Malignant peritoneal mesothelioma as a rare cause of ascites: a case report

Our plain-English summary of Malignant peritoneal mesothelioma as a rare cause of ascites: a case report, by I. Ahmed, A. Koulaouzidis, J. Iqbal, et al (Journal of Medical Case Reports, 2008).

The study

• Authors: I. Ahmed, A. Koulaouzidis, J. Iqbal, W.C. Tan
• Journal: Journal of Medical Case Reports
• Published: 2008;2:121
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Peritoneal mesothelioma is a rare tumor with diagnostic and therapeutic problems. The peritoneum is the second most common site for development of mesothelioma, which in 30-45% of cases is associated with a synchronous pleural mesothelioma. Clinical symptoms and findings may be confusing and diagnosis can be easily overlooked especially in cases where there is no previous asbestos exposure.

Case Presentation: We report a case of malignant peritoneal mesothelioma in a 75-year-old woman who presented with ascites which, in the absence of inhalational exposure to asbestos, caused diagnostic confusion, and evaded radiological detection.

Conclusion: We concluded from this case that Peritoneal Mesothelioma although rare but should be considered among the differential diagnosis of Ascites.

In plain English

This was a case report about one patient: a 75-year-old woman admitted to hospital with five weeks of worsening breathlessness, fluid in the abdomen (ascites), leg swelling and tiredness. She had never smoked and had no known previous exposure to asbestos. Her blood tests were normal, and her first ultrasound and CT scans showed nothing significant other than the ascites. Cultures of the fluid were negative, and the fluid kept returning despite repeated drainage. A repeat CT scan showed extensive nodules on the abdominal lining and massive ascites. A laparoscopic biopsy found a poorly differentiated malignant tumor, and staining showed features consistent with diffuse mesothelioma. She was treated with cisplatin and pemetrexed chemotherapy. The ascites initially resolved, but treatment was stopped because of vomiting and malaise, and she was receiving palliative care. The authors concluded that peritoneal mesothelioma, although uncommon, should be considered in people with ascites when the diagnosis is unclear, because a history of asbestos exposure may be absent and scans may miss the disease.

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 (one patient)
• Who was studied: One 75-year-old woman who had never smoked. The report does not say where or when she was treated, though the authors are from UK hospitals.
• Exposure: No known previous exposure to asbestos. No fiber type, product or job is described.
• Main results:
  • The patient's blood investigations were all normal.
  • The patient's initial ultrasound and CT scans of the abdomen and pelvis showed no significant abdominal pathology other than ascites.
  • Cultures of the patient's ascitic fluid, including culture for acid-fast bacilli, were negative, and the ascites recurred despite multiple drainages.
  • A repeat CT scan of the patient showed extensive peritoneal nodularity and omental cake with massive ascites.
  • The patient's omental biopsy, taken at laparoscopy, showed a poorly differentiated malignant tumor.
  • Immunochemical staining of the patient's biopsy showed features consistent with diffuse mesothelioma.
  • The patient responded well at first to chemotherapy with cisplatin and pemetrexed, and her ascites resolved.
  • The patient's chemotherapy was later stopped because of side effects (recurrent vomiting and general malaise), and she was having palliative treatment.
• The authors' conclusion: The authors concluded that peritoneal mesothelioma, although uncommon, should be considered in people presenting with ascites, particularly when the initial diagnosis is not clear. They noted that a history of asbestos exposure may not be present and that radiological investigations may miss the diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Ascites, Peritoneum, Mesothelioma, Pleural Mesothelioma, Asbestos Exposure, Differential Diagnosis.

Related studies

• Malignant Peritoneal Mesothelioma: A Rare Cause of Ascites — A.M. Ibrahim, M. Al-Akchar, et al. (2018)
• 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)

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