Metastatic peritoneal mesothelioma in the setting of recurrent ascites: a case report

Our plain-English summary of Metastatic peritoneal mesothelioma in the setting of recurrent ascites: a case report, by V. Samedi, S. White, M.J. Zimarowski, et al (Diagnostic Cytopathology, 2010).

The study

• Authors: V. Samedi, S. White, M.J. Zimarowski, A. Harris, J. Saffitz, H.H. Wang
• Journal: Diagnostic Cytopathology
• Published: 2010;38(9):675-81
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant peritoneal mesothelioma is uncommon but rapidly fatal with a median survival of less than 1 year. The diagnosis of this entity is often delayed because of the nonspecific presenting symptoms and nonspecific cytological features of the mesothelial cells in the peritoneal fluids. A 72-year-old man who had no known history of exposure to asbestos and had longstanding refractory ascites thought to be secondary to alcoholic cirrhosis was found to have widespread metastatic malignant mesothelioma involving the lung, liver, pancreas, peritoneal, and pelvic wall, skin and subcutaneous tissue.

Copyright 2009 Wiley-Liss, Inc.

In plain English

This article was a case report about one patient: a 72-year-old man, a retired carpenter, with no known history of exposure to asbestos. For 7 years he had had recurrent ascites (fluid build-up in the abdomen), which was thought to be caused by alcoholic cirrhosis. Fluid tests done in the year before were not reported as positive for cancer. After he came to the emergency department, a CT scan showed widespread disease in his lung, liver, femoral heads, peritoneal and pelvic wall, and the tissue under his skin. His abdominal fluid was reported as suspicious for mesothelioma, and a skin biopsy was consistent with metastatic mesothelioma. He died. The autopsy found mesothelioma that had apparently started in the peritoneum (the lining of the abdomen) and had spread to the pleura and both lungs. No cirrhosis was found. The authors concluded that this case highlights the need for awareness of peritoneal mesothelioma, even when doctors do not suspect it. They suggested the disease may develop over a longer time than generally thought. They also noted that his fluid build-up may not have been caused by mesothelioma at first.

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, including fluid cytology, skin biopsy and autopsy findings)
• Who was studied: one 72-year-old man, a retired carpenter, seen at Beth Israel Deaconess Medical Center, Boston; he had a past history of laryngeal cancer, alcoholic cirrhosis and recurrent ascites for 7 years
• Exposure: the article reports no known history of asbestos exposure; no fiber type or dose is described
• Main results:
  • Before this admission, the ascitic fluid had been examined by cytology on four occasions over the past year. None of these tests was reported as positive for malignancy.
  • A CT scan showed widespread metastatic disease in the lung, liver, femoral heads, peritoneal and pelvic wall, and subcutaneous tissue.
  • Cytology of the new peritoneal fluid showed highly atypical cells with a mesothelial profile and was reported as suspicious for mesothelioma.
  • Biopsy of skin nodules on the abdomen was consistent with metastatic mesothelioma.
  • On review, the five earlier peritoneal fluid specimens had mainly been characterized as reactive mesothelial cells, but they showed similar features to the final specimen, with fewer atypical cells.
  • At autopsy, the widespread malignant mesothelioma had apparently originated in the peritoneum.
  • At autopsy, there was no evidence of cirrhosis of the liver.
  • At autopsy, the pleura was studded with nodules of malignant mesothelioma, and both lungs had tumor nodules.
  • Death was caused by the multiorgan effects of widely disseminated peritoneal mesothelioma.
  • The authors suggested that the patient's 7-year history of recurrent effusion, without liver disease, may mean peritoneal mesothelioma has a longer natural history than generally thought.
• The authors' conclusion: The authors concluded that the case highlights the need for awareness of peritoneal mesothelioma when evaluating serous effusions, even when it is not clinically suspected. They also said mesothelioma should be included in the differential diagnosis of skin metastases.
• Limitations the authors state:
  • The femoral head involvement seen on CT was not verified, because the femoral head was not removed.
  • The authors noted that the recurrent ascites may not initially have been caused by mesothelioma. The mesothelioma may instead have arisen against a background of chronic inflammation.

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, Ascites, Median Survival, Mesothelial Cells, Malignant Mesothelioma.

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)
• A Rare Case of Biphasic Malignant Peritoneal Mesothelioma with Refractory Ascites — T. Komaki, H. Urata, et al. (2017)
• An unusual case of ascites: pitfalls in diagnosis of malignant peritoneal mesothelioma — J.R. Clark, W.B. Ross (2000)
• Challenging and uncommon diagnosis of long-evolution ascites — M. Gravito-Soares, E. Gravito-Soares, et al. (2017)
• Recombinant human endostatin (endostar) decreased recurrent ascites, pleural fluid and ascitic VEGF in a case of advanced mesothelioma — X. Chen, Y. Liu, et al. (2012)
• The role of peritoneal biopsy in the diagnosis of ascites — P.F. Jenkins, M.J. Ward (1980)

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