Malignant Peritoneal Mesothelioma Without Asbestos Exposure

Our plain-English summary of Malignant Peritoneal Mesothelioma Without Asbestos Exposure, by H. Abbas, J.C. Rodriguez, H. Tariq, et al (Gastroenterology Research, 2019).

The study

• Authors: H. Abbas, J.C. Rodriguez, H. Tariq, M. Niazi, A. Alemam, S.K. Nayudu
• Journal: Gastroenterology Research
• Published: 2019;12(1):48-51
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a rare neoplasm of the serosal linings. Mesothelioma has been linked to asbestos exposure, with prior asbestos exposure linked to 33-50% of malignant peritoneal mesotheliomas. We describe a case of malignant peritoneal mesothelioma (MPM) without any prior exposure to asbestos in a 40-year-old Hispanic female who presented to the emergency department with worsening abdominal pain and distension. She had a history of beta thalassemia trait and iron deficiency anemia. Examination revealed a distended abdomen with protruding umbilicus and positive shifting dullness. Laboratory tests showed anemia. Computed tomography (CT) of the abdomen revealed massive complex ascites suspicious of a malignant process. Ascitic fluid analysis showed serum ascites albumin gradient (SAAG) of 1.1 g/dL with a total protein of 5.2 g/dL. She underwent laparoscopic peritoneal biopsy which yielded epithelioid type malignant mesothelioma. She was started on chemotherapy with cisplatin and pemetrexed. The last follow-up was 27 months after the diagnosis. MPM is a rare and life-threatening malignancy. Frequently, the symptoms are non-specific. This poses a diagnostic challenge for physicians and probably the reason why the diagnosis is often delayed, especially in the absence of risk factors.

In plain English

This article is a case report about one patient: a 40-year-old Hispanic woman seen at the authors' hospital system in the Bronx, New York, for worsening abdominal pain and swelling. The authors described her as having no prior exposure to asbestos or other risk factors. The article does not say how her exposure history was obtained. She smoked, with a 10-pack-year history. A CT scan showed a large amount of complex fluid in the abdomen and nodular thickening of the abdominal lining, suspicious of cancer. Fluid drawn from her abdomen showed no cancer cells, so she had a laparoscopic biopsy of the peritoneum. The biopsy showed epithelioid type malignant mesothelioma. She was referred to a cancer center and started on chemotherapy with cisplatin and pemetrexed. The authors wrote that she had been healthy at follow-up visits. The article's abstract gives the last follow-up as 27 months after diagnosis. The authors concluded that malignant peritoneal mesothelioma is rare and that its symptoms are often non-specific. They wrote that this is probably why diagnosis is often delayed, especially when risk factors are absent.

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 (a single patient)
• Who was studied: One 40-year-old Hispanic woman, born and raised in the US, evaluated in an emergency room. The authors are at BronxCare Health System, Bronx, NY. The dates of care are not given.
• Exposure: The authors reported no prior asbestos exposure and no other risk factors. No fiber type, job or product is described, and the article does not explain how exposure history was assessed.
• Main results:
  • The patient's history included active smoking (10 pack-years), social alcohol use and regular marijuana use.
  • CT of the abdomen with contrast showed massive complex ascites with irregular nodular enhancement of the peritoneal wall (omental caking), suspicious of a malignant process.
  • Cytology of the abdominal fluid from a CT-guided tap (300 mL of serosanguinous fluid) did not reveal any malignant cells.
  • Laparoscopic peritoneal biopsy showed epithelioid type malignant mesothelioma. Tumor cells stained strongly positive for calretinin.
  • Chemotherapy with cisplatin and pemetrexed was started at a tertiary care oncology center. The patient was reported healthy at follow-up visits. The article's abstract states that the last follow-up was 27 months after diagnosis.
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma is a rare, life-threatening malignancy with frequently non-specific symptoms. They wrote that this poses a diagnostic challenge and is probably the reason diagnosis is often delayed, especially in the absence of risk factors.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure, Malignant Mesothelioma, Neoplasm, Mesothelioma, Ascites, Biopsy, Epithelioid.

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