Malignant peritoneal mesothelioma presenting with persistent high fever

Our plain-English summary of Malignant peritoneal mesothelioma presenting with persistent high fever, by L.Y. Chen, L.X. Huang, J. Wang, et al (Journal of Zhejiang University. Science. B, 2011).

The study

• Authors: L.Y. Chen, L.X. Huang, J. Wang, Y. Qian, L.Z. Fang
• Journal: Journal of Zhejiang University. Science. B
• Published: 2011;12(5):381-4
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare tumor that develops in the peritoneum. In this paper, we describe an extremely rare case of MPM metastasizing to the appendix in a 48-year-old female who initially presented with a persistent high fever. The woman reported a slight lower abdominal discomfort which had been relieved by urination for four months. She had lost 5 kg of weight. There was no nausea, vomiting, diarrhea, abdominal pain, or abdominal distension. Many broad spectrum antibiotics were given without relief of fever. Computed tomography (CT) scans revealed a thickened omentum majus and diffused multiple omental nodules. An omentectomy, appendectomy, and adnexectomy were carried out. A gross pathologic specimen of omentum tissue revealed a firm gray-white mass. Microscopic and immunohistochemical examinations confirmed the diagnosis of appendiceal and bilateral adnexal metastases of an MPM. These results suggest that MPM should be considered in the differential diagnosis of unexplained persistent high fever. Awareness of such atypical presentations of mesothelioma may help to make a correct diagnosis.

In plain English

This case report described one 48-year-old woman, treated at a hospital in Hangzhou, China, with malignant peritoneal mesothelioma, a rare tumor of the lining of the abdomen. Her main symptom was a persistent high fever. For four months before admission she had chills and fever of 39 to 40 °C, with slight lower abdominal discomfort that was relieved by urination. She also lost 5 kg. Several antibiotics did not relieve the fever. Blood levels of the markers CA-125 and CA-153 were above their reference ranges. CT scans showed a thickened omentum, a fatty layer of tissue in the abdomen, with multiple nodules. Surgeons removed the omentum, appendix and adnexa, the tissues beside the uterus. Microscopic and immunohistochemical tests confirmed mesothelioma that had spread to the appendix and to the adnexa on both sides. She refused chemotherapy. The authors stated that this case, like some other reported cases, was not related to asbestos exposure. The authors described it as, to their knowledge, the first reported case with appendiceal involvement. The authors concluded that this tumor should be considered when a persistent high fever has no explanation, and that a detailed history is vital for 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 48-year-old woman, a non-smoker whose husband was a farmer, treated at Sir Run Run Shaw Hospital, Hangzhou, China (article received 2010)
• Exposure: No asbestos exposure is reported. The authors state the case was not related to asbestos exposure. No fiber type, product or job exposure is described.
• Main results:
  • For four months before admission the patient had chills and fever ranging from 39 to 40 °C
  • Antibiotics (piperacillin/tazobactam, levofloxacin and metronidazole) did not relieve the fever or symptoms
  • In this patient, serum CA-125 was 63.6 U/ml (reference 0 to 35 U/ml) and CA-153 was 34.3 U/ml (reference 0 to 25 U/ml). The authors noted these were elevated but not specific for MPM.
  • CT of the abdomen and pelvis showed a thickened omentum majus with diffuse multiple omental nodules
  • After omentectomy, appendectomy and adnexectomy, microscopic and immunohistochemical examinations confirmed metastases of MPM to the appendix and both adnexa
  • Tumor cells were positive for calretinin, cytokeratin 5/6, WT-1 and pankeratin, and negative for CD15
  • The patient refused chemotherapy and was discharged on day 15 after surgery
  • The authors reported this as the first case of MPM with appendiceal involvement
• The authors' conclusion: The authors concluded that MPM should be considered in the differential diagnosis of unexplained persistent high fever and that a detailed history is vital for making the diagnosis

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Peritoneum, Omentum, Bilateral, Differential Diagnosis, Mesothelioma.

Related studies

• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Is PAX2 a reliable marker in differentiating diffuse malignant mesotheliomas of peritoneum from serous carcinomas of müllerian origin? — F.F. Gao, A.M. Krasinskas, et al. (2012)
• High Wilms' tumour gene (WT1) expression and low mitotic count are independent predictors of survival in diffuse peritoneal mesothelioma — A. Scattone, G. Serio, et al. (2012)
• Malignant peritoneal mesothelioma — K.E. Bani-Hani, K.A. Gharaibeh (2005)
• Diffuse Malignant Peritoneal Mesothelioma Presenting with Psammomatous Calcification on a Cervical Smear — A. Tan, P. Cohen, et al. (2015)
• The Safety of Iterative Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis: A High Volume Center Prospectively Maintained Database Analysis — E. Bekhor, J. Carr, et al. (2020)

Browse return to medical research.