Malignant Peritoneal Mesothelioma Mimicking Recurrent Diverticulitis

Our plain-English summary of Malignant Peritoneal Mesothelioma Mimicking Recurrent Diverticulitis, by E.S. Robalino Gonzaga, P. Guzman Rojas, V. Vanar (Curēus, 2019).

The study

• Authors: E.S. Robalino Gonzaga, P. Guzman Rojas, V. Vanar
• Journal: Curēus
• Published: 2019;11(1):e3906
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelioma is an uncommon type of cancer arising from the mesothelial cells that form the lining of several cavities in the body. Exposure to asbestos is the leading known cause of mesothelioma. We present a 73-year-old male with a significant asbestos exposure and a recent history of recurrent diverticulitis who reported persistent left lower quadrant (LLQ) pain despite several courses of empiric antibiotic therapy. A recent computed tomography (CT) performed due to nonresolving symptoms showed possible nodularity of the mesentery and subsequent positron emission tomography (PET) scan demonstrated multiple hypermetabolic mesenteric lesions, notably in the left paracolic gutter. A colonoscopy was subsequently performed which demonstrated severe diverticulosis, but no obvious luminal lesions. The patient underwent an exploratory laparoscopy showing extensive peritoneal carcinomatosis involving all mesenteric surfaces and partial involvement of the right diaphragm. Final pathology revealed malignant epithelial mesothelioma with peritoneal seeding. The patient was referred to oncology and was started on hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS). Our case highlights a challenging presentation of malignant peritoneal mesothelioma (MPM), which is often initially misdiagnosed due to vague symptoms. Physicians should consider further diagnostic workup for unrelenting LLQ abdominal pain after diverticulitis has been treated.

In plain English

This case report describes one patient, a 73-year-old man with significant asbestos exposure. He was a navy veteran who worked on a ship for many years during the 1960s, and the authors believed asbestos was the main factor in his peritoneal mesothelioma, a cancer of the abdominal lining. No fiber type was named. With a recent history of recurrent diverticulitis, he had persistent lower left abdominal pain despite several courses of antibiotics. A repeat CT scan showed possible nodularity of the mesentery, and a PET scan showed multiple active lesions. Colonoscopy found severe diverticulosis but no obvious lesions inside the bowel, and tumor marker tests were negative. Surgery found extensive peritoneal carcinomatosis on all mesenteric surfaces and on part of the right diaphragm, and part of the sigmoid colon was removed to relieve symptoms. Pathology showed malignant epithelial mesothelioma with peritoneal seeding. He was started on heated chemotherapy inside the abdomen (HIPEC) and cytoreductive surgery. The authors concluded that physicians should consider further workup for unrelenting lower left abdominal pain after diverticulitis has been treated.

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 73-year-old man with significant asbestos exposure and a recent history of recurrent diverticulitis, seen at a gastroenterology clinic; place and dates of care not stated
• Exposure: Asbestos exposure as a navy veteran who worked on a ship for many years during the 1960s; fiber type and dose not given. The authors believed asbestos was the main factor in his peritoneal mesothelioma.
• Main results:
  • Pain in the lower left abdomen persisted despite several courses of empiric antibiotic therapy
  • Repeat CT showed possible nodularity of the mesentery
  • PET scan showed multiple hypermetabolic mesenteric lesions, notably in the left paracolic gutter and part of the pelvis
  • Colonoscopy showed severe diverticulosis but no obvious luminal lesions; tumor marker serology was negative
  • Exploratory laparoscopy found extensive peritoneal carcinomatosis involving all mesenteric surfaces and partial involvement of the right diaphragm
  • A sigmoid colon resection with diverting colostomy was done for symptom relief
  • Final pathology showed malignant epithelial mesothelioma with peritoneal seeding
  • The patient was referred to oncology and started on HIPEC and cytoreductive surgery; no later outcome was reported
• The authors' conclusion: The authors concluded that physicians should consider further diagnostic workup for unrelenting lower left abdominal pain after diverticulitis has been treated, and that accurate history-taking may identify occupational exposures.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Mesothelioma, Mesothelial Cells, Asbestos Exposure, Mesentery, Diaphragm, Pathology, HIPEC.

Related studies

• Genomic profiling of malignant peritoneal mesothelioma reveals recurrent alterations in epigenetic regulatory genes BAP1, SETD2, and DDX3X — N.M. Joseph, Y.Y. Chen, et al. (2017)
• Peritoneal malignant mesothelioma in a patient with recurrent peritonitis — R.H. Riddell, M.J. Goodman, et al. (1981)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• 18F-FDG PET/CT in a recurrent diffuse malignant peritoneal mesothelioma — Q. Cao, M. Lu, et al. (2012)
• Recurrent peritoneal mesothelioma with long-delayed recurrence — A. Tandar, G. Abraham, et al. (2001)

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