"Omental Cake" in a Patient With Asbestosis Leading to the Diagnosis of Malignant Peritoneal Mesothelioma

Our plain-English summary of "Omental Cake" in a Patient With Asbestosis Leading to the Diagnosis of Malignant Peritoneal Mesothelioma, by A. García Martínez, I. Pavón Guerrero, L. Campos Gonzaga (Curēus, 2021).

The study

• Authors: A. García Martínez, I. Pavón Guerrero, L. Campos Gonzaga
• Journal: Curēus
• Published: 2021;13(5):e15116
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

We report a case of a 68-year-old man with medical history of pleural asbestosis and diagnosed with malignant peritoneal mesothelioma. This neoplasm is rare, has a poor prognosis, and is associated with asbestosis in many cases. It manifests clinically insidiously and in relation to the intra-abdominal locoregional effect. Radiological findings are variable, although the finding of "omental cake" by CT scan is characteristic but not pathognomonic, as seen in our case. A biopsy is required for the diagnosis, which can be guided by radiology or surgery. Treatment options available are cytoreductive surgery with intraperitoneal hyperthermic chemotherapy or systemic chemotherapy. However, new therapeutic options are emerging, which are still under development and research.

Copyright © 2021, García Martínez et al.

In plain English

This case report, from a digestive diseases department in Jerez de la Frontera, Spain, described one 68-year-old man, a former smoker who had worked in a shipyard and was exposed to asbestos for 16 years, last about 25 years earlier. He had a history the authors called "pleural asbestosis"; his chest CT scan showed pleural plaques. He had six months of abdominal pain and constipation. Blood tests were normal except for a raised CA 125 level (85 U/ml). An abdominal CT scan showed nodular thickening of the abdominal lining consistent with an "omental cake." An imaging-guided needle biopsy was inconclusive, but laparoscopic biopsies showed epithelioid malignant mesothelioma, and peritoneal tuberculosis was ruled out. He could not receive cytoreductive surgery with heated intraperitoneal chemotherapy, was treated with cisplatin and pemetrexed, and at one-year follow-up was in good clinical condition. The authors concluded that peritoneal mesothelioma should be suspected in patients with abdominal pain and a record of asbestos exposure, and that diagnosis is made by biopsy. A single case shows what happened to one person, not a rate.

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 68-year-old man, a former smoker with a history of pleural asbestosis, seen in the digestive diseases department of Hospital Universitario de Jerez de la Frontera, Spain, for six months of abdominal pain (mainly around the navel) and constipation
• Exposure: Occupational asbestos exposure as a shipyard worker for 16 years, with last exposure about 25 years before; fiber type not stated
• Main results:
  • Chest CT showed pleural plaques, which the authors described as signs of asbestos exposure
  • Laboratory tests were normal except for an elevated CA 125 level of 85 U/ml
  • Upper endoscopy and colonoscopy found only a colon with poor distensibility
  • Abdominal CT showed nodular thickening of the anterior parietal peritoneum consistent with "omental cake"
  • A percutaneous, imaging-guided biopsy was inconclusive for malignant disease
  • Biopsies taken by laparoscopy showed epithelioid malignant mesothelioma
  • Peritoneal tuberculosis was ruled out by negative acid-fast smear, mycobacterial culture and PCR
  • The patient could not benefit from cytoreductive surgery with hyperthermic intraperitoneal chemotherapy and was receiving systemic chemotherapy with cisplatin and pemetrexed
  • At one-year follow-up the patient was in good clinical condition
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma, though rare, should be suspected in a patient with abdominal pain and a record of asbestos exposure; imaging findings are varied and not specific, and diagnosis is made by biopsy

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Neoplasm, Prognosis, CT Scan, Biopsy, Cytoreductive Surgery, Chemotherapy.

Related studies

• A Case Report of Hypophosphatemia Leading to the Diagnosis of Mesothelioma — Z.W. Goh, F. Hasan (2022)
• Primary omental mesothelioma: a rare but important differential diagnosis in previous asbestos exposure — A. Harb, E. King, et al. (2010)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)
• Malignant peritoneal mesothelioma presenting as a complex omental lesion — R. Sudanthiram, C. Vemulapalli, et al. (2012)
• Surgical biopsy studies of omental and peritoneal nodules — D.B. Walsh, G. Williams (1971)
• Primary Peritoneal Mesothelioma Affecting the Greater Omentum That Mimicked an Omental Infarction: A Case Report — J.C. Cravero, T. Yakubik, et al. (2024)

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