Malignant Peritoneal Mesothelioma Presenting as Mucinous Ascites

Our plain-English summary of Malignant Peritoneal Mesothelioma Presenting as Mucinous Ascites, by Z. Field, A. Zori, V. Khullar, et al (ACG Case Reports Journal, 2018).

The study

• Authors: Z. Field, A. Zori, V. Khullar, M. Mota, M. Feely, R.J. Firpi
• Journal: ACG Case Reports Journal
• Published: 2018;5:e23
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We present a rare case of a 46-year-old man presenting with mucinous ascites secondary to malignant peritoneal mesothelioma (MPM) that was diagnosed via colonoscopy with biopsies. Both our findings and the clinical presentation were unique. While it is widely known that asbestos exposure is commonly associated with pleural mesothelioma, 6-10% of malignant mesotheliomas arise from the peritoneum. To date, only 4 cases of MPM with the primary tumor site in the colon have been described in the literature.

In plain English

This case report described a 46-year-old man, a Mexican immigrant in the United States since 2000. He came to the authors' institution with worsening ascites (fluid in the abdomen), first noticed 2 years earlier, that another hospital had not explained. A CT scan showed walled-off abdominal fluid and a soft-tissue thickening on the transverse colon. Draining the abdomen removed 7.5 L of thick, jelly-like mucinous fluid. Tests of the fluid found no cancer cells but abundant mucus. Colonoscopy found a 20-mm nodule under the lining of the transverse colon. Biopsies led to a diagnosis of malignant peritoneal mesothelioma, epithelioid type. After diagnosis, he reported an extensive history of housing construction and demolition work, including drywall removal, carpentry, electrical work and painting, without a respirator or mask. The article did not report measuring asbestos or name a fiber type. Surgery and heated abdominal chemotherapy were recommended but unavailable at the authors' center, so he was discharged with plans to follow up elsewhere; no further follow-up was available. The authors concluded that this cancer should be considered when ascites remains unexplained, and that colonoscopy may help with diagnosis.

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 46-year-old man with no significant past medical history, a Mexican immigrant who came to the United States in 2000, evaluated for worsening ascites at the authors' institution (authors affiliated with the University of Florida, Gainesville)
• Exposure: Occupational history taken after diagnosis: an extensive history of various housing construction and demolition jobs, including drywall removal, carpentry, electrical work, and painting, with no respirator or mask. The article does not state how long he did this work. It does not say asbestos exposure was measured or confirmed, and it names no fiber type.
• Main results:
  • CT of the abdomen and pelvis showed loculated abdominal ascites with nodular thickening of some septations, and a soft-tissue density along the surface of the distal transverse colon. There was no evidence of cirrhosis or splenomegaly.
  • Paracentesis removed 7.5 L of mucinous, jelly-like fluid. Cytology was negative for malignant cells but showed abundant mucus, and cultures, including for acid-fast bacilli, were negative.
  • Tumor markers (alpha-fetoprotein, CA125, CA19-9, carcinoembryonic antigen) were within normal limits in this patient
  • Colonoscopy showed a 20-mm submucosal nodule in the transverse colon, which was biopsied
  • Biopsy cells expressed AE1/AE3, CK7, calretinin, WT1 and D2-40, and a diagnosis of malignant peritoneal mesothelioma, epithelioid type, was made
  • Surgical debulking and hyperthermic intraperitoneal chemotherapy were recommended, but these were not available at the authors' center. The patient was discharged with plans to follow up at another center, and no further follow-up is available.
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma should be considered when evaluation of ascites does not give a definitive diagnosis, and that colonoscopy may be a useful diagnostic tool. They described the mucinous ascites as making this case unique among the 4 colonic cases they found in the literature.
• Limitations the authors state:
  • The authors note that no follow-up information on the patient is available

Topics

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

Related studies

• "Signet-ring" cells--a caveat in the diagnosis of a diffuse peritoneal mesothelioma occurring in a lady presenting with recurrent ascites: an unusual case report — B. Rekhi, S. Pathuthara, et al. (2010)
• Malignant Peritoneal Mesothelioma Presenting with High Protein, High Serum-Ascites Albumin Gradient — Z.P. Kerosky, C.R. Powell, et al. (2022)
• Pulmonary mucinous cystadenocarcinoma presenting as a pleural mesothelioma — R. Kassir, F. Forest, et al. (2013)
• Rectus abdominis muscle resection for abdominal wall recurrence of mucinous adenocarcinoma or peritoneal mesothelioma — T. Yan, P. Sugarbaker (2008)
• Benign cystic peritoneal mesothelioma incorrectly diagnosed as an ovarian borderline mucinous tumor of intestinal type at transvaginal preoperative ultrasound evaluation — A.C. Testa, G.F. Zannoni, et al. (2011)
• Tissue Xpert™ MTB/Rif assay is of limited use in diagnosing peritoneal tuberculosis in patients with exudative ascites — C. Bera, J.S. Michael, et al. (2015)

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