Malignant Peritoneal Mesothelioma: A Rare Cause of Ascites

Our plain-English summary of Malignant Peritoneal Mesothelioma: A Rare Cause of Ascites, by A.M. Ibrahim, M. Al-Akchar, Z. Obaidi, et al (Journal of Investigative Medicine High Impact Case Reports, 2018).

The study

• Authors: A.M. Ibrahim, M. Al-Akchar, Z. Obaidi, H. Al-Johany
• Journal: Journal of Investigative Medicine High Impact Case Reports
• Published: 2018;6:2324709618807506
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare diagnosis that presents with difficulties in diagnosis and management. This article reports a case of an 88-year-old male who presented with a 2-week history of abdominal distention and bloating. He worked at an insulation production factory between the ages of 23 and 25 years with presumed asbestos exposure. On the computed tomography scan of the abdomen/pelvis, the patient was found to have diffuse omental, peritoneal, and mesenteric nodularity with moderate to large ascites. Omental biopsy revealed MPM. The overall prognosis of MPM remains poor, with a median survival time of 12 months at the time of diagnosis. Treatment modalities offered in the United States include chemotherapy alone, cytoreductive surgery alone, or cytoreductive surgery/chemotherapy combination.

In plain English

This case report describes an 88-year-old man admitted to hospital after two weeks of abdominal swelling and bloating, with decreased appetite, early fullness and generalized weakness. From age 23 to 25 the patient worked at an insulation production factory, with what the authors called presumed asbestos exposure. After that the patient worked as a part-time barber for 55 years. The patient also had a 10 pack-year smoking history and significant passive smoking exposure. A CT scan of the abdomen and pelvis showed widespread nodules in the abdominal lining with moderate to large fluid buildup (ascites). A chest CT found no lung cancer but showed pleural plaques on both sides, which the authors said indicated prior asbestos exposure. Draining the abdomen produced 2.5 liters of blood-tinged fluid. An omental biopsy confirmed malignant peritoneal mesothelioma, epithelioid subtype. Because of advanced age and other illnesses, the patient was not considered a candidate for cytoreductive surgery or platinum-based chemotherapy. The patient chose no further treatment and went home with hospice care. The authors concluded that this disease should be considered in patients with new ascites, especially those with a history of asbestos exposure.

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 of a single patient
• Who was studied: One 88-year-old male patient admitted with a 2-week history of abdominal distention and bloating. The patient had coronary artery disease and hypertension. The hospital location is not stated beyond the authors' affiliations (Southern Illinois University; Johns Hopkins University).
• Exposure: Work at an insulation production factory between ages 23 and 25 with presumed asbestos exposure; no fiber type is named. The patient later worked as a part-time barber for 55 years. The patient also had a 10 pack-year smoking history and significant passive smoking exposure.
• Main results:
  • CT of the abdomen and pelvis showed diffuse omental, peritoneal and mesenteric nodularity with moderate to large ascites.
  • Chest CT was negative for primary lung malignancy but showed bilateral pleural plaques, which the authors said indicated prior asbestos exposure.
  • Tumor markers CEA, PSA, CA 19-9 and AFP were within normal limits; upper endoscopy and colonoscopy were unremarkable.
  • Paracentesis yielded 2.5 liters of blood-tinged fluid. The serum-ascites albumin gradient was less than 0.7, indicating ascites not associated with portal hypertension.
  • Ultrasound-guided omental biopsy showed tumor cells positive for calretinin, WT-1, CK5/6 and mesothelia (as printed), confirming malignant peritoneal mesothelioma, epithelioid subtype.
  • Because of advanced age and comorbidities (coronary artery disease and hypertension), the patient was deemed not a candidate for cytoreductive surgery or platinum-based chemotherapy.
  • The patient opted not to pursue further treatment. A palliative peritoneal catheter was placed and the patient was discharged with home hospice care.
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma should be included in the differential diagnosis of patients with new ascites, especially with a history of asbestos exposure, and that further imaging, including abdominal CT and biopsy of suspicious lesions, should be sought.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Ascites, Asbestos Exposure, Biopsy, Prognosis, Median Survival, Chemotherapy, Cytoreductive Surgery.

Related studies

• Malignant peritoneal mesothelioma as a rare cause of ascites: a case report — I. Ahmed, A. Koulaouzidis, et al. (2008)
• Malignant Peritoneal Mesothelioma as a Rare Cause of Dyspeptic Complaints and Ascites: A Diagnostic Challenge — S. Marques de Sousa, F. Pereira, et al. (2020)
• A Rare Case of Biphasic Malignant Peritoneal Mesothelioma with Refractory Ascites — T. Komaki, H. Urata, et al. (2017)
• Ascites as a Rare Manifestation of Malignant Peritoneal Mesothelioma: A Case Report — S. Lief, S. Patibandla, et al. (2024)
• Benign multicystic peritoneal mesothelioma: a rare cause of intra-abdominal cystic disease — B. Campbell, D. Mehanna, et al. (2017)
• Peribronchiolar metaplasia: a common histologic lesion in diffuse lung disease and a rare cause of interstitial lung disease: clinicopathologic features of 15 cases — J. Fukuoka, T.J. Franks, et al. (2005)

Browse return to medical research.