one 75-year-old woman with malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. The authors recorded no history of asbestos exposure, smoking or alcohol use. For five months she had weakness, loss of appetite, increasing paleness and weight loss. Later she developed diffuse abdominal pain, diarrhea, nausea, night sweats and fever. Tests showed anemia, a raised platelet count, raised C-reactive protein and raised liver enzymes. Her CA-125 tumor marker was 4,239.6 U/mL. CT scans showed thickening of the abdominal lining in an "omental cake" pattern and many small nodules in both lungs. A CT-guided needle biopsy of an abdominal implant was compatible with malignant peritoneal mesothelioma. Because her condition declined, she received no chemotherapy, surgery or radiotherapy, was moved to comfort care, and died about a month later. The authors noted her fever and high platelet count as paraneoplastic phenomena and concluded that the disease's nonspecific signs make diagnosis difficult and worsen the prognosis.

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 75-year-old woman with arterial hypertension, dyslipidemia and diabetes mellitus, treated in the Department of Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Portugal. Dates of care are not stated; the article was published in 2023.
• Exposure: No asbestos exposure was reported. The patient also had no history of smoking or alcohol consumption.
• Main results:
  • The patient had five months of weakness (asthenia), loss of appetite (anorexia), progressive paleness and weight loss. Abdominal pain, diarrhea, nausea and night sweats came later.
  • Blood tests on presentation to the emergency department showed anemia (hemoglobin 9 g/dL), mild leukocytosis and worsening thrombocytosis. CRP was 189.8 mg/L (reference below 10 mg/L), and the liver enzymes ALT, AST, ALP and GGT were elevated.
  • The abdominal and pelvic CT scan showed thickening of the peritoneal leaflets and reflections in an omental cake pattern, with a small amount of fluid. The largest peritoneal implant measured 23 by 14 mm.
  • The chest CT scan showed multiple bilateral lung nodules smaller than a centimeter, without fully specific characteristics.
  • The tumor marker CA-125 was 4,239.6 U/mL; the normal range is 0 to 35 U/mL.
  • A CT-guided core needle biopsy of a peritoneal implant, with immunohistochemistry, showed mesothelial proliferation compatible with malignant peritoneal mesothelioma.
  • The patient received no systemic treatment, surgery or radiotherapy, was transitioned to comfort care, and died about a month later.
  • The authors interpreted the fever and thrombocytosis as paraneoplastic phenomena and described evidence of extra-abdominal disease.
• The authors' conclusion: The authors concluded that, because the disease is rare and its signs and symptoms are nonspecific, malignant peritoneal mesothelioma is difficult to diagnose, and the difficult diagnostic path worsens the prognosis. They added that survival may improve with targeted treatments and early diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Peritoneum, Localized Malignant Mesothelioma, CT Scan, Bilateral, Biopsy, Tumor Marker, Ascites.

Related studies

• Peritoneal mesothelioma — M. Kannerstein, J. Churg (1977)
• Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients — E.A. Levine, J.H. Stewart, et al. (2014)
• Epidemiology of peritoneal mesothelioma: a review — P. Boffetta (2007)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis — J.H. Helm, J.T. Miura, et al. (2015)
• Absence of carcinogenic response to multiwall carbon nanotubes in a 2-year bioassay in the peritoneal cavity of the rat — J. Muller, M. Delos, et al. (2009)
• Papillary peritoneal tumors in women — A. Foyle, M. Al-Jabi, et al. (1981)

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